Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Rashmi Jain on 7 July 2016. Overall the practice is rated as requires improvement. Our key findings across all the areas we inspected were as follows:

• The system for recording significant events and the actions taken in response to events was not sufficiently robust.

• Medicines and equipment was in place to deal with medical emergencies, however, not all staff had been trained in basic life support.

• There were systems in place to reduce risks to patient safety but not all of these were sufficiently robust. For example some staff acted as chaperones without having undergone the appropriate checks for this and some health and safety related assessments and risk management plans had not been carried out.

• Infection control practices were good and there were regular checks on compliance with infection control measures.

• Clinical staff assessed patients’ needs and delivered care in line with current evidence based guidance.

• Feedback from patients about the care and treatment they received from clinicians and staff in all other roles was very positive. Patients said they were treated with dignity and respect and they were involved in decisions about their care and treatment.

• Data showed that outcomes for patients at this practice were similar to outcomes for patients locally and nationally.

• Staff told us they felt well supported to meet the roles and responsibilities of their work. However, not all staff had been provided with basic mandatory training such as safeguarding and fire safety.

• The appointments system was sufficiently flexible to accommodate urgent appointments, same day appointments and pre-booked appointments. Patients said they found it easy to make an appointment and there was good continuity of care.

• The practice provided ground floor facilities and access for disabled people. However, the practice did not provide additional facilities for disabled people such as a hearing loop system.

• Complaints had been investigated and responded to in a timely manner. However, appropriately detailed information about how to complain was not made readily available to patients.

• The practice provided a range of enhanced services to meet the needs of the local population.

• The practice sought patient views about improvements that could be made to the service. This included the practice having and consulting with a patient participation group (PPG).

Areas where the provider must make improvements:

• Implement an effective and formalised system to capture and respond to significant events and to share the learning from these.

• Implement an effective complaints procedure that provides patients with appropriate and accurate information about how to complain, how they can expect their complaints to be handled and what they can do if theyre not happy with the outcome of their complaint.

• Carry out risk assessments and produce management plans for health and safety related areas of work.

• Ensure appropriate policies and protocols are in place for the safe storage of vaccines.

• Ensure the required recruitment checks are carried out for staff in line with their roles and responsibilities.

• Ensure staff are provided with the required training for roles and responsibilities.

• Ensure all patient records are stored securely in line with the Data Protection Act.

Areas where the provider should make improvements:

• Review the provision made for people who require reasonable adjustments such as facilities for patients who are disabled.

• Carry out full cycle clinical audits to monitor the clinical care provided and improve outcomes for patients.

• Improve the system for ensuring safety alerts are formally shared and acted upon.

• Implement a system to log and track prescriptions allocated.

• Formalise the arrangements for staff meetings and document the outcome of meetings.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This was a follow up to our inspection of December 2013 to check improvements required had been made. At our last inspection we found the complaints policy of the practice was not followed and that it was not fully accessible to patients who used the surgery. We had also found background checks the practice was required to conduct on staff applying to work at the practice, were not applied consistently. The owner of the surgery, Dr Rashmi Jain was required to make improvements in these areas.

At the time of this inspection, there were no patients waiting to be seen by the doctor, so we were unable to ask them for their views on the service. We found that the waiting and reception areas were well laid out, clean and tidy. When we walked through the administrative support area, we saw this was well ordered and that there were sufficient staff available to answer phones and respond to people arriving in the reception area. In the waiting area, we saw that information was available on clinics run by the surgery and the times of these, for example, the diabetes clinics. We further noted that an information leaflet on the practice, was freely available in the reception area. This contained details of how to make a complaint and how to request a copy of the complaint procedure.

When we reviewed staff files we found they were uniform in their layout which made them easy to follow and check. We found that staff had undergone the necessary background checks and copies of documents that support this were held in their staff files.

During this inspection we visited the Stretton Medical Centre. We spoke with the registered manager / GP, practice manager, reception staff and a sample of patients on the day of our visit.

Patients spoken with were positive about the practice and commented that they were happy with the care they received. Comments received from patients included: "Absolutely love it"; "Brilliant doctors"; "Good with children" and "I feel involved in my care".

The practice provided patients' with a range of health care information leaflets and information on the practice.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Rashmi Jain, also known as Stretton Medical Centre on 7 July 2016. The overall rating for the practice was ‘requires improvement’. The full comprehensive report on the July 2016 inspection can be found by selecting the ‘all reports’ link for Dr Rashmi Jain on our website at www.cqc.org.uk.

At our previous inspection in July 2016 we rated the practice as ‘requires improvement’ for four of the five key questions we inspect against. The service required improvement for providing safe, effective, responsive and well-led services. The practice was therefore rated as ‘requires improvement’ overall. We issued four requirement notices to the provider relating to: the governance arrangements, staff recruitment, staff training and the management of complaints.

This inspection visit was carried out on 17 October 2017 to check that the provider had met their plan to meet the legal requirements. Overall the practice is now rated as good. Our key findings across all the areas we inspected were as follows:

• The system for recording significant events and the actions taken in response to events had been improved.

• Medicines and equipment was in place to deal with medical emergencies and staff had been provided with training in basic life support.

• Improvements had been made to reduce risks to patient safety. For example some staff who acted as chaperones had undergone the appropriate checks for this and health and safety related assessments and risk management plans had been carried out. A sufficiently detailed fire risk assessment had not been carried out but this was addressed immediately following the inspection visit.

• Infection control practices were good and there were regular checks on compliance with infection control measures.

• Clinical staff assessed patients’ needs and delivered care in line with current evidence based guidance.

• The practice used performance indicators to measure their performance. Data showed that the practice achieved results comparable to other practices locally and nationally for outcomes for patients.

• Feedback from patients about the care and treatment they received from clinicians and staff in all other roles was positive. Patients said they were treated with dignity and respect and they were involved in decisions about their care and treatment.

• Staff told us they felt well supported to meet the roles and responsibilities of their work.

• The appointments system was sufficiently flexible to accommodate urgent appointments, same day appointments and pre-booked appointments. Patients told us they found it easy to make an appointment and there was good continuity of care.

• Complaints had been investigated and responded to in a timely manner.

• A range of enhanced services were provided to meet the needs of the local population.

• The practice sought patient views about improvements that could be made to the service. This included the practice having and consulting with a patient participation group (PPG).

Areas where the provider should make improvements:

• The arrangements for repeat prescribing for patients taking high risk medications should be kept under review.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice