We carried out an announced comprehensive inspection at Dr K Dhillon known as Eagle Way Surgery on 20 September 2016. The overall rating for the practice was good, with safe rated as requires improvement. The full comprehensive report on the September 2016 inspection can be found by selecting the ‘all reports’ link for Dr K Dhillon on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 9 April 2018 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 20 September 2016. Additional areas of concern subsequently identified since the first inspection were also discussed. 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.

Our key findings were as follows:

• There was now an effective system to monitor and review patients who were prescribed medicines, including those that were high risk.
• Staff carrying out cytology procedures had received up to date training.
• Staff administering vaccinations had been suitably trained to respond to a medical emergency in the event of a patient suffering from anaphylaxis.
• The contents of the first aid kits were in date. There was a system to monitor expiry dates.
• The infection control audit had been revised. The carpets, walls and curtains used in the clinical rooms had been considered in this.
• Prescription stationery was being tracked.
• Carers were not routinely offered an annual health check, although some patients received these opportunistically, and there were systems to direct relevant patients to avenues of support.
• The practice was higher than average for the prescribing of certain antibiotics.

The practice should:

• Continue to take steps to review and improve data concerning the prescribing of certain antibiotics.

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 K Dhillon, also known as Eagle Way Surgery on 20 September 2016. This inspection was to follow up on requirement notices served on the provider following an earlier inspection on 22 July 2015.

At that inspection, the practice was rated overall as requires improvement, with requires improvement for providing safe, responsive and well-led services. We found that staff were unclear about their responsibilities to raise concerns, information about safety was not consistently recorded, and medicines were not well managed and that systems to monitor complaints and audits were not effective, amongst other issues. Further, we said that the practice should improve in some areas, including maintaining accurate records of discussions and investigations. It was rated as good for providing effective and caring services.

Following our inspection of 22 July 2015, we asked the provider to send us an action plan detailing how they were going to improve services and further to our recent inspection of 20 September 2016, the practice is now rated as good.

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

• Significant events were raised, discussed and analysed in a uniform and timely manner.

• There were effective systems in place to manage and act upon patient safety and medicine alerts.

• In one of the first aid kits some of the plasters, bandages and antiseptic swabs had expired.

• Some areas of the practice appeared to be in need of deep-cleaning, such as the walls, carpets and curtains in the clinical rooms. This had not been identified and actioned in the infection control audit.

• Not all GPs administering vaccines had undertaken recent refresher training to respond to a patient experiencing anaphylaxis. A GP taking samples for the cytology screening programme had not received recent training to reflect changes in procedures.

• There was no high risk medicines policy and one patient had not had monitoring in accordance with published guidance.

• The practice did not consistently follow its own policy on repeat prescribing.

• Blank prescription stationery was securely stored but the practice were not tracking the issue to their clinical staff.

• There were procedures in place for monitoring and managing risks to patient and staff safety.

• Data for the year 2015/2016 showed that the practice was performing in line with most indicators, although data relating to cervical screening was low, at 13% below local and England average.

• Audits were regularly discussed at practice meetings. In some instances, these were selected to check compliance with NICE guidelines.

• There was a positive relationship with other healthcare professionals, and minutes of meetings evidenced that patients with complex needs were regularly discussed.

• Appropriate and proactive referrals were made to secondary care healthcare specialists where required.

• The practice had identified 38 patients as carers, which amounted to 1.6% of the practice list. However, the practice did not offer an annual health check for carers.

• Patients without an appointment could call into the practice opportunistically. On the day of our inspection, we saw that they were given an immediate appointment and did not wait very long to be seen.

• Morning and afternoon surgeries were extended in accordance with demand.

• The provider had a clear understanding of the practice population, and what action was required to meet their needs.

The areas where the provider must make improvement are:

• Implement an effective system for the monitoring and review of prescribed medicines including those that are high risk.

• Ensure that GPs carrying out cytology procedures have received up to date training.

• Ensure that GPs administering vaccinations are suitably trained to respond to a medical emergency in the event of a patient suffering from anaphylaxis.

The areas where the provider should make improvement are:

• Ensure the contents of the first aid kits are in date and there is a system in place to monitor expiry dates.

• Revise the infection control audit to effectively include and assess the carpets, walls and curtains used in the clinical rooms and take relevant actions.

• Put in place a system to track the issue of prescription stationery around the premises.

• Offer an annual health check to patients who are carers.

• Improve the recall system to encourage relevant patients to attend for cervical screening.

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 K Dhillon on 22 July 2015. Overall the practice is rated as requires improvement.

Specifically, we found the practice to require improvement for providing safe, responsive and well led services. It also rated as required improvement for providing services for older people, people with long-term conditions, families, children and young people, working age people (including those recently retired and students), people living in vulnerable circumstances, and people experiencing poor mental health (including people with dementia). The practice was rated as good for providing effective, and caring services.

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

• Staff were unclear of their responsibilities to raise concerns, and to report incidents and near misses and how to do so. Information about safety was discussed and actioned appropriately but not consistently recorded.
• Risks to patients were assessed and well managed, with the exception of the management of medicines.
• Data showed patient outcomes were average for the locality. Although some audits had been carried out, we saw no evidence that audits were driving improvement in performance to improve patient outcomes.
• 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.
• Patients reported they had ready access to on the day, routine and urgent appointments.
• The practice were in the process of revising their policies and procedures to reflect practice and inform how they governed the practice, but these were new and had not been embedded to reflect practice.
• Regular discussions were held between the clinical team and wider practice but were not routinely recorded and actions reviewed to ensure they were progressed and resolved.
• The practice had not proactively sought feedback from staff or patients.
• Not all staff had received regular performance reviews or attended practice meetings.

The areas where the provider must make improvements are:

• Review patients’ medicines in response to medicines alerts. Ensure effective systems are in place to management and monitor the prescribing of medication and conducting of medication reviews.
• Provide non clinical staff with appropriate support, training, development plans and appraisals.
• Assess, monitor and improve the quality and safety of services provided in the carrying on of the practice such as management and monitoring of complaints, clinical audits being used to inform improvements, practice meetings demonstrating probity and monitoring and mitigating risks.
• Ensure they establish and operate an effective and accessible system for identifying, receiving, recording, handling and responding to complaints.

In addition the provider should:

• Maintain accurate and comprehensive records of investigations, discussions and decisions.
• Provide staff with training in infection and prevention control and fire safety
• Obtain a mercury spirometer spillage kit, if they intend to retain the device
• Formalise systems, processes and policies to manage and monitor risks to patients, staff and visitors to the practice.
• Consider the risks associated with the practice not having access to oxygen and an automated external defibrillator
• Consider the availability of additional services and literature for patients with disabilities and for patients whose first language was not English
• Conduct an equality impact assessment for patients (An equality impact assessment may assist in analyse of policies and practices to ensure they do not discriminate or disadvantage people).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice