Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Jagtar Chaggar on 8 December 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the September 2016 inspection can be found by selecting the ‘all reports’ link for Dr Kanjana Paramanathan on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 4 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 8 October 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

• During our previous inspection the practice reviews and investigations of incidents or significant events were not thorough enough and lessons learned were not communicated widely to support improvement. At this inspection the practice had reviewed its significant event protocol, developed a more effective process and introduced a learning and analysis element to the significant event investigation template.

• Patient Group Directions (PGD) were signed by a manager and were up to date at this inspection.

• When we inspected the practice in December 2016 we saw procedures for prescribing medicines which required regular monitoring were not implemented consistently for all patients’ prescribed high risk medicines. At this inspection we saw that an effective system had been implemented.

• There were appropriate emergency medicines available in the practice.

• The practice had addressed areas of high exception reporting for long term disease management (QOF).

• Audits we looked at referenced quality standards and care pathways. The findings identified improvements in several areas of the referral process. Audits were detailed and had identified areas for improvement which they were acting on.

• Staff files looked at demonstrated that appraisals had taken place for all staff within the last 12 months.

• Reviews of some care plans demonstrated reference to guidance and the GP we spoke with was able to demonstrate competency in accessing care plans on the system.

• Examples of referral letters we looked at were appropriate in formation. Most GPs used a template on the system for referral letters which they then used to make the referral.

• During our previous inspection we saw that there was no hearing loop in the practice. The practice had considered the installation of a hearing loop and had developed alternative arrangement s to support patients with a hearing impairment in the interim until they moved to new premises

• The practice had reviewed its management structure and had developed a clear organisational chart detailing line management responsibilities and roles.

• When we inspected the practice in December 2016 we saw locum GPs did not appear to have engagement in areas such as QOF performance and the management of long term conditions. They were not routinely involved in evidence based guidelines discussions and there was a risk they may therefore not be aware of valuable clinical information. At this inspection we saw evidence that sessional GPs had taken over responsibility in clinical areas such as for diabetes and mental health. Records of meetings we looked at demonstrated their attendance where guidance was discussed.

The areas of practice where the provider should make improvements are:

• Consider effective ways to ensure patients are made aware of the benefits of health screening programmes.

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. Jagtar Chaggar on 8 December 2016. Overall the practice is rated as requires improvement.

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, but records did not clearly evidence that learning had taken place and that action points had been addressed.
• A system was in place for the management of high risk medicines, however we saw that one high risk medicine had not been included in this monitoring process.
• The practice did not demonstrate that they had an effective system in place in access and monitor quality improvements within the practice. However the practice proactively sought feedback from staff and patients, which it acted on.
• Staff had been trained and had 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.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The provider was aware of and complied with the requirements of the duty of candour.
• The leadership structure was not clear in relation to roles and responsibilities.

The areas where the provider must make improvement are:

• The provider must have systems and processes for quality monitoring and improvement, of the service such as an effective audit process and analysis and learning from incidents.
• The provider must do all reasonably practicable to mitigate risks, for example by ensuring clinical oversight of patient referral letters, including urgent referral via the two-week wait.

The areas where the provider should make improvement are:

• Continue to identify carers registered at the practice so as to offer appropriate support and guidance.
• Consider findings from the national patient survey in order to identify ways to make improvements to the patient experience.
• Review clinical knowledge of the care planning system to ensure accurate and up to date care plans for patients where appropriate.
• In the absence of a hearing loop consider how patients and visitors who may require this facility would be supported to ensure information is accessible.
• Clarify the lead roles and responsibilities within the practice.
• The system for monitoring of high risk medicines should be reviewed to ensure all appropriate medicines are included and review emergency medicines to ensure they are in line with guidance
• The practice should consider how to further promote reviews and attendance at national screening programmes.
• The practice should record checks made of the emergency equipment to ensure appropriate monitoring takes place.
• The practice should regularly review the Patient Group Directions (PGD) to ensure these are current and signed by the lead GP.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

On the day of our inspection we spoke with six patients and six members of staff. One patient said, “I am happy to attend any of the doctors they are all good practitioners." All of the patients we spoke with said they were able to obtain appointments at a time to suit their needs and that they felt the quality of care they received was good.

We saw that patient's views and experiences were taken into account in the way the service was provided which demonstrated that they felt listened to. All of the patients we spoke with told us they were treated with dignity and respect. One patient told us, “They are good staff relating to all communities." We found that patients experienced care and treatment that met their needs.

Patients told us and we saw that care was delivered in a clean environment.

Staff had received training in safeguarding (protecting vulnerable adults and children) to ensure patients were protected from the risk of abuse.

There were established quality monitoring systems in place to assess and improve the quality of service that patients received.