Archived: Dr Latif Hussain Also known as Milehouse Medical Practice

Updated 5 April 2017

Dr Latif Hussain is registered with the Care Quality Commission (CQC) as a single handed GP practice in Newcastle, Stoke-on-Trent. The practice holds a General Medical Services (GMS) contract with NHS England. A GMS contract is a contract between NHS England and general practices for delivering general medical services and is the commonest form of GP contract. The practice area is one of high deprivation when compared with the national and local Clinical Commissioning Group (CCG) area. At the time of our inspection the practice had 2273 patients. The practice age distribution is in line with the national and CCG area however 5% of the practice population is aged 85 years and over. This is higher than the CCG and national averages of 2%. The percentage of patients with a long-standing health condition is 49% which is lower than the local CCG average of 57% and the national average of 54%.

The practice is open between 8.15am and 7pm Monday to Friday except Thursdays when it closes at 1pm. They provide a sit and wait surgery between 9am and 10.30am and 4.15pm and 6pm Monday to Friday. Patients can pre-book appointments Tuesday between 4.30pm and 6pm and Wednesday between 5pm and 7pm. Appointments can be booked four weeks in advance. Extended hours appointments are available on Monday and Wednesday between 6.30pm and 7pm. The practice does not routinely provide an out-of-hours service to their own patients but patients are directed to the out-of-hours service, Staffordshire Doctors Urgent Care when the practice is closed.

The practice team consists of:

• One male GP partner

• A practice nurse

• A health care assistant

• A practice manager

• Two reception and administrative staff.

The practice provides a number of specialist clinics and services. For example long term condition management including asthma, diabetes and high blood pressure. It also offers services for child health developmental checks and immunisations, travel vaccinations and NHS health checks.

The practice is a training practice for medical students to gain experience and higher qualifications in general practice and family medicine.

Updated 5 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Dr Latif Hussain on 4 August 2015. After the comprehensive inspection, the practice was rated as requires improvement. Improvements were required to ensure the employment of fit and proper persons.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Dr Latif Hussain on our website at www.cqc.org.uk.

We undertook an announced comprehensive inspection on 18 October 2016 to check that the practice now met legal requirements. Overall the practice is rated as requires improvement.

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Learning was shared with staff and reported to external agencies when required.

• Required recruitment checks had been made before a member of staff was employed to work at the practice. However, the physical and mental health of newly appointed staff had not been considered.

• Effective systems had not been put in place to mitigate risks to patients who took high risk medicines.
• An overarching training matrix and policy had been put in place to monitor that all staff were up to date with their training needs and received regular appraisals.

• Patient feedback was overwhelmingly positive about the sit and wait appointment system. Data from the National Patient Survey published in July 2016 showed that 96% of respondents described their experience of making an appointment as good.

• Feedback from patients about their care was consistently positive and was reflected in the national patient survey published in July 2016.
• The practice had reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group (CCG) to secure improvements to services where these were identified. For example, the practice had carried out a re-audit of A&E attendances and shared their findings with the local CCG to inform the development of future services.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.
• The practice had a vision which was to provide safe, effective and high quality primary care to their practice population. However, the practice did not have a supporting business plan that reflected this vision to ensure the future direction of the practice was monitored and evaluated.
• The practice had visible clinical and managerial leadership but governance and audit arrangements were not effective.

The areas where the provider must make improvement are:

• Implement a formal system to log, review, discuss and act on alerts received that may affect patient safety.

• Implement effective systems to mitigate risks to patients who take high risk medicines.

• Implement an effective system for the management of uncollected repeat prescriptions to ensure patients with long term conditions receive the treatment they require.

• Implement effective governance and audit systems to mitigate risks and improve the quality of the service provision.

• Implement a system to ensure that information is shared with the out of hours service for patients nearing the end of their life or if they had a ‘do not attempt cardiopulmonary resuscitation’ (DNACPR) plan in place.

The areas where the provider should make improvement are:

• Implement processes to demonstrate that the physical and mental health of newly appointed staff have been considered to ensure they are suitable to carry out the requirements of the role.

• Mitigate risks identified in arrangements to take appropriate action in the event of a medical emergency by ensuring that all staff are aware of where the automated external defibrillator is located.

• Develop a business plan to ensure the future challenges and direction of the practice are monitored and evaluated.

Where a service is rated as inadequate for one of the five key questions or one of the six population groups or overall, it will be re-inspected within six months after the report is published. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group or overall, we will place the service into special measures. Being placed into special measures represents a decision by the CQC that a service has to improve within six months to avoid the CQC taking steps to cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 29 November 2016

The practice is rated as requires improvement for the care of people with long-term conditions. The provider was rated as requires improvement for safe and effective, inadequate in well-led and good for caring and responsive. The issues identified as requiring improvement overall affected all patients including this population group.

• Nursing staff were supported by the GP in chronic disease management and patients at risk of hospital admission were identified as a priority.

• Performance for diabetes in all five related indicators was above the Clinical Commissioning Group (CCG) and national averages.

• All these patients had a named GP and a structured annual review to check their health and medicine needs were being met. For those patients with the most complex needs, the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 29 November 2016

The practice is rated as requires improvement for the care of families, children and young people. The provider was rated as requires improvement for safe and effective, inadequate in well-led and good for caring and responsive. The issues identified as requiring improvement overall affected all patients including this population group.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances.

• The practice’s uptake for the cervical screening programme was 80%, which was comparable to the CCG and national averages of 82%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with midwives and health visitors.

• New mothers were offered post-natal checks and development checks for their babies.

• Data from NHS England for  the time period 1 April 2015– 31 March 2016 showed that childhood immunisation rates for the vaccinations given were above the national average.

Updated 29 November 2016

The practice is rated as requires improvement for the care of older people. The provider was rated as requires improvement for safe and effective, inadequate in well-led and good for caring and responsive. The issues identified as requiring improvement overall affected all patients including this population group.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• The practice provided care and treatment to over 100 patients living in care homes. These patients had received regular health and medication reviews.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• Patients over 75 years of age were invited for an over 75 health check. We saw that 77 out of 178 patients (43%) had received a health check in the first six months.

Updated 29 November 2016

The practice is rated as requires improvement for the care of working-age people (including those recently retired and students). The provider was rated as requires improvement for safe and effective, inadequate in well-led and good for caring and responsive. The issues identified as requiring improvement overall affected all patients including this population group.

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

• Extended hours appointments were available on Monday and Wednesday between 6.30pm and 7pm for working aged patients. Telephone consultations were also available.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

• All patients between the age of 40 and 74 years of age were offered NHS health checks.

Updated 29 November 2016

The practice is rated as requires improvement for the care of people experiencing poor mental health (including people with dementia).The provider was rated as requires improvement for safe and effective, inadequate in well-led and good for caring and responsive. The issues identified as requiring improvement overall affected all patients including this population group.

• The practice provided weekly visits to two care homes with a high number of patients suffering with dementia. Ninety-nine per cent

• The percentage of patients with a diagnosed mental health condition who had a comprehensive, agreed care plan documented in their record, in the preceding 12 months was 100%. This was above the CCG average of 87% and the national average of 88% however their exception reporting rate was 18% which was slightly higher than the CCG average of 12% and the national average of 13% meaning fewer patients had been included.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• Staff had a good understanding of how to support patients with mental health needs and dementia. The practice was working towards becoming a dementia friendly practice.

• The GP had been approved by the Secretary of State to carry out diagnostic assessments for the compulsory admission of a person to hospital for the treatment of mental disorder under the Mental Health Act 1983.

Updated 29 November 2016

The practice is rated as requires improvement for the care of people whose circumstances may make them vulnerable. The provider was rated as requires improvement for safe and effective, inadequate in well-led and good for caring and responsive. The issues identified as requiring improvement overall affected all patients including this population group.

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability and patients with drug related problems who received medication to help them in the management of their addiction.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with the Integrated Local Care Team (ILCT), a team that included health and social care professionals, to provide effective care to patients nearing the end of their lives and other vulnerable patients.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.

• The GP was trained in the assessment of deprivation of liberty safeguards (DOLS). These safeguards ensure that important decisions are made in people’s best interests.

• The GP had provided his personal mobile number to the families of those approaching the end of their lives so he was easily contactable for support when the practice was closed.

• The practice had not shared information with the out of hours service for patients nearing the end of their life or if they had a ‘do not attempt cardiopulmonary resuscitation’ (DNACPR) plan in place.