We carried out an announced comprehensive inspection at Dr Samir Sadik (also known as Waterloo Medical Centre) on 9 January 2019 as part of our inspection programme.

We rated this practice as inadequate overall and they were placed into special measures.

The domain ratings were:

Safe – Inadequate

Effective – Requires improvement

Caring – Good

Responsive – Good

Well-led – Inadequate

A warning notice was issued in respect of Regulation 17 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 (good governance). This stated improvement must be made by 30 April 2019.

This inspection on 9 May 2019 was to check the requirements of the warning notice had been met. We found that improvements had been made.

In particular:

• A programme of work was underway to establish clear system and process for the safe prescribing of high-risk medicines and to ensure patients were being appropriately monitored.
• We saw that a programme of medicine and prescribing audits was in place. We saw evidence of improvement being made in relation to monitoring and reviewing patients prescribed high risk medicines.
• A programme of work had been established to ensure health and safety systems were in place. Risk assessments had been carried out, however there were actions identified which still needed to be completed.
• There was a system in place to oversee children on the safeguarding register.

The rating of inadequate awarded to the practice following our full comprehensive inspection on 9 January 2019 remains unchanged. The practice will be re-inspected, and their rating revised if appropriate in the future.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced comprehensive inspection at Dr Samir Sadik (AKA Waterloo Medical Centre) on 9 January 2019 as part of our inspection programme.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as inadequate overall. In relation to the population groups we have rated as requires improvement.

We found that:

• The practice did not consistently provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients in the main received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• The practice was not well led and did not always have systems and process in place to monitor and mitigate risk.

We have rated this practice as inadequate overall.

We rated the practice as inadequate for providing safe services because:

• The practice did not have clear systems and processes to keep patients safe.
• The practice did not have appropriate systems in place for the safe management of medicines.
• The practice did not have systems and process in place to assess the risk associated with health and safety or fire safety within the practice.

We rated the practice as requires improvement for providing effective services because:

• There was limited monitoring of the outcomes of care and treatment.
• The practice was unable to show that staff had the skills, knowledge and experience to carry out their roles.

We rated the practice as inadequate for providing well-led services because:

• The overall governance arrangements were ineffective.
• The practice did not have clear and effective processes for managing risks, issues and performance.

We rated the practice as good for providing caring and responsive services because:

• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.

The areas where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way.
• 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:

• Ensure there is a formal record of the actions taken in response to safety alerts.

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.

Following the inspection, we were provided with details of actions the provider has initiated to address the concerns identified within the report.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Samir Sadiks’ on 10 February 2016. Overall the practice is rated as good.

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

• Staff understood and fulfilled their responsibilities to raise concerns and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.

• Data showed patient outcomes were comparable to those locally and nationally.

• Feedback from patients about their care was consistently and strongly positive.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Patients said they found it easy to make an appointment and that there was continuity of care, with urgent appointments available the same day.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group.

• Information about services and how to complain was available and easy to understand.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• There was a clear leadership structure and staff felt supported by management. The practice sought feedback from staff and patients, which it acted on.

However there were areas of practice where the provider must make improvements:

• Ensure recruitment and selection processes are in place in line with legal requirements.

In addition the provider should:

• Have a formalised business continuity plan in place
• Look to establish a full cycle audit programme in addition to those initiated by the CCG.
• Ensure sufficient levels of nursing staff are in post.
• Ensure an adequate recall system is implemented to ensure patients who require anuual reviews, receive them in a timely manner.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We found a bright, airy, clean practice with ample seating for patients. We found there was parking at the front of the practice. The practice was all on one level and there was appropriate disabled access to the service.

We spoke with two patients on the day. Patients spoke positively about the practice and commented that they were happy with the care they received.

The practice provided patients with information about the services available through leaflets displayed throughout the practice.

The practice had electronic patient records in place to record the contact patients had with the service but also had the historic records in paper base stored for reference if required.

We found staff had access to contact details for both child protection and adult safeguarding teams. They were able to describe the appropriate actions to take if they had any safeguarding concerns.

The practice had a range of policies and procedures in place for staff to access, which supported the safe running of the service. We found the practice had an audit programme ongoing and the results were fed back at practice meetings on a monthly basis.

The practice leaflet provided patents with information about how to raise a concern or complaint. Patients we spoke with told us they would raise any concerns with the clinical or reception staff and felt they would be appropriately dealt with in a swift manner.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Samir Sadik on 10 February 2016. The overall rating for the practice was good, with one area, safe rated as requires improvement. The full comprehensive report on the February 2016 inspection can be found by selecting the ‘all reports’ link for Dr Samir Sadik on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 19 October 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 10 February 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is rated as Good and the practice is now rated good for being ‘safe’.

Our key findings were as follows:

• Recruitment records relating to people employed now include information relevant to their employment such as photo identification and DBS checks in line with legal requirements.

We also noted the practice had made additional improvement which included:

• We saw the practice had an up to date business continuity plan in place.
• Additional nursing staff had been recruited and the practice had the flexibility to add additional nursing sessions when required.
• A new recall system has been introduced to ensure patients have access to annual reviews in a timely manner.
• We saw an audit cycle had been initiated by the lead GP.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice