Letter from the Chief Inspector of General Practice

Our previous comprehensive inspection at Dr Kanchan Arora (Great Hollands Medical Practice) on 1 June 2016 found breaches of regulations relating to the safe, effective and well-led delivery of services. The overall rating for the practice was requires improvement. Specifically, we found the practice to require improvement for provision of safe, effective and well led services. It was good for providing caring and responsive services. Consequently we rated all population groups as requires improvement. The full comprehensive report on the June 2016 inspection can be found by selecting the ‘all reports’ link for Dr Kanchan Arora (Great Hollands Medical Practice) on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 8 February 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 1 June 2016. This report covers our findings in relation to those requirements and improvements made since our last inspection.

We found the practice had made improvements since our last inspection. At our inspection on the 8 February 2017 we found the practice was meeting the regulations that had previously been breached. We have amended the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe, effective, caring, responsive and well led services. Overall the practice is now rated as good. Consequently we have rated all population groups as good.

Our key findings were as follows:

• All staff who acted as a chaperone had received a Disclosure and Barring Service (DBS) checks and staffing levels were reviewed to keep patients safe and safeguarded from abuse.
• Blank prescription forms and pads were kept securely and tracked through the practice.
• The practice was operating an effective system to monitor the cleaning standards in the premises.
• We found that completed clinical audit cycles were driving positive outcomes for patients.
• There was an effective system in place to follow up patients on two weeks referral procedure for hospital appointments.
• Staff had undertaken training relevant to their role.
• The practice had demonstrated improvements in patients’ outcomes for patients with learning disabilities and patients experiencing poor mental health.
• The practice had installed a hearing induction loop at reception.
• The practice had displayed information about a translation service in the waiting area.
• Staff we spoke with on the day of inspection was aware about a translation service and whistleblowing policy.
• Information posters and leaflets were available in multi-languages.
• The practice had demonstrated significant improvements in governance arrangements.
• The practice had taken steps to identify carers to enable them to access the support available via the practice and external agencies. The practice had actively contacted patients aged above 75 years old to identify more carers. The practice had redesigned new patient questionnaire to identify new carers at the time of new registrations. Written information was available for carers to ensure they understood the various avenues of support available to them. The practice register of patients who were carers had increased from 25 (0.63%) patients to 66 patients (1.7% of the practice patient population list size).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

Our previous comprehensive inspection at Dr Kanchan Arora (Great Hollands Medical Practice) on 1 June 2016 found breaches of regulations relating to the safe, effective and well-led delivery of services. The overall rating for the practice was requires improvement. Specifically, we found the practice to require improvement for provision of safe, effective and well led services. It was good for providing caring and responsive services. Consequently we rated all population groups as requires improvement. The full comprehensive report on the June 2016 inspection can be found by selecting the ‘all reports’ link for Dr Kanchan Arora (Great Hollands Medical Practice) on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 8 February 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 1 June 2016. This report covers our findings in relation to those requirements and improvements made since our last inspection.

We found the practice had made improvements since our last inspection. At our inspection on the 8 February 2017 we found the practice was meeting the regulations that had previously been breached. We have amended the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe, effective, caring, responsive and well led services. Overall the practice is now rated as good. Consequently we have rated all population groups as good.

Our key findings were as follows:

• All staff who acted as a chaperone had received a Disclosure and Barring Service (DBS) checks and staffing levels were reviewed to keep patients safe and safeguarded from abuse.
• Blank prescription forms and pads were kept securely and tracked through the practice.
• The practice was operating an effective system to monitor the cleaning standards in the premises.
• We found that completed clinical audit cycles were driving positive outcomes for patients.
• There was an effective system in place to follow up patients on two weeks referral procedure for hospital appointments.
• Staff had undertaken training relevant to their role.
• The practice had demonstrated improvements in patients’ outcomes for patients with learning disabilities and patients experiencing poor mental health.
• The practice had installed a hearing induction loop at reception.
• The practice had displayed information about a translation service in the waiting area.
• Staff we spoke with on the day of inspection was aware about a translation service and whistleblowing policy.
• Information posters and leaflets were available in multi-languages.
• The practice had demonstrated significant improvements in governance arrangements.
• The practice had taken steps to identify carers to enable them to access the support available via the practice and external agencies. The practice had actively contacted patients aged above 75 years old to identify more carers. The practice had redesigned new patient questionnaire to identify new carers at the time of new registrations. Written information was available for carers to ensure they understood the various avenues of support available to them. The practice register of patients who were carers had increased from 25 (0.63%) patients to 66 patients (1.7% of the practice patient population list size).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

When we visited Dr Kanchan Arora in December 2013 we found that some systems to reduce the risk of infection were not operated effectively. We asked the practice to take action to address the issues we identified. The practice sent us a plan setting out the actions they would take. We carried out this visit to check that actions had been taken.

During this visit we spoke with the GP and a health care assistant. We did not speak with patients as this was not necessary.

The practice had made significant improvements.

We found the practice had ensured staff received relevant training in control of infection processes and procedures. A system to monitor the standards of cleanliness had been introduced. We saw this was operating effectively.

We reviewed the standards of cleanliness achieved in the GP consulting rooms, treatment rooms and general areas. We found the practice to be clean and tidy.

At this inspection we followed up on concerns we identified during our last visit on 12 June 2013. We spoke with the practice manager and a member of staff.

We found improvements had been made to the cleanliness of the environment. However, there were areas in treatment rooms where we found dust and dirt. The system for identifying and acting on concerns related to hygiene and infection control was not fully effective.

Staff told us they were provided with training in hygiene and infection control and relevant policies. They said they were aware of the process for reporting and investigating significant events and incidents.

We saw appropriate risk assessments and relevant action was taken to identify risks to the health safety and welfare of patients.

We found that patients of the practice were well cared for and had treatment that met their needs. All of the patients we met spoke positively about the treatment and support they had been given. On patient told us "I am satisfied with the way the surgery operates. Dr Arora is highly committed and takes great care of her patients”.

Patients who used the service were protected from the risk of abuse. One patient said: "I have complete trust and faith in my GP. They are fantastic”.

We found the consulting rooms clean and tidy. However, the shared waiting room and children's area was unhygienic. Patients' we spoke with told us that they had raised the condition of the children's area with the practice but no action had been taken.

We found that patients were protected from unsafe or unsuitable equipment. This was because the equipment used was risk assessed and well maintained.

Staff received appropriate personal development. Staff had received appraisals and training. We noted that some staff had received supervision which was often not recorded.

The practice asked patients' for their views and acted upon their feedback. However, we found that there was not an effective system to effectively identify, assess and manage risks relating to the health, welfare and safety of patients and others.

Patient complaints were responded to in accordance with the practice complaints policy. We found that the practice manager reviewed complaints on a regular basis.