Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection February 2015 – Requires Improvement)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Outstanding

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 – Outstanding

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

We carried out an announced comprehensive inspection at Dr Maassarani and Partners on 10 January 2018. Overall the practice is rated as good.

Previously we carried out an announced comprehensive inspection at Dr Maassarani and Partners on 03 February 2015. The overall rating for the practice was requires improvement. The practice was required improvement for safe and well-led services. Requirement notices were made as improvements were needed in the pre recruitment checks completed by the provider and quality of staff supervision and training. The full comprehensive report on the February 2015 inspection can be found by selecting the ‘all reports’ link for Dr Maassarani and Partners on our website at www.cqc.org.uk.

At this inspection we found:

• Systems in place to ensure staff recruitment was safe were established.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• In response to the GP survey results the provider had put systems in place to review and monitor their processes in areas with a lower than average satisfaction rate.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• In the 2017 GP survey patients said they did not always get to see the GP of their choice, however patients we spoke with and who completed CQC comment cards told us 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 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.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

We saw areas of outstanding practice:

• The practice was outstanding in the area of responsiveness to people in vulnerable circumstances. The practice accepted vulnerable migrants and had taken steps to employ staff from the migrant groups. Their role was to provide outreach into these communities to encourage a take up of health, social support and educational services.

• The practice recognised the impact of long term debt and unemployment on mental and general health and worked with a local charity to provide job opportunities for young unemployed people and also a debt management service which had directly benefited their patients.

• The systems and processes in place for enabling patients experiencing poor mental health to engage with the practice and receive care, treatment and support were outstanding.

The areas where the provider should make improvements are:

• The provider should review their processes for identifying and documenting themes from complaints and incidents.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

This is the report of findings from our inspection of Dr Maassarani and Partners. The practice is registered with CQC to provide primary care services. We undertook a planned, comprehensive inspection on 3 February 2015 and we spoke with patients, relatives, staff and the practice management team.

The practice was rated overall as Requires Improvement.

Our key findings were as follows:

• Staff understood their responsibilities to raise concerns, however not all staff were engaged in reporting incidents and near misses.
• Risks to patients were assessed and well managed, with the exception of those relating to recruitment checks.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Data showed patient outcomes were good for the locality.
• 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 usually available on the day they were requested.
• The practice had a number of policies and procedures to govern activity, however these were not always followed in practice for example the recruitment and complaints procedures.
• The practice held weekly and monthly team meetings and staff reported feeling well supported by the leadership team.
• The practice sought feedback from patients and worked closely with the practice Patient Participation Group (PPG).

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

Importantly, the provider must:

• The provider must ensure suitable arrangements are in place to demonstrate staff are receiving appropriate training, supervision and appraisal at all times. Regulation 23.

• The provider must ensure its recruitment arrangements are in line with Regulation 21 and Schedule 3 of the Health and Social Care Act 2008 to ensure necessary employment checks are in place for all staff. This must include a Disclosure and Barring Service (DBS) check for all staff with chaperoning responsibilities. Regulation 21.

In addition the provider should:

• Improve the practice by ensuring learning from adverse events, incidents, complaints, errors and near misses that occur.
• Ensure doctors have emergency drugs available for use in patients’ homes or have in place a risk assessment to support their decision not to have these available.
• The provider should ensure all emergency equipment is checked to ensure it is safe and ready for use. They should review the storage of emergency medicines held at the practice to ensure that when needed they can be accessed swiftly and safely.
• The complaints process should include a documented audit trail of the steps taken and the decisions reached, including the learning that has taken place.
• The practice should take the responsibility to liaise with the other practices in the building to put together a policy for dealing with emergency patients that arrive in the main reception such as described in the report.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice