Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Dr Bhupendra Bhadauria’s practice, at Jubilee Health Centre, on 15 April 2015. While no breaches of legal requirements were found, the practice was rated as requires improvements for providing safe services. This was because we identified some areas where the provider should make improvements.

We undertook a focused inspection on 7 July 2016 to check that the provider had made improvements in line with our recommendations. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Dr Bhupendra Bhadauria on our website at www.cqc.org.uk.

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

• Staff adhered to appropriate chaperoning processes were trained on how to chaperone in line with recognised guidelines.

• Discussions with staff indicated that they had a good understanding of the Mental Capacity Act 2005.

• Additionally, staff received training in Mental Capacity and completed safeguarding training to the appropriate level required for their job role; staff also highlighted that mental capacity was covered during safeguarding training. Some staff members had also completed Dementia Awareness training.

• The practice was proactive in identifying and managing significant events. We saw that themes from significant events, complaints and incidents were monitored and learning was shared with staff.

• There were effective systems are in place for the management of risks to patients and there were adequate arrangements in place to respond to medical emergencies.

• The practice was continuing to target health promotion and preventative care services for patients which included chlamydia screening and NHS health checks.

• Staff worked with multidisciplinary teams and engaged with health visitors to understand and meet the range and complexity of patients’ needs.

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 Bhupendra Bhadauria’s practice on 15 April 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing well-led, effective, caring and responsive services. It was also good for providing services for the care of older people, people with long term conditions, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable and for providing care to people experiencing poor mental health (including people with dementia). It required improvement for providing safe care.

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

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Chaperones were available for patients however we found that staff had not been trained on how to chaperone in line with General Medical Council (GMC) chaperoning guidelines.
• There was a clear leadership structure and staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• Patients said they found it easy to make an appointment with the GP, with urgent appointments available the same day.
• Health promotion was in place at the practice however the practice did not have a systematic approach to identifying and targeting health promotion and preventative care services such as chlamydia screening and NHS health checks.
• Risks to patients were assessed and well managed however we found some gaps around sharing information with key services such as health visitors and sharing learning from significant events, complaints and incidents within the practice.
• Information about services and how to complain was available and easy to understand.
• Complaints and significant events were managed appropriately however we found that themes were not monitored to ensure that effective systems were in place in relation to managing patient risks, specifically with regards to lacking emergency equipment (an automated external defibrillator). Overall, the practice had good facilities and was well equipped to treat patients and meet their needs.

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

Importantly the provider should:

• Ensure that General Medical Council (GMC) chaperoning guidelines are followed by providing appropriate chaperone training to staff who carry out chaperoning duties
• Ensure staff have a good understanding of the Mental Capacity Act 2005 including the principle that all individuals are presumed to have capacity and how to act appropriately in the event that a person may lack capacity.
• Ensure that emerging themes from significant events and incidents are monitored and ensure that effective systems are in place for the management of risks to patients, specifically where lacking emergency equipment such as the automated external defibrillator. Guidelines set by the Resuscitation Council (UK) Quality standards for cardiopulmonary resuscitation practice and training state that defib is essential equipment.
• Develop robust systems to ensure that shared learning is documented from significant events, complaints and incidents.
• Develop a systematic approach to identifying and targeting health promotion and preventative care services such as chlamydia screening and NHS health checks for patients who would benefit from them.
• Engage with other service and ensure information is routinely shared with other services such as the health visitors, to ensure patients receive good continuity of care and key information is shared between the health visitors and the practice

Ensure staff are aware of systems to support patients who may have difficulty accessing the service (such as patients with no fixed abode).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

During our announced inspection we spoke with eight patients, the registered provider (the lead GP), the practice manager, a practice nurse 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'm happy with the practice”. Another patient said: “They are fine, the nurse is nice she knows me quite well”. Patients we spoke with told us that obtaining repeat prescriptions was not a problem and requests for them were actioned within two to three 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 fit for purpose and kept clean and well organised. Staff had carried out an audit of their hygiene practices and processes for the prevention of infections. This meant that steps had been taken to minimise the risks of infections to patients.

Patients who used the practice were asked for their views about their care and treatment and they were acted upon. Surveys had been undertaken and the results had been analysed and shared with staff.