We did not review the ratings awarded to this practice at this inspection.

We carried out an announced comprehensive follow up inspection of Dr Sangeeta Rathor on 03 December 2018. We rated the practice as requires improvement for safe, effective responsive and caring; inadequate for well led. In line with our enforcement procedures we issued a warning notice in relation to regulation 12: Safe care and treatment and regulation 17: Good Governance of the Health and Social Care Act 2008.The full comprehensive report on the 03 December 2018 inspection can be found by selecting the ‘all reports’ link for Dr Sangeeta Rathor on our website at https://www.cqc.org.uk/location/1-511237925

This inspection was an announced focused inspection carried out on 07 March 2019 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulation that we identified in our previous inspection on 03 December 2018.

This report covers our findings in relation to those requirements made since our last inspection.

At this inspection we found that actions had been taken to improve the provision safe and well-led services in relation to the warning notices.

Specifically:

•The practice had developed systems and processes to keep patients safe.

•Governance systems had been improved to ensure the leaders had capacity to provide clinical oversight and leadership.

The comprehensive report of the 03 December 2018 inspection which was published on 26 February 2019 should be read in conjunction with this report.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced comprehensive inspection at Dr Sangeeta Rathor on 7 June 2016. The overall rating at that time for the practice was good.

This inspection was an announced comprehensive inspection carried out on 3 December 2018. The inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014 as part of our inspection programme. This inspection identified breaches of regulation.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as requires improvement overall.

We rated the practice as requires improvement for providing safe services because:

• The practice did not have clear systems and processes to keep patients safe.
• We found areas of concern related to, safeguarding procedures, a lack of safe management of medicines and lack of monitoring to ensure clinical staff were working within their remit.

We rated the practice as requires improvement for providing effective services because:

• Staff had not all received an annual appraisal in a timely manner.
• The practice could not evidence how they ensured some clinical staff were up to date with current guidance and were provided with appropriate supervision.

We rated the practice as requires improvement for providing caring services because:

• Staff dealt with patients with kindness and respect and involved them in decisions about their care. The practice organised and delivered services to meet patients’ needs.
• Patients could access care and treatment in a timely way. However, results from the national GP patient survey showed that patient’s satisfaction with how they could access care and treatment were much lower than local and national averages.

We rated the practice as requires improvement for providing responsive services.

• The practice had good facilities and was well equipped to treat patients and meet their needs.
• However, results from the national GP patient survey showed that patient’s satisfaction with how they could access care and treatment were low in all key questions compared to local and national averages.

We rated the practice as inadequate for providing well-led services because:

• Leaders could not show that they had the capacity and skills to deliver high quality, sustainable care and lacked the capacity to provide clinical oversight and leadership at the practice.
• The overall governance arrangements were inadequate.
• We found that many systems and processes were not established and operated effectively to provide good governance. We saw no evidence of systems and processes for learning, continuous improvement and innovation.
• We found that though the practice had policies these were not followed.

• The practice was unable to demonstrate that they had actively responded to patient feedback and involved patients in the process.

The areas where the provider must make improvements are:

• Ensure that care and treatment is provided in a safe way.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Review and improve the process of identifying carers

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Sangeeta Rathor –Allenby Clinic on 7 June 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 an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• 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 said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• 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 easy to make an appointment with a named GP and 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.
• 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 and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Review the below average QOF scores for patients with diabetes so as to improve.

• Review governance and application of recruitment procedure.

• Review GP National Patient Survey results to improve scores relating to patient access.

• Review the process of identifying carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice