This practice is rated as

Good

overall.

At our previous inspection in November 2017 the practice had an overall rating as Good, but we rated the practice requires improvement for providing safe services. We issued a requirement notice and the provider informed us of actions they would take in order to make improvements.

We undertook a focussed inspection on 4 September 2018 to deduce whether the improvements required had been made. Following this inspection:

• Are services safe? – Good

We carried out the announced focussed inspection on 4 September 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether Dr M L Swami and Partners was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

At this inspection we found:

• The practice had defined and embedded systems, processes and practices to minimise risks to patient safety.
• Prescribing of high risk medicines ensured patients received monitoring required to take these medicines safely.
• Test results were monitored and acted on to ensure patient care was followed up where actions were required.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall.

At our previous inspection in June 2016 the practice had an overall rating as Good.

Following the November 2017 inspection, the key questions are rated as:

• Are services safe? – Requires improvement

• Are services effective? – Good

• Are services caring? – Good

• Are services responsive? – Good

• Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

• Older People – Good

• People with long-term conditions – Good

• Families, children and young people – Good

• Working age people (including those recently retired and students – Good

• People whose circumstances may make them vulnerable – Good

• People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Dr M L Swami and Partners in Reading, Berkshire on 21 November 2017. We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether Dr M L Swami and Partners was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen and any notable events either positive or negative were learned from.
• The practice had defined and embedded systems, processes and practices to minimise risks to patient safety.
• However, we found these systems had not identified risks related to the ongoing monitoring of patients on medicines where care was shared with other health services. There were also risks identified related to actions following test results or other patient related information received into the practice.
• Staff had received training appropriate to their roles and the population the practice served. Any further training needs had been identified and planned.
• Our findings showed that systems were in place to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence (NICE) guidelines and other locally agreed guidelines.
• Clinical outcomes in national data submissions showed high performance for managing patients with long term conditions.
• We received positive feedback from patients and external stakeholders which access GP services from the practice.
• Patients found the appointment system easy to use.
• The practice learned lessons from individual concerns and complaints and also from analysis of trends. For example, telephone access had been a historic concern within the practice. As a result, the practice reviewed the telephone system and increased staff who answered calls.
• The practice had clear and visible clinical and managerial leadership and supporting governance arrangements.

The areas where the provider must make improvements are:

• Ensure risks to patients are identified, assessed and mitigated to protect patients’ health and welfare.

The areas where the provider should make improvements are:

• Review the potential requirements of patients with limited mobility and access to services to patients who may need additional support, with regard to the legal requirements of the Disability Discrimination Act (1995) and Equality Act (2010).
• Undertake a full review of the requirements of the accessible information standard.

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 M L Swami & Partners, 79 Russell Street, Reading, Berkshire on 8 October 2015. This inspection was undertaken to check the practice was meeting regulations and to consider whether sufficient improvements had been made since our last inspection which was carried out in January 2015.

Our inspection in January 2015 found breaches of regulations relating to the safe, effective and well-led delivery of services. As a result of these the overall rating for the practice was inadequate and the practice was placed into special measures for six months.

Following the inspection in January 2015, we received an action plan which detailed the actions to be taken to achieve compliance. At our inspection on the 8 October 2015 we found the practice was meeting all of the regulations that had previously been breached.

This showed that the practice had made significant improvements since our last inspection.

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. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and managed.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.
• All staff had received training appropriate to their roles and any further training needs had been identified and planned for.

• 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 that there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

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

The areas where the provider must make improvements are:

• Take action to address concerns about poor patient satisfaction.

In addition the provider should:

• Identify the last Legionella risk assessment to confirm when the next assessment is due.
• Log verbal complaints to enable the identification of trends in patient satisfaction.
• Ensure emergency lighting is adequate for the practice.

I am taking this service out of special measures. This recognises the hard work and significant improvements that have been made to the quality of care provided by this service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of Dr M L Swami & Partners on 15 January 2015. We have rated the overall practice as inadequate.

Specifically, we found the practice inadequate for providing safe services and being well led. It was also inadequate for providing services for all the six population groups. 

Improvements were also required for providing effective services. It was good for providing caring and responsive services.

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

Patients were at risk of harm because systems and processes were not in place and implemented in a way to keep them safe. We found concerns in recruitment, infection control, staffing, medicine management, anticipating events, quality and monitoring systems and dealing with emergencies.

We found patient needs were not always assessed in line with professional guidelines. The practice did not have system in place to carry out completed (a minimum of two cycles) clinical audits. Multidisciplinary working was taking place but was generally informal and record keeping was limited or absent

We found the practice had not taken all measures to identify, assess and manage risk. The practice did not have a documented business or strategic plan in place.

Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. Information to help patients understand the services available was easy to understand.

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

Action the provider MUST take to improve:

• Ensure all recruitment and employment information required by the regulations are documented in all staff members’ personnel files.
• Ensure all staff identified as requiring a DBS check have one undertaken as soon as possible. Undertake a risk assessment to determine which members of staff require a Disclosure Barring Service (DBS) check and which members do not.
• Ensure there are systems in place to regularly assess and monitor the quality of the services provided. And to identify, assess and manage risks relating to health, welfare and safety of patients.
• Ensure appropriate clinical staffing levels are in place.
• Ensure arrangements are in place to deal with emergencies and major incidents.
• Ensure systems are in place to monitor fridge temperatures. To ensure systems are in place for all medicines to be stored safely and securely.
• Ensure systems are in place to safeguard patients against the risk of abuse.
• Ensure staff receive regular appropriate training, specific to their role. This includes, training in, safeguarding, infection control and chaperoning.
• Ensure appropriate infection control systems are in place, in line with national guidelines.

Action the provider SHOULD take to improve:

• Implement recording systems, to document clinical and multidisciplinary meetings that take place.
• Ensure systems are in place to undertake completed clinical audits regularly
• Ensure systems are place to ensure lessons are learnt from complaints and significant events.

On the basis of the ratings given to this practice at this inspection, I am placing the provider into special measures. This will be for a period of six months. We will inspect the practice again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

On 8 October 2015 we carried out a comprehensive inspection of Dr M L Swami & partners and found concerns relating to identifying and taking action on patient feedback in regard to the quality of care patients received. Following the inspection the provider sent us an action plan detailing how they would make the required improvements.

We carried out a desktop review of Dr M L Swami & partners on 4 May 2016 to ensure these changes had been implemented and that the service was meeting regulations. Our previous inspection in October 2015 had found a breach of regulations relating to the delivery of caring services. The rating for the provision of caring services has been updated to reflect our findings.

We found the practice had made improvements since our last inspection on 8 October 2015 and they were meeting the regulation, relating to identifying and taking action on patient feedback regarding the standards of care patients received, that had previously been breached.

Specifically the practice had:

• Completed training for GPs in consulting and communicating with empathy.

• Undertaken an extensive practice patient satisfaction survey in March 2016 to follow up on areas of delivery of care where it had previously received poor feedback. The survey was conducted by an independent survey organisation and was distributed at random to 300 patients and 272 responded.

• Results of the patient survey showed a significant increase in patient satisfaction for several aspects of care compared to the results of the 2015 national patient survey.

We have changed the rating for this practice to reflect these improvements. The practice is now rated good for the provision of safe, effective, caring, responsive and well led services.

Our last inspection also identified some areas where the practice should make improvement. The action plan we received and subsequent evidence showed that the practice had made the necessary improvements. They had completed a risk assessment for legionella (Legionella is a term for a particular bacterium which can contaminate water systems in buildings) and were carrying out the recommendations of the assessment. They had also installed additional emergency lighting and introduced a verbal complaints and concerns log.

Overall the practice remains rated as good.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice