Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Dr Ravinder Kooner on 24 March 2016. The overall rating for the practice was good. However, the practice was rated as requires improvement for providing safe services. This was because the provider did not have a defibrillator available at the practice or an appropriate risk assessment to indicate how they would deal with a medical emergency; there was no practice policy or clear system in relation to safeguarding vulnerable adults and the practice did not have a range of health and safety risk assessments for the premises.

The full comprehensive report can be found by selecting the ‘all reports’ link for Dr Ravinder Kooner on our website at www.cqc.org.uk.

This inspection was an announced focussed inspection carried out on 5 December 2017 to confirm that the practice had met the legal requirements in relation to the breach in regulation 12 that we identified in our previous inspection on 24 March 2016. No action plan was sent following the breach in legal requirements. This report covers our findings in relation to those requirements and also where additional improvements have been made.

Overall the practice is rated as good. However, the practice was still found to be requires improvement for providing safe services.

Our key findings were as follows:

• The practice had access to an automated external defibrillator (AED) for use in medical emergencies.

• The practice had a policy for safeguarding vulnerable adults, but the process for escalating concerns was unclear. Non-clinical staff had received training appropriate to their roles, but three GPs had not undertaken safeguarding adults training to the required level 2.

• The practice had completed a fire risk assessment but actions had not been completed.

• The practice did not have other appropriate risk assessments to keep people safe; including health and safety of the premises, hazardous substances and legionella.

• Quality and Outcomes Framework (QOF) exception reporting rates for patients with mental health and dementia had improved. Results for 2016/17 demonstrated exception reporting was in line with local and national averages.

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 Ravinder Kooner, also known as Cole Park Surgery on 24 March 2016. Overall, the practice is rated as good.

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

• The practice had a number of policies and procedures to govern activity.

• There was an effective system in place for reporting and recording significant events.

• Data showed patient outcomes were average or low compared to the local and national average. Although some audits had been carried out, we saw limited evidence that audits were driving improvement in performance to improve patient outcomes.

• Patients said they were treated with compassion, dignity and respect

• Information about services and how to complain was available and easy to understand.

• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• The practice had sought feedback from patients and had an active patient participation group.

• Staff did understand and fulfil their responsibilities to raise concerns, and to report incidents and near misses.

• Staff did not have training in respect of safeguarding vulnerable adults.

• Risks to patients were not adequately assessed and managed, including those relating to fire safety, health and safety, hazardous substances and legionella.

• The practice did not have a defibrillator and had not assessed the risk of this in the event of a medical emergency.

The areas where the provider must make improvements are:

• Risks assess how to respond to medical emergencies.

The areas where the provider should make improvements are:

• Ensure that appropriate systems and process are established to protect patients from abuse.

• Review the exception-reporting rate for mental health and dementia patients.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

We did not speak to people who used the service during this inspection visit as we were following up on two compliance actions made at the previous inspection visit on the 9th December, 2013.

At our previous inspection we made a compliance action as the surgery did not have a defibrillator or the availability of oxygen.

At our previous inspection we made a compliance action as staff were not receiving formal recorded supervision or appraisals on a regular basis.

We saw that both compliance actions were met at this inspection visit.

During our visit we spoke with four patients that included the patients' representative group. They told us "No complaints about the surgery", "A more pleasurable environment than it used to be" and "The waiting time can be quite long if you want to see your GP about a long term condition, but for everyday ailments it's pretty quick".

Patients' said and we saw that staff treated them with dignity and respect.

They were given the information and time they needed to decide if the treatment recommended was what they wanted and this was the surgery they wished to provide it.

The procedure for consultation and treatment was fully explained including any treatment cost.

Patients' were told about any risks that might arise from the treatment chosen and had received consultations and treatment in private.

They did not tell us about the surgery infection control or quality assurance systems, complaints or medication procedure or number of staff available to meet their treatment needs.

They did tell us and we saw that the surgery was kept clean, tidy, was fit for purpose and patients felt safe using the service.

The arrangements for emergency response required an oxygen cylinder that was not present.

Staff did not receive regular, minuted supervision.

We found that the surgery gave suitable information so that people could make an informed decision if they wished to proceed with the proposed treatment.

We saw records were kept up to date and a suitable complaints procedure was in place that patients' had access to.

There were adequate numbers of suitably qualified staff to meet patients' needs.