Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Rajpreet Millan, also known as Whitwell Surgery on 28 September 2016. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months. The full comprehensive report on the September 2016 inspection can be found by selecting the ‘all reports’ link for Dr Rajpreet Millan on our website at www.cqc.org.uk.

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 29 June 2017. Overall the practice is now 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 in place for reporting and recording significant events. The practice carried out a thorough analysis of the significant events and completed an action log that was discussed at staff meetings.
• A log of near misses and errors in the dispensary was kept and discussed at practice meetings.
• Standard procedures were in place, which covered all aspects of the dispensing process. There was a record kept that had been reviewed and dispensary staff had read them.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Clinical audits demonstrated quality improvement. There had been three clinical audits undertaken since the previous inspection. All of these were completed audits where the improvements made were implemented and monitored.
• Essential mandatory training had been identified and staff had access to appropriate training resources. This included infection control, basic life support, fire safety, safeguarding and information governance.
• 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.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The principal GP in the practice demonstrated they had taken steps to develop the experience, capacity and capability to run the practice and ensure high quality care.
• The practice proactively sought feedback from staff and patients, which it acted on. They had formulated a patient participation group (PPG) and completed their own patient survey.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider should make improvement are:

• Share the minutes of multi-disciplinary team meetings with other health care professionals.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an unannounced focused inspection of Dr Rajpreet Millan also known as Whitwell Surgery on 15 February 2017. This inspection was undertaken to follow up on warning notices we issued to the provider and the registered manager in relation to Regulation 12 Safe Care and Treatment and Regulation 17 Good Governance.

The practice received an overall rating of inadequate at our inspection on 28 September 2016 and this will remain unchanged until we undertake a further full comprehensive inspection within six months of the publication date of the initial report.

The full comprehensive report from the September 2016 inspection can be found by selecting the ‘all reports’ link for Dr Rajpreet Millan on our website at www.cqc.org.uk.

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

• The practice had complied with the warning notices we issued and had taken the action needed to comply with the legal requirements.
• There was evidence that the principle GP and the practice manager had provided leadership in responding to the actions required following the issue of the warning notices to ensure compliance with the regulations.
• Systems and processes had been put in place to keep patients safe that included control of substances hazardous to health and legionella.
• Systems and processes in the dispensary had been improved to comply with best practice and legal requirements.
• Essential staff training had been completed.
• Processes had been implemented to ensure the management of safety alerts received and patients receiving high risk medicines.

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 Rajpreet Millan, also known as Whitwell Surgery on 28 September 2016. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months. The full comprehensive report on the September 2016 inspection can be found by selecting the ‘all reports’ link for Dr Rajpreet Millan on our website at www.cqc.org.uk.

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 29 June 2017. Overall the practice is now 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 in place for reporting and recording significant events. The practice carried out a thorough analysis of the significant events and completed an action log that was discussed at staff meetings.
• A log of near misses and errors in the dispensary was kept and discussed at practice meetings.
• Standard procedures were in place, which covered all aspects of the dispensing process. There was a record kept that had been reviewed and dispensary staff had read them.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Clinical audits demonstrated quality improvement. There had been three clinical audits undertaken since the previous inspection. All of these were completed audits where the improvements made were implemented and monitored.
• Essential mandatory training had been identified and staff had access to appropriate training resources. This included infection control, basic life support, fire safety, safeguarding and information governance.
• 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.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The principal GP in the practice demonstrated they had taken steps to develop the experience, capacity and capability to run the practice and ensure high quality care.
• The practice proactively sought feedback from staff and patients, which it acted on. They had formulated a patient participation group (PPG) and completed their own patient survey.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider should make improvement are:

• Share the minutes of multi-disciplinary team meetings with other health care professionals.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

During our inspection we spoke with four patients and communicated with two by email, five members of staff and a community nurse.

When patients received care or treatment they were asked for their consent and their wishes were listened to. One patient told us: "Normally I accept the recommended treatment". We found that when minor surgery had been carried out that written consent had been requested from patients before the surgery had commenced.

We saw that patients' views and experiences were taken into account in the way the service was provided and that they were treated with dignity and respect. The patients we spoke with provided positive feedback about their care. A patient told us: "It's good, I never have a problem".

Patients received their medicines when they needed them and their medicines were regularly reviewed by the doctor. The surgery included a dispensary for medicines to reduce travel time for patients.

Staff had received training in safeguarding children and vulnerable adults. They were aware of the appropriate agencies to refer safeguarding concerns to that ensured patients were protected from harm.

The provider had an established system in place for monitoring the quality of service provision. There was an established system to regularly obtain opinions from patients about the standards of the services they received. This meant that on-going improvements could be made by the practice staff.