Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Dr Mahreen Chawdhery on 26 May 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said 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 and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Ensure that systems are in place for ongoing risk assessment of the medicines required to respond effectively in an emergency.

• Should ensure that all staff are aware of practice safeguarding leads and the correct procedures for chaperoning.

• Ensure that the practice’s business continuity plan contains emergency contact information for all staff working at the practice.

• Undertake a programme of quality improvement to improve patient outcomes.

• Review the training and support arrangements for the practice nurse to ensure that they receive adequate peer support from nurses within the locality.

• Review ways to improve patient confidentiality for consultations that are carried out in the nurses room.

• Ensure complaints responses follow practice policy and comply with requirements of The Local Authority Social Services and NHS Complaints (England) Regulations 2009.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Most people we spoke with told us they were happy with the care and treatment they received when visiting the practice. We found people were treated with dignity and respect and individual needs were met in relation to their care and treatment.

We saw systems were in place to promote safe practice and continuity of care. Records we viewed detailed patients medical history, treatment and referrals made to a specialist. When patients came for a follow up appointments this was recorded on patient’s records.

There were effective recruitment processes in place and appropriate checks were undertaken before staff began work.

There were systems in place to monitor the quality of the service. The service provider took on board the views of people using the service to make improvements, for example updating the practice website regularly.

The practice had a process and policy for making a complaint. Information was displayed in the reception area to inform patients how to make a complaint and who to complain to.

We reviewed the information available to us about Dr Mahreen Chawdhery on 8 June 2019. We did not find evidence of significant changes to the quality of service being provided since the last inspection. As a result, we decided not to inspect the surgery at this time. We will continue to monitor this information about this service throughout the year and may inspect the surgery when we see evidence of potential changes.