We carried out an announced comprehensive inspection at Dr Parmod Luthra (also known locally as Spring Grove Medical Practice) on 03 January 2019 as part of our inspection programme.

At the last inspection in December 2017 we rated the practice as requires improvement overall and specifically requires improvement for providing safe, effective and well-led services because:

• The practice had failed to act on patient correspondence and pathology results in a timely manner.
• We found concerns regarding the management of blank prescription forms, infection control, fire drills and effective monitoring of people experiencing poor mental health (including people with dementia).
• There was a lack of good governance in some areas.

Previous reports on this practice can be found on our website at: https://www.cqc.org.uk/location/1-525624918

At this inspection, we found that the provider had demonstrated improvements in most areas, however, they were required to make further improvements in some areas and are rated as requires improvement for providing safe services.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as good overall and good for all population groups, except requires improvement for Working age people (including those recently retired and students) for providing effective services, because of low cervical screening.

We rated the practice as requires improvement for providing safe services because:

• Risks to patients were assessed and well managed in most areas, with the exception of those relating to the management of the spread of infections to the patients and staff were not adequate.
• Other risks to patients were assessed and well managed.
• Staff understood and fulfilled their responsibilities to raise concerns, and report incidents and near misses. When incidents did happen, the practice learned from them and improved their processes.

We rated the practice as good for providing effective, caring, responsive and well led services because:

• The practice routinely reviewed the effectiveness and appropriateness of the care it provided.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• The practice was encouraging patients to register for online services and 40% of patients were registered to use online Patient Access.
• The practice was aware of and complied with the requirements of the Duty of Candour.
• There was a clear leadership structure and staff felt supported by management.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure care and treatment is provided in a safe way to patients.

The areas where the provider should make improvements are:

• Consider ways to improve the identification of carers to enable this group of patients to access the care and support they need.
• Review ways to improve uptake of childhood immunisation, cervical and bowel cancer national screening.
• Improve the system in place to assure that the appropriate recruitment checks are always carried out in accordance with regulations.
• Take appropriate actions to reduce identified risks while waiting for concerns to be resolved.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Letter from the Chief Inspector of General Practice

This practice is rated as

requires improvement

overall.

(Previous inspection June 2015 - The practice was rated as good overall but effective domain was rated as requires improvement).

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 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 Parmod Luthra (also known locally as Spring Grove Medical Practice) on 14 December 2017. We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether Dr Parmod Luthra was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

At this inspection we found:

• There were inconsistent arrangements in how risks were assessed and managed.
• The practice did not always act on patient correspondence and pathology results in a timely manner.
• Data showed patient outcomes were low for patients experiencing poor mental health, and the cervical and bowel cancer national screening programme uptakes.
• The practice had a number of policies and procedures to govern activity, but it was not clear when they were written or when they had been reviewed.
• We found that completed clinical audits were driving positive outcomes for patients.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Staff had received up to date training relevant to their role. Staff appraisals had been completed in a timely manner.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it. However, some patients raised concerns regarding the long waiting time in the waiting area and dissatisfaction about the service provided by some reception 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.
• The practice proactively sought feedback from staff and patients, which it acted on.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns. However, in their response the practice had not always included information of the complainant’s right to escalate the complaint to the Ombudsman if dissatisfied with the response.
• There was a clear leadership structure and staff felt supported by management. However, some governance arrangements within the practice were not operated effectively.

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.

The areas where the provider should make improvements are:

• Review the system in place to promote the benefits of cervical and bowel cancer national screening in order to increase patient uptake.
• Review and take action to improve patient satisfaction with waiting times and reception staff.
• Ensure a consistent approach to recording significant events.
• Review and implement the system to invite patients aged over 75 for a formal routine health check to ensure continuity of care.
• Review the process of identifying carers to enable them to access the support available via the practice and external agencies.
• Ensure a response to complaints includes information of the complainant’s right to escalate the complaint to the Ombudsman if dissatisfied with the response.

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 Spring Grove Medical Practice on 2 June 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, caring, responsive and well-led services and requires improvement for providing effective services. It was also good for providing services for older people, working age people (including those recently retired and students), people living in vulnerable circumstances, people experiencing poor mental health (including people with dementia) and requires improvement for people with long term conditions and families, children and young people.

Our key findings were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and accidents.
• Patients said they were treated with compassion, dignity and respect. Information was provided to help patients understand the care available to them.
• The practice worked with other organisations and with the local community in planning how services were provided to ensure that they met people’s needs.
• The practice implemented suggestions for improvement and made changes to the way it delivered services as a consequence of feedback from patients.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Information about how to complain was available and easy to understand.

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

The provider should:

• Ensure all clinical staff have a clear understanding of Gillick competencies.
• Formalise the practice vision and share with staff, and develop a strategy to deliver it.
• Develop a comprehensive business continuity plan to ensure continuity of care in the event of a major disruption to the service.
• Develop action plans to improve the practice’s performance in the management of diabetes and childhood immunisations.
• Review cervical screening programme to identify and address barriers to uptake amongst the local community.
• Provide access to an automated external defibrillator (used to attempt to restart a person’s heart in cardiac emergencies) as recommended by the UK resuscitation council guidelines or carry out a risk assessment.
• Establish a patient participation group (PPG) to engage with patients and involve them in the running of the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

During our visit to the practice we provided people with comment cards to tell us about their experience of the service, and we received five of these completed by people. People told us they received a good service, that staff were helpful and they were treated with respect. Some comments received were “excellent in all respects”, “staff are caring and everyone is polite”. We looked at the feedback forms that the practice asked people to complete, as well as the log of complaints received. We also looked at feedback people had put onto the NHS Choices website. This information helped us to gain an overview of people’s experiences of the service.

We spoke with the lead GP and one other GP, a GP registrar, the practice manager, the healthcare assistant and administrative staff. We also spoke with a pharmacist from the Clinical Commissioning Group who carried out work at the service each week.

The staff demonstrated a clear understanding of safeguarding issues and the steps they needed to take when they suspected a child or adult might be at risk of abuse.

The staff received training and support for their work with people and enhancing their professional development.