Letter from the Chief Inspector of General Practice

We carried out an announced focused inspection at Dr Om Sharma on 21 September 2015. This was to check that improvements had been made to meet the legal requirements following our comprehensive inspection on 10th October 2014

Overall the practice is rated as good.

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

• Appropriate standards of cleanliness and hygiene were followed.
• A robust system was in place for identifying, recording, and learning from safety incidents and significant events.
• Systems were in place to keep patients safe and to protect them from harm. Staff recruitment, training, and infection control had been strengthened.
• There was appropriate emergency equipment and medicines were available to deal with home visits and emergencies.
• Clinical audits were used to improve outcomes for patients and provide assurances as to the quality of care.

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

Importantly the provider should

• Ensure medicines that have expired are disposed of appropriately and within a safe time frame.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We inspected this service on 10 October 2014 as part of our new comprehensive inspection programme. We had previously inspected this practice on 23 September 2013, 1 and9 October 2013 and found that the practice did not meet required standards in safeguarding children and vulnerable adults; management of medicines; safety of equipment; requirements relating to workers; supporting workers and assessing and monitoring the quality of service provision. The practice sent us an action plan telling us what they would do to address these issues. We returned on 2 July 2014 and found they still did not meet required standards in management of medicines; safety of equipment; requirements relating to workers; supporting workers and assessing and monitoring the quality of service provision. We told the practice to take immediate action to address issues relating to workers and assessing and monitoring the quality of service provision. The practice sent us an action plan informing us how they would address the remaining issues. We returned to the practice on 3 September 2014 and found that required standards had still not been met for requirements relating to workers and assessing and monitoring the quality of service provision.

At this inspection we found that adequate improvements had been made in safeguarding children and vulnerable adults; management of medicines; safety of equipment; requirements relating to workers and supporting workers.

There had been some improvement in assessing and monitoring the quality of the service provision. However, there were still concerns regarding the analysis of significant events, the lack of risk assessments to keep patients safe from the risk of harm and the failure to seek the views of patients. We met with stakeholders on 28 October 2014 to discuss our concerns and to identify ways to support the practice in the changes they need to make. We will continue to monitor the situation and will re-inspect the practice to ensure that the required improvements have been carried out.

The overall rating for this service is requires improvement. We found the practice to be good in the effective, caring and responsive domains but required improvement in the safe and well led domains. We found the practice provided good care to people with long term conditions, families, children and young people and people in vulnerable circumstances. Improvements were required in the care of older people, working age people and people experiencing poor mental health.

Our key findings were as follows:

• Patients told us they were satisfied with the appointments system and said it met their needs.

• Patients were not kept safe because arrangements were not in place to investigate and learn from key safety risks. The practice did not have a system in place for monitoring significant events over time.
• Systems were not in place to keep patients safe from the risk and spread of infection because where infection control audits had identified problems, action plans had not been put in place to monitor and make the required improvements.
• Evidence we reviewed demonstrated that most patients were satisfied with how they were treated and that this was with compassion, dignity and respect.

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

Importantly, the provider must:

• Identify, assess and manage risks relating to the health, welfare and safety of patients and others who may be at risk within the practice. This must include risk assessments to manage the lack of access to emergency equipment during a medical emergency; the emergency management of patients during a GP home visit; Control of Substances Hazardous to Health (COSHH) and the prevention of the spread of infection in accordance with Regulation 10(1)(a) Health & Social Care Act 2008 (Regulated Activities) Regulations 2010 Safety and Suitability of Premises.
• Analyse significant events and incidents that resulted in and had the potential to result in harm to patients in accordance with Regulation 10(2)(c)(i) Health & Social Care Act 2008 (Regulated Activities) Regulations 2010 Safety and Suitability of Premises.
• Regularly seek the views of patients and those acting on their behalf to enable the provider to come to an informed view in the relation of the standard of care and treatment provided to patients in accordance with Regulation 10 (2)(e)Health & Social Care Act 2008 (Regulated Activities) Regulations 2010 Safety and Suitability of Premises.
• Second audit cycles are carried out to ensure that changes made to patients’ care and treatment have made improvements to their health outcomes.

In addition the provider should ensure:

• Care plans are completed for patients where a need has been identified.
• Health promotion advice and complaints leaflets are made available for patients whose first language is not English.
• A system for recording the serial numbers of prescriptions pads is introduced to prevent access to medicines in the event of theft of the GPs’ prescription pads used for home visits.
• An infection control lead responsible for infection control is identified and appropriate training given.
• Recruitment procedures include an explanation of gaps in employment history.
• Records are put in place to monitor that oxygen and airway management equipment are in date and fit for purpose.
• All staff receive training in the Mental Capacity Act 2005.
• A business plan is put in place identifying long term plans, vision and strategy to meet the needs of their practice population.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice

We carried out this inspection because of concerns raised at previous inspections in respect of safe staff recruitment and quality monitoring of the service. As a result of these concerns we had taken enforcement action, and we were checking to see if the necessary improvements had been made.

We did not speak with any patients during our visit.

We found that staff recruitment procedures did not always ensure that patients were cared for, or supported by, suitably qualified, skilled and experienced staff. Staff records were still lacking in important information that would demonstrate that individual members of staff were of good character and physically and mentally fit to perform their role.

We found systems were not always in place to monitor the quality of the service and to identify and manage risks to ensure the welfare and safety of people who used the service. There were still no clear lines of leadership, reporting and responsibility at the practice. Checks and audits that would ensure a quality service was offered to patients did not always take place in a consistent manner. Improvements in respect of handling complaints and the analysis of significant incidents had not taken place.

When we last visited this location we identified concerns in relation to medicines, the safety, suitability and availability of equipment, staff recruitment and support and the quality monitoring of the service that patients received.

This visit was to check to see if improvements had been made.

A consultant practice manager had recently been employed and they were working with the provider to make the necessary improvements. A number of policies and systems had been introduced since our previous visit, however as these were in the early days of development we were unable to test that these had been sustained.

We found there had been some improvements in all but one of the areas of concern but further development was still needed.

We found that improvement had not been made in regard to the staff recruitment procedures and the provider could not be assured that staff had been recruited safely or that the provider had gained assurances that the person was of good character.

During the inspection we spoke with four patients, six staff and visiting healthcare professionals. We looked at a range of documents including four patient records.

All of the patients said they were happy with their overall experience of the practice. They felt involved in decisions about their care and treatment and understood the treatment options available to them. One patient said, “I saw the practice nurse, she’s excellent. She always explains what she’s doing and what the issue is, she’s brilliant.”

Care and treatment was mostly delivered in a way that ensured patients’ safety and welfare however, we found that overall, the provider did not have an effective system to regularly assess and monitor the quality of the service they provided. As a result, recruitment and selection processes were not robust and checks that staff were appropriately supported and trained were not undertaken.