This practice is rated as good overall. (Previous rating 09 2017 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Dr Aaron Patel on 25 September 2018, to follow up on breaches of regulations. At our previous two inspections of the practice, we rated them requires improvement for providing responsive services. This was because at both inspections, we found that the national GP patient survey results showed that patients rated the practice below local and national averages on questions relating to telephone access, opening hours, waiting times and their experience of making appointments. Also at the 20 July 2017 inspection, the population group of people with long term conditions was rated as requires improvement because of high clinical exception reporting rates among people in this population group. The practice was also rated as requires improvement at their 27 April 2016 inspection because they did not have a website and had identified a relatively low proportion of patients with caring responsibilities.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system had improved in recent months. The provider had introduced some changes to improve access to appointments, including additional nurse appointments and telephone consultations. Patients we spoke with told us they were now able to access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

• Review their training arrangements to ensure reception staff received training in the sepsis for primary care services.
• Review their policies and procedures to ensure they reflected current staff details. For example, their complaints leaflet to ensure it is updated with the correct current complaints manager’s details.
• Review their arrangements to continue to improve uptake of childhood immunisations and cervical screening.

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 Aarron Patel’s Surgery on 27 April 2016. The overall rating for the practice was good, however it was rated requires improvement for providing responsive services. The full comprehensive report on the April 2016 inspection can be found by selecting the ‘all reports’ link for Dr Aarron Patel on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 20 July 2017 to confirm that the practice had carried out their plan to improve the service as identified in our previous inspection on 27 April 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

At our previous inspection on 27 April 2016, we found the practice had a high exception reporting for those with long term conditions. Additionally, results from the national GP patient survey showed patient satisfaction with how they could access care and treatment was below the local CCG and national averages. In addition, the practice did not have an active patient participation group (PPG) and the practice had identified less than 1% of its practice list as carers. At this inspection we found some of these issues had been addressed, however we still had concerns about patient access as the latest national GP survey results did not show improvements. The practice provided us with an action plan detailing how they intended on improving services; however these measures had yet to demonstrate any improvement. The practice is still rated as requires improvement for providing responsive services.

Our key findings were as follows:

• The practice still did not have a practice website, however they told us patients could book appointments and request repeat prescriptions online through NHS Choices.

• Childhood immunisation data submitted to the local CCG for the quarter which ended in June 2017 showed the practice had achieved 100% in all areas.

• At the last inspection, 29 patients were identified as carers. The practice reviewed how patients with caring responsibilities were identified and recorded, for example, standardising the code which should be used on the clinical system. Over 1% of the patient population (49) were now identified and flagged on the clinical system as carers.

• The business continuity business plan was updated in April 2017 and contained all the necessary information. Hard copies were held off site by the practice manager and principal GP.

• The practice now had a PPG which consisted of four members who the practice told us had scheduled their first meeting to take place in August 2017.

• Patient’s feedback from the most recent national GP patient survey showed the practice was still below the local CCG and national averages for questions pertaining to how they could access care and treatment.

• Data from the Quality and Outcomes Framework (QOF) 2015/16 showed the practice still had higher than average exception reporting rates for those with long term conditions.

However, there were also areas of practice where the provider needed to make improvements.

Importantly, the provider must:

Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

In addition the provider should:

• Take steps to improve the practice’s performance in the management of long term conditions.

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 at Dr Aarron Patel on 27 April 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Exception reporting at the practice was much higher than the local and national averages.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients’ feedback on the ease of making an appointment with a named GP, satisfaction with practice opening hours and experience of booking appointments was below the national average.
• 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 proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.
• There was not an active Patient Participation Group.
• The practice were unable to evidence that there was a system in place to review and improve patient feedback from national survey results.

The areas where the provider should make improvement are:

• The provider should improve outcomes for patients with long term conditions including review clinical exceptions for all long term conditions to ensure they meet the clinical criteria for exception reporting.

• Review patient feedback from national survey results and identify ways to improve telephone access and access to routine appointments.

• Review and improve the uptake in vaccinations of patients under the age of five years old.

• The provider should take action to ensure there is an active Patient Participation Group within the practice.

• To review how patients with caring responsibilities are identified and recorded on the patient record system to ensure information, advice and support is made available to them.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

We spoke to people visiting the surgery on the day of our inspection. People told us they were happy with the service provided by the medical staff at the practice. One person said “I have no problem here”. Another said “the doctors and nurses are really good”. People told us the GPs were approachable, listened, and they could ask questions if they needed to.

Some people we spoke to on the day of our inspection told us they had been able to make an appointment which suited them on that day. However, a number of people told us it was difficult firstly to get an appointment and secondly an appointment with a named GP, or nurse. People we spoke to had positive views about the reception staff at the practice. One person said “reception staff are fine, there are no problems”. All those we spoke to said that their privacy and dignity were respected.

People's care was planned and delivered in a way that met their individual needs. We looked at four people's records regarding chronic disease planning, care and advice. There was evidence that plans were discussed with patients and appropriate referrals made.

We found that people were protected from the risk of abuse because the provider had procedures in place for safeguarding vulnerable adults and children. Medical staff we spoke to were aware of these procedures. The provider had effective systems in place to assess the risk and to prevent, detect and control the spread of infection. There was also an adequate system dealing with complaints made by people who used the service.