Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Nagendra Kumar Gupta’s practice on 26 February 2016. The practice was rated as good for providing caring and responsive services, requires improvement for providing safe and effective services and inadequate for providing well-led services. The overall rating for the practice was requires improvement. We issued three requirement notices to the provider in respect of good governance, safe care and treatment and fit and proper persons employed.

The full comprehensive report on the February 2016 inspection can be found by selecting the ‘all reports’ link for Dr Nagendra Kumar Gupta on our website at www.cqc.org.uk.

We carried out an announced comprehensive follow up inspection on 21 December 2016 to check that action had been taken to comply with legal requirements and assess what improvements had been made. We found some improvements had been made however further improvement was necessary. Specifically the practice must:

• Ensure risks associated with fire safety are assessed and staff receive fire awareness training.

It should also :

• Implement a system to monitor the use of prescription pads.
• Ensure Patient Group Directions are signed by a GP.
• Ensure all emergency medicines are in date.
• Identify and support more patients who are also carers.
• Consider providing access to a hearing loop to aid communication with those patients with a hearing impairment.
• Formalise the strategy to deliver the practice vision.
• Ensure all key policies are in place.

Overall the practice was rated as requires improvement.

This inspection was an announced focused inspection carried out on 5 December 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 21 December 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

• Risks associated with fire safety have been assessed and staff have received fire awareness training.
• A system to monitor the use of prescription pads has been implemented.
• Patient Group Directions had been signed by a GP.
• All emergency medicines are in date.
• 32 carers have been identified and support offered.
• A hearing loop had been installed to aid communication with those patients who have a hearing impairment.
• There was a strategy to deliver the practice vision.
• All key policies are in place, were accessible and were in date.

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 Nagendra Kumar Gupta’s practice on 26 February 2016. The practice was rated as good for providing caring and responsive services, requires improvement for providing safe and effective services and inadequate for providing well-led services. The overall rating for the practice was requires improvement. We issued three requirement notices to the provider in respect of good governance, safe care and treatment and fit and proper persons employed.

The full comprehensive report on the February 2016 inspection can be found by selecting the ‘all reports’ link for Dr Nagendra Kumar Gupta on our website at www.cqc.org.uk.

This inspection was an announced comprehensive follow up inspection on 21 December 2016 to check that action had been taken to comply with legal requirements and assess what improvements had been made. We found some improvements had been made however further improvement was necessary. Overall the practice is rated as requires improvement.

Our key findings were as follows:

• 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 although the risks associated with fire had not been assessed.
• 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. However, fire awareness training had not been carried out for staff.
• 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.
• Information about services and how to complain was available and there were systems in place for handling complaints and concerns.
• Patients we spoke with 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 adequate facilities and was equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management.

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

Importantly, the provider must:

• Ensure risks associated with fire safety are assessed and staff receive fire awareness training.

In addition the provider should:

• Implement a system to monitor the use of prescription pads.
• Ensure Patient Group Directions are signed by a GP.
• Ensure all emergency medicines are in date.
• Identify and support more patients who are also carers.
• Consider providing access to a hearing loop to aid communication with those patients with a hearing impairment.
• Formalise the strategy to deliver the practice vision.
• Ensure all key policies are in place.

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 Nagrendra Kumar Gupta on 26 February 2016. Overall, the practice is rated as requires improvement.

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

• Staff did not always fulfil their responsibilities to raise concerns, and to report incidents and near misses. However, when these were raised to the management team, reviews and investigations were thorough. Patients received a verbal and written apology.
• Risks to patients were not always assessed and well managed.
• Clinical staff did not have ready access to clinical guidelines.
• Information about services was available but not everybody would be able to understand or access it. For example, information leaflets were not available in other languages.
• The practice had a number of policies and procedures to govern activity, but some were overdue a review.
• The practice did not have a patient participation group.
• Urgent appointments were usually available on the day they were requested.
• All patients said they were treated with compassion, dignity and respect. They all said they felt cared for, supported and listened to.

The areas where the provider must make improvements are:

• Ensure effective systems are in place for reporting and recording significant events.
• Ensure that systems are in place to record and disseminate discussions and agreed decisions to all relevant staff.
• Ensure recruitment arrangements include all necessary pre-employment checks for all staff.
• Ensure a risk assessment is carried out to determine if staff who act as chaperone need a DBS check.
• Ensure all staff have annual basic life support training.
• Ensure fire risk assessment and electrical appliance testing is carried out.
• Ensure infection control audits are carried out and cleaning equipment is stored in a suitable location.

In addition the areas where the provider should make improvements are:

• Review and update the practice business continuity plan.
• Record all verbal complaints and correspondents with patients.
• Review its provisions of services to female patients.
• Review its systems for monitoring blank prescriptions.
• Implement processes and systems to gain feedback from people who use services.

Where a service is rated as inadequate for one of the five key questions or one of the six population groups or overall, it will be re-inspected within six months after the report is published. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group or overall, we will place the service into special measures. Being placed into special measures represents a decision by CQC that a service has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice