We had previously carried out an announced comprehensive inspection of Dr Tahir Haffiz’s practice, known as the Barnsbury Medical Practice, on 10 October 2017. We rated the practice as inadequate and it was placed in special measures with effect from 14 December 2017. We identified concerns over governance at the practice and served a warning notice under regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also served a requirement notice under regulation 12, relating to safety at the practice, due to concerns over sharing learning from significant events and cleaning and safety checks. The report of the comprehensive inspection can be found by selecting the ‘reports’ link for the practice on our website at http://www.cqc.org.uk/location/1-485343677. Following the inspection, the practice sent us a plan of the action it intended to take to meet the requirements of the regulation.

We carried out this focussed inspection on 26 February 2018, to review the practice’s action plan, looking at the identified breaches set out in the warning notice, under the key question Well-led and at the issues relating to safety at the practice. We found that the practice had made some improvements sufficient for us to withdraw the warning notice. However, further improvement needs to be made in relation to clinical performance and it needs to be sustained. Up to date Quality and Outcomes Framework (QOF) data showed improved performance, but also increased exception reporting, which was above average and was a concern. Accordingly, we have served a further requirement notice, under regulation 9. We found that the requirement notice served under regulation 12 in relation to safety at the practice had been met.

We have not reviewed the ratings for the key questions or for the practice overall. We will consider the practice’s ratings when we carry out a full comprehensive inspection at the end of the period of special measures.

Our key findings were as follows:

• The practice had taken appropriate action in relation to monitoring general cleaning, the cleaning of medical equipment, and safety checks of emergency equipment and medication, so that care was delivered in a safe way.
• The practice had introduced systems to ensure that significant events and safety alerts were reviewed and appropriately actioned.
• Relevant and current evidence-based guidance and standards, including National Institute for Health and Care Excellence (NICE) best practice guidelines, were reviewed and discussed at clinical meetings.
• There was evidence that clinical performance had improved, but at the date of the inspection there was a significant increase in QOF exception reporting.

There were areas of practice where the provider needs to make improvements. Importantly, the provider must:

• Ensure the care and treatment of patients is appropriate, meets their needs and reflects their preferences.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We previously inspected Dr Tahir Haffiz’s practice, known as the Barnsbury Medical Practice, in April 2015. We rated the practice as good overall and requires improvement for providing effective services. This was because published data showed that patient outcomes were below local and national averages.

We carried out this announced comprehensive inspection on 10 October 2017. Overall the practice is now rated as inadequate.

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

• The delivery of high quality care is not assured by the leadership, governance and culture in place.
• Data from the Quality and Outcomes Framework showed patient outcomes were significantly below local and national averages and had not improved. There were no detailed or realistic plans in place to bring about improvement.
• Patient feedback indicated there were frequent delays with appointments.
• Although risks to patients were assessed, the systems to address these risks were not implemented well enough to ensure patients were kept safe.
• There were shortfalls in planning and providing services to meet the needs of the local population.
• There was insufficient evidence that learning from significant events and other relevant information was shared appropriately.
• There was a limited programme of clinical audit to drive improvement.

The areas where the practice must make improvement are:

• Ensure care and treatment is provided in a safe way to patients. For example, by sharing with all staff learning from significant events, safety alerts and clinical guidance; maintaining cleaning logs and records of safety checks.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. For example, systems and processes to assess, monitor and improve the quality and safety of the services provided.

The areas were the practice should make improvement are:

• Inform patients of the availability of chaperones and translation services.
• Review the current system to ensure that all staff members receive annual appraisals.
• Review the current system of recording clinical and practice meetings, so that relevant information is shared appropriately.
• Record verbal as well as written complaints.
• Consider how patients who wish to see a female practitioner at the practice can do so.
• Establish a process to contact patients who do not attend for their cervical screening test.

I am placing this practice in special measures. Practices 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 practice will be kept under review and if needed could be escalated to urgent enforcement action.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection on the 22nd April 2015. Overall the practice is rated as good.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

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.
• Staff had received training appropriate to their roles and any further training needs had been identified and planned.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Data showed that some patient outcomes were below average for the locality.

• Information about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.

There were areas of practice where the provider needs to make improvements.

The provider should

• Continue in its efforts to engage with patients and improve the uptake of annual reviews, health checks and screening for eligible patients to improve patient outcomes.

• Make arrangements to enable patients to book appointments and order repeat prescriptions online, via the practice website.

• Continue with plans to re-establish regular meetings of the patient participation group, to help gather feedback and comments from patients.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

This practice is rated as inadequate overall. (Previous inspection 10 2017 – Inadequate)

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Inadequate

Are services caring? – Good

Are services responsive? – Requires improvement

Are services well-led? - Inadequate

We carried out an announced comprehensive inspection at Dr Tahir Haffiz on 30 May 2018 to follow up on breaches of regulations identified in a previous inspection on 10 October 2017. There were breaches in infection control, emergency processes, quality improvement and safety systems. The full comprehensive report from the inspection on 10 October 2017 can be found by selecting the ‘all reports’ link for Dr Tahir Haffiz on our website at .

A focussed inspection was carried out on 26 February 2018, this inspection was not rated and took place to ensure the practice was complying with the breaches in regulations as identified by the warning notices they were issued in their previous inspection. This report can be found by selecting the ‘all reports’ link for Dr Tahir Haffiz on our website at . This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

At this inspection in May 2018 we found:

• Processes to keep patients safe and safeguarded from abuse were not effective.
• Systems for learning from significant events and complaints were not effective.
• Not all staff members knew how to access practice policies and procedures which were saved on the practices computer system.
• There was no comprehensive management oversight of clinical training and training updates.
• Information required to prescribe high risk medicines was not effectively documented.
• Learning and changes made as a result of patient safety alerts were not effectively shared with all relevant staff members.
• There were flaws in recruitment processes; references and evidence of membership with a professional body were not always obtained.
• Although the practice demonstrated improvement in the Quality and Outcomes Framework (QOF) further improvements were required to bring the practice in line with local and national averages.
• Low cytology uptake had not been adequately addressed.
• There was no documented vision and values with a strategy to address them.
• Portable appliance testing was out of date.
• There was evidence of quality improvement including a completed clinical audit cycle.
• Emergency equipment was routinely checked to ensure it was in date and fit for use.
• Childhood immunisation rates were above the 90% national targets.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure care and treatment is provided in a safe way to patients.
• 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 systems are in place to improve cytology uptake.
• Consider ways to improve confidentiality at the reception desk.
• Review the practices recruitment processes to ensure legal requirements are being met.

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.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice