Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Sumedha Tillu on 30 November 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for Dr Sumedha Tillu on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 08 November 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the improvements we had identified in our previous inspection on 30 November 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice continues to be rated as requires improvement.

• During our previous inspection on 30 November 2016 we found that staff assessed patients’ needs and delivered care in line with current evidence based guidance. Information received with regards to the delivery of effective care prompted us to re look at this key question. Random sampling of patient records demonstrated that patients care needs were being effectively managed.

• The practice had developed a comprehensive action plan in place to improve all areas of the GP patient survey published in July 2016. The practice was able to demonstrate improvements in most areas of the survey published in July 2017. However, the results were still significantly below both CCG and national averages.

• During our previous inspection in November 2016 responses to the national patient survey results (July 2016) regarding access were generally lower than both the local and national averages. The practice was now taking part in hub working arrangements to offer seven day access to appointments. The latest survey results showed that the practice had made improvements in almost all aspects. However, the practice achievement still remained below local CCG and national averages.

The areas where the provider should make improvements are:

• Continue to explore ways to improve patient satisfaction and health screening.

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 The Hawthorns Medical Centre on 30th November 2016. Overall the practice is rated as requires improvement.

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.
• The practice was lower than average for its satisfaction scores on consultations with GPs and nurses
• A carers champion monitored the health and wellbeing of patients in relation to their caring responsibilities when they attended for a consultation or health check. They were directed to the various avenues of support available to them including an Asian Carers service.
• Information about the services provided 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 told us 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.

However there were areas of practice where the provider should make improvements:

• Continue to encourage patients to attend national cancer screening programmes and review the actions taken to monitor impact.

• The practice should continue to monitor patient satisfaction in order to identify areas for further improvement and monitor progress against the action plan. 

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

During our inspection we spoke with 10 patients and five members of staff.

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. A patient said: "The doctor explained things. I am satisfied. Staff are co-operative, never any concerns".

The patients we spoke with provided positive feedback about their care. A patient told us: "Whenever I have a problem they sort it out. It's good". Patients who received regular medicines told us they were regularly reviewed to check that they still needed them.

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

The premises were clean, tidy and well organised. There were effective systems in place to prevent patients from acquiring infections during their visits to the practice.

The provider had systems in place for monitoring the quality of service provision. There was an established system to regularly obtain opinions from patients about the standards of the services they received. This meant that on-going improvements could be made by the practice staff.

We carried out an announced comprehensive inspection at Dr Tillu’s practice, also known as The Hawthorns Medical Practice over two days on 4 and 18 December 2018 as part of our inspection programme. The practice was rated as requires improvement for the caring and responsive key questions and requires improvement overall at the previous inspection in November 2017. You can read the report from our last focused inspection on 8 November 2017; by selecting the ‘all reports’ link for Dr Sumedha Tillu on our website at www.cqc.org.uk.

This report covers our findings in relation to improvements made since our last inspection and any additional improvements we found at this inspection. The report covers our findings in relation to all five key questions and six population groups.

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 now rated the caring and responsive key questions as good as the practice had made improvements in these areas. This means that this practice is now rated 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 been working with cancer screening co-ordinators to improve the uptake of patients attending screening appointments and evidence provided showed an increase in all national screening targets.
• The practice achievement in the national patient survey published in August 2018 continued to be low regarding access in comparison to the national averages. The practice however had taken steps to improve this, they were also part of a hub where patients could access appointments outside of surgery hours and at weekends.
• Due to the poor uptake of the national patient survey where 2% of the practice population had completed a survey, the practice had conducted an inhouse survey to gather patient feedback and an action plan had been implemented to improve patient satisfaction.
• The practice organised and delivered services to meet patients’ needs. Regular reviews were completed of the effectiveness and appropriateness of the care it provided.
• The practice had a comprehensive programme of quality improvement activity which demonstrated quality improvements. Clinical leads routinely reviewed the effectiveness and appropriateness of the care provided and implemented action plans to improve any identified areas.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The way the practice was led and managed promoted the delivery of high-quality, person centred care.

The areas where the provider should make improvements are:

• Review the current emergency equipment to take action in the diagnosis of Sepsis in children.
• Continue to gather feedback to monitor services and improve patient satisfaction.

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