Letter from the Chief Inspector of General Practice

We undertook an announced focussed inspection of Dr R Chibber's Practice on 06 September 2016. We found the practice to be good for providing safe services and it is rated as good overall.

We had previously conducted an announced comprehensive inspection of the practice on 15 January 2016. As a result of our findings during that visit, the practice was rated as good for being effective, caring, responsive and well-led, and requires improvement for being safe, which resulted in a rating of good overall. We found that the provider had breached three regulations of the Health and Social Care Act 2008: Regulation 19(2)(a) fit and proper persons employed; Regulation 12(2)(h) Safe care and treatment, and Regulation 9(3(b) person-centred care. You can read the report from our last comprehensive inspection at www.cqc.org.uk/location/1-538798433. The practice wrote to us to tell us what they would do to make improvements and meet the legal requirements.

We undertook this focussed inspection on 06 September 2016 to check that the practice had followed their plan, and to confirm that they had met the legal requirements. This report only covers our findings in relation to those areas where requirements had not been met previously.

Our key findings on 06 September 2016 were as follows:

• All staff who undertook chaperone duties had been trained and received a Disclosure and Barring Service (DBS) check.

• All staff had undertaken infection control training and an infection control audit of the practice had been completed.

• There was a legionella risk assessment in place.

• A defibrillator and medical oxygen were available at the practice.

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 R Chibber’s Practice on 15 January 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and a system was in place for reporting, recording and learning from significant events. The provider did not have policy and procedures in place to guide staff in the handling of notifiable safety incidents in accordance with the Duty of Candour, however.

• Risks to patients were assessed and well managed, with the exception of those relating to some recruitment checks, aspects of infection control, and equipment to deal with medical emergencies.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff demonstrated they had the skills, knowledge and experience to deliver effective care, however not all staff had had an annual appraisal in the 12 months prior to the inspection to review their performance and discuss areas for improvement and development, and their appraisal was overdue.
• Results from the national GP survey published in July 2015 were in line with CCG and national averages for the most part. One of the GPs was reducing their clinical hours and this had resulted in a few results that were below the CCG and national averages about the caring and responsive nature of the service. Improvements had been made to the telephone and appointment system and patient feedback we received as part of this inspection was very positive about these aspects of the service.
• Urgent appointments were available on the day they were requested.
• Information about services and how to complain was available and easy to understand.
• The practice was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• The practice had an active patient participation group.

The areas where the provider must make improvements are:

• Ensure DBS checks are completed on all staff acting as chaperones.

• Ensure an infection prevention and control audit is carried out annually and that all staff receive infection prevention and control training relevant to their role.

• Ensure a legionella risk assessment is completed for the practice premises.

• Ensure oxygen and an automated external defibrillator (AED) is available to meet the needs of patients in medical emergencies.

In addition the provider should:

• Put in place policy and procedures to guide staff in the handling of notifiable safety incidents in accordance with the Duty of Candour.
• Consider the level of child safeguarding training required for the practice safeguarding lead, and the need for safeguarding adults training for all staff.

• Put in place a written business continuity plan to ensure clear instruction and guidance is available to all staff.

• Put systems in place so that staff receive timely annual appraisals.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

People who used the service understood the care and treatment choices available to them. Staff told us that when people arrived at the surgery they were spoken to at the front counter but if they needed to discuss something in private they could do this in an area next to the door of the surgery reception or in a consulting room if one was empty. People we spoke with told us that the GP or nurse would take the time to listen to them and respond to what they told them. One person said, “ they listen to me and tell me what my options are”.

People we spoke with were positive about the surgery. One person told us, “the staff are much better than they used to be, they are much more caring and responsive to my needs”. Another person said, “I have trust in this practice, my whole family come here”. People told us they do not have to wait long to speak to the receptionist when calling the surgery and that they were able to get a routine appointment within a week. Emergency appointments were available on the day.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. People told us that they felt safe at the surgery and felt comfortable with reporting any concerns they had to staff.

There were effective recruitment and selection processes in place. We examined three staff records and found that there were written records of references being checked. We found evidence that the practice had checked the professional registrations of the GPs and practice nurse against the professional registers and the performers list.

People who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. The Patient Participation Group (PPG) members told us that the people they spoke with were positive about the surgery, one member told us, “ people like the personal touch and the doctor knows their history”. The PPG members told us that they felt the surgery was willing to listen to patient’s issues and respond to them.