We previously carried out an announced comprehensive inspection at Dr SM Bhate and Dr H El-Shakankery on 12 December 2016. Overall the practice was rated as good. However the domain of well-led was rated as requires improvement.

We carried out a focused inspection at the practice on 7 February 2018. We rated the practice as good overall, however the domain of well-led remained requires improvement, as although the practice had implemented an action plan to address the issues identified during the previous inspection, not all of the required improvements had been made.

We carried out an announced comprehensive inspection at the practice on 11 December 2018 to ensure the practice had implemented changes to address the issues raised in our previous inspection. We saw at this inspection that improvements had been made.

We have rated this practice as good overall and good for all population groups.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• The practice had improved the way they recorded and managed significant events.
• Patients received effective care and treatment that met their needs.
• 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.
• The practice had improved the way they handled complaints. The policy was in line with national guidance and patients were made aware of the next steps they could take if they were unhappy with the outcome of a complaint.
• The way the practice was led and managed promoted the delivery of high-quality, person-centred care.

Whilst we found no breaches of regulations, the provider should:

• Carry out an appraisal for the practice manager and continue with their programme of appraisals for staff.
• Ensure that all staff, including GPs, have completed the mandatory training on matters such as health and fire safety.
• Provide basic training such as health and fire safety for all GPs.
• Continue to promote and recruit members for the practice patient participation group.

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

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 SM Bhate and Dr H El-Shakankery on 12 December 2016. The overall rating for the practice was good, although the practice was rated as requires improvement for providing well-led services. We issued a requirement notice with respect to Regulation 17 on Good Governance because we found that processes were not in place to assess, monitor and improve the quality of service provided in carrying out the regulated activities for which the practice is registered. The full comprehensive report for the December 2016 inspection can be found by selecting the ‘all reports’ link for Dr SM Bhate and Dr H El-Shakankery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 7 February 2018 to review in detail the actions taken by the practice to improve the quality of care. This report covers our findings in relation to those requirements and additional improvements made since our last inspection.

The practice is rated as requires improvement for providing well-led services, and overall the practice is rated as good.

Our key findings at this inspection were as follows:

• Although the practice had implemented an action plan to address the issues identified during the previous inspection not all of the required improvements had been made.
• The practice identified low numbers of internal significant events and the practice may not have always recognised events that had occurred that should be recorded and managed as significant events. This limited potential learning for the practice.
• The practice approach to the management of complaints had not improved. The practice did not record or manage verbal complaints and they failed to unsure patients were aware of the next steps they could take if they were unhappy with the outcome of a complaint.

At our previous inspection on 12 December 2016, we also told the provider that they should make improvements so that they followed their own policies and procedures when they recruited staff. In addition, we told the provider they should undertake regular checks to ensure that clinical staff were appropriately registered with the relevant clinical body. We saw at this inspection that improvements had been made:

• The practice had a process in place to ensure relevant recruitment checks were carried out and recorded. Records we checked confirmed that improvements had been made.
• The practice now had a process in place to undertake regular checks to ensure that clinical staff were appropriately registered. Records we checked confirmed this.

At this inspection, we found that there were some areas of practice where the provider still needed to make improvements. We also found that the practice’s registration with CQC was not up to date.

Importantly the provider must:

• Ensure there is an effective system for identifying, receiving, recording, handling and responding to complaints by patients and other persons in relation to the carrying on of the regulated activity. For details, please refer to the requirement notice at the end of the report.

The areas where the provider should make improvements are:

• Complete the process for the registration of the partnership with the Care Quality Commission.
• Take steps to establish effective systems and processes of good governance in accordance with the fundamental standards of care in relation to the governance and management of significant events.

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 SM Bhate and Dr H El-Shakankery on 21 January 2016, when we rated the practice as requiring improvement overall. The full comprehensive report on the January 2016 inspection can be found by selecting the ‘all reports’ link for Dr SM Bhate and Dr H El-Shakankery on our website at www.cqc.org.uk.

We undertook this comprehensive inspection on 12 December 2016 to check the practice had improved since the previous inspections, they had followed their plan to improve, and to confirm that they now met legal requirements. Overall, the practice is now rated as good.

Our key findings were as follows:

• The practice had made improvements in some areas, but we identified continuing concerns relating to the effectiveness of governance arrangements within the practice. The practice did not demonstrate an open and proactive approach to learning and improving. Although the practice made improvements, these were reactive and focused on individual concerns, rather than looking at the wider context for improvement of the practice overall.
• There was a system in place for reporting and recording significant events; however this was not always effective in supporting the practice to learn and improve.
• 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.
• There were mixed views on patient satisfaction in terms being 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 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.
• When there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal apology and were told about any actions to improve processes to prevent the same thing happening again. However, the practice did not complete this process by confirming this in writing.
• There was an overarching governance framework, however, this lacked some arrangements to monitor and improve quality and identify risk. For example, staff remained unsure of what constituted a significant event and had therefore identified very few.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Ensure systems and processes operate effectively to ensure the practice can assess, monitor and improve the quality and safety of the service provided, including making good use of the significant events and complaints to gain insight into areas for improvement.

In addition the provider should:

• Check they are following their own policies and procedures if and when they need to recruit staff.
• Undertake regular checks that clinical staff are appropriately registered with the relevant professional organisations, such as the Nursing and Midwifery Council (NMC).

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 SM Bhate and Dr H El-Shakankery on 21 January 2016. Overall the practice is rated as requires improvement.

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

• There was an effective system in place for reporting and recording significant events, and these were investigated thoroughly. However, some staff told us they were unsure about what needed to be reported.
• Risks to patients were assessed and well managed, with the exception of those relating to recruitment checks.
• The majority of patients said they were treated with compassion, dignity and respect. However, not all felt cared for, supported and listened to.
• Information about how to complain was limited.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• 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.
• There was a clear leadership structure and staff felt supported by management.
• The provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider must make improvements are:

• Ensure recruitment arrangements include all necessary employment checks for all staff, including locum doctors. This includes keeping records of the immunity status of clinical staff.
• Ensure detailed information and guidance about how to complain is available and accessible to everyone who uses the service.
• Strengthen governance arrangements to ensure that services meet the needs of the patient population. This includes putting systems in place to evidence that staff have read safety alerts which are received by the practice.

In addition the provider should:

• Implement a system to ensure that the professional registration and medical indemnity cover of clinical staff is checked at regular intervals.
• Keep copies of the business continuity plan off the practice premises, so it can be accessed by staff in the event of an emergency preventing access to the practice.
• Consider a formal risk assessment to document the reasons for stocking four emergency medications and not keeping these together in an emergency medications bag.
• Audit minor surgery at the practice to monitor infection rates and to monitor the quality of tissue samples sent for further investigation when disease is suspected.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We spent time observing how the practice worked and speaking to patients, staff and stakeholders. Patients told us they felt their needs were met by the practice and we saw positive exchanges between patients and staff. One person said, "Our whole family have been here for years, they know us well." Another said their “Views were listened to". Patients we spoke with told us they sometimes had to wait for a routine appointment but that emergency slots meant they could see a doctor easily if they needed to. One told us the reception staff were "Really good."

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We saw the general practitioners were following national guidance as well as local Clinical Commissioning Group guidelines to make sure they were following best practice.

We saw the practice was up to date with infection control policies and procedures and when we spoke with staff they had a clear understanding how to reduce the risk of cross infection. The surgery was clean and well maintained.

Staff were provided with support, guidance and training to make sure they were able to carry out their role safely and their performance was monitored to maintain the standards. The training programme was being reviewed at the time of our visit and the practice manager shared information after the visit about the training arranged in November to make sure the staff had updates to their mandatory training.