Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Anil Indwar (also known as Walford Street Surgery) on 23 June 2017. The overall rating for the practice was good. However, we rated the practice requires improvement for providing well-led services. The full comprehensive report on the June 2017 inspection can be found by selecting the ‘all reports’ link for Dr Anil Indwar on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 22 November 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 23 June 2017. 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.

Our key findings were as follows:

• There were six patents on the practices dementia list and examples we looked at showed that the practice used hospital letters which outlined the management of the patient as part of their care plan. Evidence we looked at showed that there was enough information to deliver effective care and family members had an input in the plan where appropriate.

• The practice held a register of patients on the palliative care list and we saw evidence of discussion at multidisciplinary meetings. Information to deliver appropriate care to the patient was embedded into the patient record system. However, key information such Do Not Attempt Cardiopulmonary resuscitation (DNACPR) and patient’s wishes for end of life was not immediately accessible which would be useful for other clinicians such as out of hours doctors or locum GPs.

• The practice had established a formal recording process for clinical supervision. The practice nurse and the GP met formally most Fridays to discuss case reviews of complex patients.

• We looked at three recruitment files and saw that appropriate recruitment processes had been followed.

• We spoke with two staff members and they demonstrated adequate knowledge of the role of a chaperone. We looked at training records which showed that staff had completed chaperone training.

• The practice had assessed the premises to consider access for patients who had difficulty with their mobility. We saw that appropriate action had been taken and arrangements were in place to signpost patients elsewhere if they were unable meet their needs at the practice.

• We saw evidence of actions taken to improve the uptake of national screening programmes for breast and bowel cancer. The practice was working with a representative from the screening services at the Clinical Commissioning Group (CCG). Evidence we looked at showed that improvements were being made to the number of patients engaging with the screening programme.

In addition the provider should:

• Make key information such Do Not Attempt Cardiopulmonary resuscitation (DNACPR) and patient’s wishes for end of life easily accessible on the patient record system for the benefit of other care providers such as the out of hours clinicians and locum GPs.

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 Anil Indwar’s practice on 2 June 2

We carried out an announced comprehensive inspection at Dr Anil Indwar’s practice on 2 June 2016. Following that inspection the overall rating for the practice was requires improvement. The full comprehensive report for the June 2016 inspection can be found by selecting the ‘all reports’ link for Dr Anil Indwar on our website at www.cqc.org.uk.

This inspection was undertaken to follow up progress made by the practice since the inspection on 2 June 2016. It was an announced comprehensive inspection on 23 June 2017. Overall the practice is rated Good

• We found the practice had taken action to address concerns identified at our previous. This included improvements in the management of safety alerts, medicines and fire safety. However during this inspection we continued to identify areas for improvement.
• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had systems to minimise risks to patient safety.

• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment. The practice explained the process for clinical supervision, however this was not always documented..
• There was limited evidence of improvement activity. Clinical audits seen were one cycle and had yet to demonstrate any quality improvement.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Results from the national GP patient survey showed access to appointments was mostly in line with local averages but below national averages. The practice had taken some action to improve access and make more appointments available. Urgent same day appointments were available.
• The practice was well equipped to treat patients and meet their needs. However, access for patients who used a wheelchair was difficult due to the limitations of the premises. Some adaptations had been made but no formal assessment undertaken to identify what further improvements could be made.
• There was a clear leadership structure and staff felt supported by management.
• Feedback from patients and their involvement in improving the service was limited in the absence of a patient participation group.
• The provider was aware of the requirements of the duty of candour. Examples were seen in which patients were informed and apologised to when things went wrong with care and treatment.

The areas where the provider must make improvement are:

• Ensure effective systems and processes to assess, monitor and improve the quality and safety of the services provided.

The areas where the provider should make improvement are:

• Consider the use of care plans in the management of dementia and palliative care to ensure patients wishes are formally recorded.
• Consider the benefits to establishing a formal recording process for clinical supervisions.
• Ensure records are available to demonstrate reliable recruitment processes are being followed for all staff.
• Ensure all staff are fully aware of their roles and responsibilities when acting as a chaperone.
• Review and continue to take action to improve the uptake of national screening programmes for breast and bowel cancer.

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 Anil Indwar (also known as Walford Street Surgery) on 23 June 2017. The overall rating for the practice was good. However, we rated the practice requires improvement for providing well-led services. The full comprehensive report on the June 2017 inspection can be found by selecting the ‘all reports’ link for Dr Anil Indwar on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 22 November 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 23 June 2017. 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.

Our key findings were as follows:

• There were six patents on the practices dementia list and examples we looked at showed that the practice used hospital letters which outlined the management of the patient as part of their care plan. Evidence we looked at showed that there was enough information to deliver effective care and family members had an input in the plan where appropriate.

• The practice held a register of patients on the palliative care list and we saw evidence of discussion at multidisciplinary meetings. Information to deliver appropriate care to the patient was embedded into the patient record system. However, key information such Do Not Attempt Cardiopulmonary resuscitation (DNACPR) and patient’s wishes for end of life was not immediately accessible which would be useful for other clinicians such as out of hours doctors or locum GPs.

• The practice had established a formal recording process for clinical supervision. The practice nurse and the GP met formally most Fridays to discuss case reviews of complex patients.

• We looked at three recruitment files and saw that appropriate recruitment processes had been followed.

• We spoke with two staff members and they demonstrated adequate knowledge of the role of a chaperone. We looked at training records which showed that staff had completed chaperone training.

• The practice had assessed the premises to consider access for patients who had difficulty with their mobility. We saw that appropriate action had been taken and arrangements were in place to signpost patients elsewhere if they were unable meet their needs at the practice.

• We saw evidence of actions taken to improve the uptake of national screening programmes for breast and bowel cancer. The practice was working with a representative from the screening services at the Clinical Commissioning Group (CCG). Evidence we looked at showed that improvements were being made to the number of patients engaging with the screening programme.

In addition the provider should:

• Make key information such Do Not Attempt Cardiopulmonary resuscitation (DNACPR) and patient’s wishes for end of life easily accessible on the patient record system for the benefit of other care providers such as the out of hours clinicians and locum GPs.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

During our announced inspection we spoke with six patients, the registered provider (the lead GP), the practice manager, a practice nurse, the administrator and a receptionist.

Patients' needs were assessed and care and treatment was planned and delivered in line with their individual wishes. Patients told us how they were treated with care and respect. One patient told us: “I have always been treated well”. Another patient said: “Today a treatment I am due to start has been explained to me why I needed the treatment and that's fine”. Patients we spoke with told us that obtaining repeat prescriptions was not a problem and requests for them were actioned within two days. We found that referral of patients to hospitals had been made promptly and efficiently.

Staff had received training in safeguarding vulnerable adults and children. They were aware of the appropriate agencies to refer safeguarding concerns to ensure that patients were protected from risks of harm.

We found that the premises were appropriate for its intended function and all areas of the practice were seen to be hygienic and well organised.

The registered provider had systems in place for monitoring the quality of service provision. They told us they intended to expand this process to obtain individual patients' opinions about the service they received.