We carried out an announced comprehensive inspection of the practice on 31 January 2019 as part of our inspection programme.

Our judgement of the quality of care at this service is based on a combination of what we found when we inspected, information from our ongoing monitoring of data about services and information from the provider, patients, the public and other organisations.

This practice as rated as requires improvement overall.

We concluded that:

• Patients were supported, treated with dignity and respect and were involved as partners in their care.
• People’s needs were met by the way in which services were organised and delivered.

However, we also found that:

• People were not always adequately protected from avoidable harm and abuse.
• The delivery of high quality care was not always assured by effective governance procedures.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

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 of the practice on 14 April 2015. Breaches of legal requirements were found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breaches of regulation 12(2)(b)(c)(d)(g)(h) and regulation 17(2)(b) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook this focussed inspection on 15 September 2015 to check that they had followed their plan and to confirm that they now met the legal requirements. This report covers our findings in relation to those requirements and also where additional improvements have been made following the initial inspection. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Dr Kaushal Kishore Misra on our website at www.cqc.org.uk.

Overall the practice is rated as Good. Specifically, following the focussed inspection we found the practice to be good for providing safe services and well led services. As the practice was now found to be providing good services for safe and well-led, this affected the ratings for the population groups we inspect against. Therefore, it was also good 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 whose circumstances make them vulnerable and people experiencing poor mental health (including people with dementia).

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

• Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and managed, including those for medicines management, staffing, health and safety, infection control and responding to emergencies.
• The practice had a number of updated policies and procedures to govern activity.
• The practice held regular staff and governance meetings.
• All staff had received updated mandatory training for basic life support and fire safety.

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 Kaushal Kishore Misra on 14 April 2015. Overall the practice is rated as requires improvement.

Specifically, we found the practice to be requires improvement for providing safe and well led services. It also requires improvement for providing services for older people, people with long-term conditions, families, children and young people, people whose circumstances make them vulnerable and people experiencing poor mental health (including people with dementia).

The practice was good for providing effective, caring and responsive services. It was also good for providing services for working age people (including those recently retired and students).

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

• Staff understood and fulfilled their responsibilities to raise concerns and to report incidents and near misses. Some information about safety was recorded, monitored, appropriately reviewed and addressed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.
• 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.
• Urgent appointments were available on the day they were requested and the practice offered telephone consultations and later appointments with the patient’s named GP.
• Staff felt well supported by management and felt it was easy to raise any concerns.
• The practice had proactively sought feedback from patients and the patient participation group and had made changes as a result of feedback.
• Some risks to patients were assessed and managed, however health and safety risk assessments including fire and infection control did not provide full assurance that risks were monitored.
• Adequate recruitment checks for valid professional registration were not in place.
• Data showed patient outcomes were average or above for the locality.
• Audits had been carried out that had improved patient outcomes, but not all audits were recorded to demonstrate improvements.
• The practice had a number of policies and procedures to govern activity, but some of these were three years old and had not been reviewed since.
• The practice did not hold regular governance meetings and issues were discussed at ad hoc meetings.

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

Importantly, the provider must:

• Review and update infection control and cleaning procedures in the practice, including regular infection control and cleaning audits, secure disposal of clinical waste and control of substances hazardous to health.
• Ensure that staff are adequately updated in basic life support training, relevant to their role.
• Update the practice fire risk assessment and ensure staff have fire training at a relevant level, yearly or as required.
• Ensure there are robust systems to record and monitor medicines held in the practice including vaccines.
• Ensure that adequate checks for professional registration are carried out for new staff.

In addition the provider should:

• Identify risks to the practice through regular audit and risk assessments and maintain a risk log.
• Ensure that practice policies are regularly reviewed, updated and shared with staff.
• Ensure that there are robust incident reporting processes and all incidents and safety alerts are shared with practice staff.
• Ensure that the practice has effective safeguarding procedures, including systems to flag vulnerable adults and formal adult safeguarding training for staff relevant to their roles.
• Have assurances in place that criminal records checks are aligned with staff roles and are updated where necessary.
• Ensure that a programme of clinical audits reflect the needs of the practice and the audits are formally recorded to demonstrate improved outcomes for patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice