Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection of Dr Sunil Mayor's practice at Bath Road Surgery on 8 January 2016. At that inspection we found the practice was meeting all legal requirements but we rated the practice as 'requires improvement' overall and for the key questions of whether the practice was caring and well-led. Specifically:

• We found that practice should improve aspects of the patient experience. In particular, the practice should enable patients to have reasonable access to their preferred GP. 
• At the time of the last inspection, the practice had made significant changes to its systems and processes and had recently recruited several members of staff. We found that the practice needed more time to be able to demonstrate that new policy and practice was fully embedded and to ensure that improvements to the service were sustained.

The previous inspection reports for this practice can be found by selecting the ‘all reports’ link for Dr Sunil Mayor on our website at www.cqc.org.uk.

We undertook this focused inspection to assess whether the practice was acting on these areas and had effective systems of self governance. The inspection included a visit to the practice on 24 November 2016. This report covers our findings from this focused inspection.

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

• The practice was providing a caring service. The practice recognised the value of providing continuity of care and were increasingly enabling patients to see their preferred GP.
• The practice had visible leadership, a strategic approach to improvement and effective systems of governance.  The practice staff worked well together as a team and with other health and social services professionals and bodies.
• The practice demonstrated sustained and continued improvements in its performance since our previous inspection, for example in relation to the management of long term mental health and diabetic control.

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 of Dr Sunil Mayor on 8 January

2016. Overall the practice is rated as requires improvement.

We found that improvements had been made since the previous inspection of January and February 2015 when the practice was rated as inadequate and placed into ‘special measures’. The practice was meeting the regulations which it had previously breached.

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

• The GP principal, practice manager and the staff had worked hard to undertake a complete review of the service, make many improvements and creating an open team culture.
• There was a positive, 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.
• There was mixed patient feedback about the practice. The national GP patient survey results tended to score below average for questions asking about care and concern. The feedback we received from patients was wholly positive.
• 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. Urgent appointments were available the same day.
• The practice had taken steps to improve continuity of care for patients.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice was developing its leadership structure and staff felt supported by management through this process. The practice proactively sought feedback from staff and patients, which it acted on.
• On being placed in special measures the practice had sought external advice and support and had engaged positively to improve its service.

The areas where the provider should make improvements are:

• Work on fully embedding new policy and practice and the shift to collaborative team working to ensure improvement is sustained.
• Demonstrate how the practice is supporting patients with serious mental illness, for example through coordinated care planning.
• Provide more information about accessible mental health support services in Hounslow in the waiting area.
• Improve patient experience in particular that patients report having reasonable access to their preferred GP and improved involvement in decisions about their care.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

The Care Quality Commission received concerns about the practice from an anonymous source. The concerns alleged that the practice was prescribing morphine, a controlled drug, "illegally" and also alleged that the practice recruited staff with no right to work in the UK.

We conducted an inspection to check that the practice was complying with relevant standards and legislation. We found that the practice was managing medicines appropriately. The practice did not have any controlled drugs on the premises and there were no concerns about prescribing patterns or the way in which the practice stored vaccines and medicines.

The practice had recruitment processes in place and checked that new members of staff had the right to work in the UK. However we found that the practice did not always check new staff members' references. The practice obtained Disclosure and Barring Service checks for all clinical staff members but it had not done so for administrative staff who occasionally acted as chaperones.

During the course of the inspection we reviewed the practice's systems for identifying risk and monitoring the quality of the service. We found that although the practice had a system for reviewing significant events, this did not result in effective action to prevent reoccurrence. The practice quality assurance systems also did not prompt staff to ensure that appropriate follow up action was taken, for example, by referring concerns to other statutory agencies.

We reviewed the information available to us about Dr Sunil Mayor on 3 May 2019. We did not find evidence of significant changes to the quality of service being provided since the last inspection. As a result, we decided not to inspect the surgery at this time. We will continue to monitor this information about this service throughout the year and may inspect the surgery when we see evidence of potential changes.