This practice is rated as Good overall. (The previous rating on 15 December 2017 was requires improvement).

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We previously carried out an announced comprehensive inspection at Dr Narendra Patel on 15 December 2017. The overall rating for the practice was requires improvement with requires improvement in safe, effective and well led and good in caring and responsive. Breaches of legal requirements were found and requirement notices were served in relation to safe care and treatment, good governance and staffing. The full comprehensive report on the December 2017 inspection can be found by selecting the ‘all reports’ link for Dr Narendra Patel on our website at www.cqc.org.uk.

We carried out an announced comprehensive follow up inspection at Dr Narendra Patel on 16 October 2018 to follow up on breaches of regulations we found at our previous inspection.

At this inspection we found:

• The practice had introduced systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice had appropriate systems to safeguard children and vulnerable adults from the risk of abuse. However, there were no processes in place for the practice to reconcile their safeguarding registers with the health visiting team.
• There had been improvements in the recruitment process however, the recruitment policy did not fully reflect legal guidance.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. However, the care provided to patients near the end of their life was not delivered according to evidence-based guidelines or supported through a coordinated approach between services.
• The practice worked with Age UK to provide ‘The 80 Plus Service’. The service provided social support and liaison with other services.
• Unverified data showed that care and treatment provided for patients with asthma and high blood pressure was in line with the national average however, some care indicators for patients with diabetes or patients experiencing poor mental health remained below national averages.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system very easy to use and reported that they were able to access care when they needed it.
• There had been an improvement in governance procedures. Appropriate actions had been completed in response to risk assessments, policies were correctly dated and systems to act of safety alerts had been put in place.
• The practice had a virtual patient participation group however it was not active. We saw no evidence of feedback gathered from the group.

The areas where the provider must make improvements are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

• Update the recruitment policy so that it reflects legal requirements.
• Consider systems to reconcile safeguarding registers with the health visiting team.
• Complete a formal risk assessment to record the processes non-clinical staff followed to protect themselves and patients in the absence of immunisation for hepatitis B.
• Consider ways of gathering feedback from the virtual patient participation group to shape and improve services.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Letter from the Chief Inspector of General Practice

This practice is rated as requires improvement overall. (We previously inspected this practice on 14 January 2015 and rated it as Good overall.)

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires improvement

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 – Requires improvement

People with long-term conditions – Requires improvement

Families, children and young people – Requires improvement

Working age people (including those recently retired and students – Requires improvement

People whose circumstances may make them vulnerable – Requires improvement

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

We carried out an announced comprehensive inspection at Dr Narendra Patel on 15 December 2017 as part of our inspection programme.

At this inspection we found:

• The practice had systems to keep patients safe and safeguarded from the risk of abuse however, policies did not reflect the most up to date guidance and not all staff had received appropriate safeguarding training.

• The practice had audited antimicrobial prescribing. There was evidence of actions taken to support good antimicrobial stewardship. The practice was the fourth lowest prescriber of antibiotics within the Clinical Commissioning Group.

• Protocols for the care of patients with diabetes or asthma had not been updated to reflect current National Institute for Health and Care Excellence (NICE) guidelines.

• Patients with long term conditions were offered an annual review of their health. However data showed that care and treatment provided for patients with conditions, such as asthma, high blood pressure or diabetes, and patients experiencing poor mental health were below local and national averages.

• The practice had a system in place to monitor training completed by staff. Some staff had not received mandatory training as identified by the practice.

• Some clinical staff had not received training specific to their role to support them in providing appropriate treatment for people who lacked mental capacity.

• Staff involved and treated patients with compassion, kindness, dignity and respect.

• The practice had only identified two patients as carers (0.1% of the practice list). They planned to work with the Age UK co-ordinator to increase their identification of carers.

• Patients were highly complementary regarding the care and treatment they received from the practice. The national patient survey rated the practice as the leading practice in the region for patient satisfaction and it ranked 52nd out of 7,000 practices nationwide.

• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.

• The practice’s complaints leaflet was out of date and was not readily available for patients to refer to. A complaint had not been dealt with in line with their own complaints policy.

• Staff stated they felt respected, supported and valued and there was an open culture within the practice, however systems for reporting and learning from significant and complaints were not always followed.

• There were clear responsibilities and roles of accountability. However, structures, processes and systems to support good governance and management were not clearly set out or effective.

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.

• Ensure persons employed in the provision of the regulated activity receive the appropriate training necessary to enable them to carry out their duties.

For details, please refer to the requirement notices at the end of the report.

The areas where the provider should make improvements are:

• Implement systems to proactively improve the identification of carers registered with the practice.

• Update their practice complaints leaflet and ensure it is readily available for patients to refer to. Ensure that all complaints are dealt with in line with their own complaints policy.

• Review access arrangements for disabled patients through the front door.

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. Narendra Patel practice on 14 January 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing a safe, well-led, effective, responsive and caring service. It was also rated as good for providing services for all population groups.

Our key findings were as follows;

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.
• The appointment system was sensitive to the needs of the population groups and offered extended hours every Monday from 6.30pm to 7.30pm.
• All staff understood their responsibilities in raising concerns and reporting incidents and near misses.
• The practice linked with the Clinical Commissioning Group and other local providers to enhance services and share best practice.
• Complaints were sensitively handled and patients are kept informed of the outcome of their comments and complaints
• The practice had a clear vision which had quality and safety as its top priority.

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

Importantly the provider should:

• Complete an appropriate Legionella risk assessment.
• Ensure there is a completed fire risk assessment which is acted upon.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice