Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Nisha Pathak on 9 May 2017. The overall rating for the practice was good. However, for providing safe care, the practice was rated as requires improvement. The full comprehensive report on the May 2017 inspection can be found by selecting the ‘all reports’ link for Dr Nisha Pathak on our website at www.cqc.org.uk.

This inspection was a focused inspection, carried out on 22 November 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 9 May 2017. 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:

• The practice had made arrangements to ensure pathology results were being actioned in a timely manner.

• The practice had recently started to communicate latest clinical guidance to all GPs through email communication in the absence of clinical meetings.

• We saw evidence of health screening promotion with patients being encouraged to attend appointments for cancer screening.

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 of Dr Nisha Pathak on 22 March 2016. The overall rating for the practice was requires improvement. The full comprehensive report for the March 2016 inspection can be found by selecting the ‘all reports’ link for Dr Nisha Pathak on our website at www.cqc.org.uk.

This was an announced comprehensive follow up inspection carried out on 9 May 2017 to confirm that the practice had carried out their plan to meet the required improvements in relation to the breaches in regulations that we identified in our previous inspection on 22 March 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

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

• When we inspected the practice in March 2016 we saw there was an open and transparent approach to safety and a system in place for reporting and recording significant events. However, the learning from significant events was not consistent. At this inspection, records we looked at demonstrated that action had been taken to improve.

• Staff we spoke with demonstrated a personal awareness of guidance such as NICE. However in the absence of clinical meetings the provider did not demonstrate how they ensured all clinical staff were up to date with latest guidance

• Most risks to patients were generally assessed and well managed; however, some risks were not effectively managed. For example, the practice received test results in electronic as well as in paper format. We saw evidence that some blood tests and X-ray results had not been actioned timely. The provider GP had a preference for processing incoming blood tests and X-ray results in paper format and staff told us that this often caused the delays.

• During our previous inspection in March 2016 patients said they found it difficult to make an appointment with a named GP which affected continuity of care. At this inspection, we were told that the provider GP who previously only carried out administrative duties now offered consultations three days a week. There had also been two regular locum GPs since December 2016.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. The July 2016 national GP patient survey results aligned with these views.

• When we inspected the practice in March 2016 we saw administration staffing levels were not adequate to meet patient needs. At this inspection we were told that one additional receptionist and two apprentice reception staff had been recruited. Staff we spoke with confirmed this and told us that greater stability in regards to staffing had been achieved.

• Information about services and how to complain was available. During our previous inspection we identified that information on how to escalate complaints that were not satisfactorily resolved was not provided in the complaints response. At this inspection we saw this information had been included in the response letter.

• When we inspected the practice in March 2016 staff members told us that they were not involved in discussions regarding developments proposed for the practice. At this inspection staff told us there was greater communication about the future direction and developments of the practice.

We saw one area of outstanding practice:

The practice had a proactive approach to registering patients for online services. Many patients were unsure of how to register or use the online service. The practice responded by having a computer available in the reception waiting area so that it could be used to guide patients on using the system. We saw evidence that 694 patients (26% of the list size) had been registered for online services. We were told that many patients were regularly using the service.

The areas where the provider must make improvement are:

• Introduce effective systems or processes to mitigate the risks relating to the timely management and actioning of hospital communications.

The areas where the provider should make improvement are:

• Consider in the absence of clinical meetings how the provider could demonstrate how all clinical staff were kept up to date with latest guidance.
• Continue to consider promotion of the bowel cancer screening programme to achieve improvement.

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 Nisha Pathak on 9 May 2017. The overall rating for the practice was good. However, for providing safe care, the practice was rated as requires improvement. The full comprehensive report on the May 2017 inspection can be found by selecting the ‘all reports’ link for Dr Nisha Pathak on our website at www.cqc.org.uk.

This inspection was a focused inspection, carried out on 22 November 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 9 May 2017. 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:

• The practice had made arrangements to ensure pathology results were being actioned in a timely manner.

• The practice had recently started to communicate latest clinical guidance to all GPs through email communication in the absence of clinical meetings.

• We saw evidence of health screening promotion with patients being encouraged to attend appointments for cancer screening.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice