Background to this inspection
Updated
11 October 2018
Umar Medical Centre is a GP practice registered with CQC under a partnership of Drs Anwar and Sarah Alam. A third GP partner, Dr Mohammed Alam, had joined the practice in April 2017, but at the time of our inspection had not been added to the CQC provider registration. It is a single location registered at the main site (3 Lime Street, Blackburn, BB1 7EP) with a branch surgery situated in Darwen (42 Railway Road, Darwen, BB3 2RJ). This inspection visited the main site only. The main site is situated in a residential area close to the centre of the town. There is limited on-street parking.
The practice delivers primary medical services to a list size of approximately 8100 patients under a personal medical services (PMS) contract with NHS England, and is part of the NHS Blackburn with Darwen Clinical Commissioning Group.
The average life expectancy of the practice population is in line with local and slightly lower than national averages (76 years for males and 81 years for females, compared to 79 and 83 years nationally).
The practice delivers services to a patient cohort consisting of 69% black and ethnic minority (BME) groups. The practice caters for a lower proportion of patients over the age of 65 years (7%) and 75 years (3%) compared to local (14% and 6% respectively) and national averages (17% and 8% respectively). The practice has a higher proportion of younger patients under the age of 18 years (33%, compared to 25% locally and 21% nationally). The practice also caters for a lower percentage of patients who experience a long-standing health condition (43%, compared to the local and national averages of 54%).
Information published by Public Health England rates the level of deprivation within the practice population group as two on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest.
The practice is staffed by three GP partners (two males and one female) and a further three salaried GPs (two males and one female). In addition, the practice employs three practice nurses. Clinical staff are supported by a practice manager who has been in post since January 2018 and a team of nine administrative and reception staff. At the time of our visit the practice had recruited a new assistant practice manager, although they were not due to commence their role until after our inspection.
The main surgery is open between 8am and 6.30pm Monday, Wednesday and Friday, 8am and 8pm Tuesday, and 8am and 8.30pm on a Thursday. The branch surgery opens between 8am and 12.30 and then between 2.30pm and 6pm each Monday, Wednesday and Friday and from 8am until 12.30 and 1.30pm until 4.30pm each Tuesday and Thursday. Surgeries are offered throughout the time the practice is open. Extended hours appointments are available on Tuesday and Thursday evenings. In addition, the practice’s patients can access extended hours appointments until 8pm on weekday evenings and on weekends at four other local practices. These appointments can be booked through the practice’s receptionists and are offered by the local GP federation.
Outside normal surgery hours, patients are advised to contact the out of hours service by dialling 111, offered locally by the provider East Lancashire Medical Services.
The practice had previously been inspected on 7 March 2018, when a full comprehensive inspection was completed. Following this inspection, the practice was rated inadequate overall and placed into special measures. We issued warning notices for breaches identified with Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Safe care and treatment) and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Good Governance). The full comprehensive report following the inspection in March 2018 can be found on our website here: https://www.cqc.org.uk/location/1-583513367/reports.
Updated
11 October 2018
This practice is rated as Inadequate overall. (Previous inspection July 2016 – Good)
The key questions are rated as:
Are services safe? – Inadequate
Are services effective? – Inadequate
Are services caring? – Requires Improvement
Are services responsive? – Inadequate
Are services well-led? - Inadequate
As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:
Older People – Inadequate
People with long-term conditions – Inadequate
Families, children and young people – Inadequate
Working age people (including those recently retired and students – Inadequate
People whose circumstances may make them vulnerable – Inadequate
People experiencing poor mental health (including people with dementia) - Inadequate
We carried out an announced comprehensive inspection at Umar Medical Centre on 7 March 2018 in response to concerns raised by members of the public.
At this inspection we found:
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The practice was negotiating a period of transition with recent changes to the GP partnership and a newly appointed practice manager. The practice had also experienced a turbulent time over recent months with staff absence.
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There was some confusion amongst staff around roles, responsibilities and the staffing structure. We found staff morale was low with limited evidence of a team ethos.
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The practice lacked clear systems to manage risk and mitigate against the repeat of safety incidents. When incidents did happen, we found examples where the practice had not learned from them or improved its processes.
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There was limited evidence of clinical audit or quality improvement to demonstrate the effectiveness and appropriateness of the care provided.
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Staff delivered care and treatment according to evidence-based guidelines.
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The practice demonstrated an awareness of the patient population it served and took pride in being integrated into the local community. The GPs delivered healthcare awareness sessions at the local mosque and schools.
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We found significant gaps in governance arrangements. There were gaps in practice policies and procedures to govern key activities.
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The practice was unable to evidence that an infection prevention and control audit had been completed.
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There was a lack of managerial oversight of training and staff training needs. Appraisals for staff had not been completed regularly.
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Information flow within the practice was largely informal. The practice lacked a meeting structure to formally document the dissemination of any changes to staff.
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Patients rated the practice lower than others for many aspects of care, although patients told us staff involved and treated them with compassion, kindness, dignity and respect.
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Patients found the appointment system confusing to use and reported that they could not always access care when they needed it.
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The practice lacked a systematic approach to managing and responding to patient complaints.
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There was confusion and dysfunction in how the practice managed incoming post.
The areas where the provider must make improvements as they are in breach of regulations are:
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Ensure care and treatment is provided in a safe way to patients.
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Ensure there is an effective system for identifying , receiving ,recording, handling and responding to complaints by patients and other persons in relation to the carrying on of the regulated activity.
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Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
The areas where the provider should make improvements are:
I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.
Special measures will give people who use the service the reassurance that the care they get should improve.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice