Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Roshan Khuroo (also known as Stockland Green Practice) on 19 January 2017. The overall rating for the practice was requires improvement. Data taken from the July 2016 national GP patient survey showed areas where patient satisfaction was below local and national averages and the overarching governance arrangements did not support effective management of risks. The full comprehensive report on the January 2017 inspection can be found by selecting the ‘all reports’ link for Dr Roshan Khuroo on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 10 October 2017 to confirm that the practice had carried out their plan to improve in areas we identified in our previous inspection on 19 January 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is rated as good.

Our key findings were as follows:

• Data from the 2016/17 Quality and Outcomes Framework showed the practice was an outlier for some QOF clinical domains; however, data showed areas of improvement since our previous inspection. Staff were aware of the practice performance and were taking action to improve patient engagement.
• Since our previous inspection, the practice had reviewed their systems to improve the uptake of national screening programs and had used various methods such as attending local community events and accommodated additional clinics to increase uptake.
• The 2016/17 Child Health Information data provided by the practice showed improvement in the uptake of childhood immunisations. For example, vaccinations given to under two year olds ranged from 82% to 95%.

• Although, results from the July 2017 national GP patient survey showed patients’ satisfaction remained below local and national averages; patients’ satisfaction had slightly improved in some areas. For example, satisfaction with accessing the service by phone had improved and comments from patients we spoke with were positive about phone access.

• Since our previous inspection, the practice had carried out their own patient survey, which showed patients were satisfied with some of the services provided. For example, patients were positive about phone access and experience of making an appointment. However, patients we spoke with during our inspection had mixed views regarding levels of satisfaction. In particular, patients were not always satisfied with consultations.

• The practice was aware of areas of low patient satisfaction; an action plan was in place and staff continued working to improve areas where satisfaction was below local and national averages.
• To address concerns relating to staffing levels and appointment availability the practice recruited additional staff and implemented a new rota system.

The provider should make improvements in the following areas:

• Continue to monitor and ensure on-going improvement to patient satisfaction, such as responses to clinical and non-clinical aspects of survey outcomes.

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 Roshan Khuroo’s practice in Erdington, Birmingham on 19 January 2017. Overall the practice is rated as requires improvement.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. The practice had identified, recorded and analysed significant events in order to identify areas of learning and improvement and so mitigate the risk of further occurrence.
• Arrangements were in place to safeguard children and vulnerable adults from abuse, and local requirements and policies were accessible to all staff.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients we spoke with said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment, however results from the GP survey were lower for several aspects of care in comparison to local and national averages.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it difficult to make an appointment and access the service via the telephone and the GP national patient survey reflected these comments.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• Clinical audits were carried out to demonstrate quality improvement and to improve patient care and treatment.
• The practice worked closely with other organisations in planning how services were provided to ensure that they meet patients’ needs.
• Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs. Staff spoke positively about the team and about working at the practice
• 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 provider was aware of the requirements of the duty of candour.

There were areas of practice where the provider should make improvements:

• Encourage patients with learning disabilities to attend annual reviews.
• Encourage patients to attend national screening programmes and review current processes to promote the benefits of regular reviews.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

On the day of our announced inspection we spoke with one patient and three members of staff. Later we spoke with four more patients by telephone two of which were also members of the Patient Participation Group (PPG). The role of the PPG is to act as an advocate on behalf of patients' and to assist with patient surveys concerning the overall quality of the service provision.

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. When patients received care or treatment they were asked for their consent and their wishes were listened to. One patient told us: "The doctor tells me all about it and I agree". Another patient said: "I go to see Doctor X. They are very nice, one of the best doctors because they have time for you and listens".

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

The premises were modern and had been purpose built. The layout of the premises protected patient's privacy and safety.

We saw that medicines were stored safely but there were no systems in place to monitor medicines stock control. The practice had an effective system to regularly assess and monitor the quality of the rest of the service that patients received.