We carried out an announced comprehensive inspection at Dr Sunita Bhalchandra Kulkarni on 6 February 2019 as part of our inspection programme.

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 and good for all population groups except patients experiencing poor mental health which we rated as outstanding.

We rated the practice as requires improvement for providing a safe service. This is because:

• Not all staff had received safeguarding training at appropriate levels for their role.
• An effective employee immunisation programme was not in place.
• Fire drills had not been completed within the health centre since 2017 however false fire alarms had occurred and evacuation procedures followed appropriately.
• Regular reviews of a practice nurse’s prescribing had not been completed.
• A system was not in place to prevent the accidental interruption of the electrical supply to the vaccine refrigerator.

We rated the practice as good for effective, caring and responsive. This is because:

• Patients received effective care and treatment that met their needs.
• Staff worked together and with other organisations to deliver effective care and treatment.
• We rated the population group for patients experiencing poor mental health as outstanding for effective because the practice had developed effective tools to support and monitor patients who were suicidal.

• 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.

We rated the practice as requires improvement for well-led. This is because:

• Governance arrangements to ensure staff compliance with training were ineffective.
• Not all of the recommendations made at our previous inspection in November 2014 had been actioned.
• Several policies referred to by staff to support the governance of processes and systems at the practice had not been reviewed since 2014.
• The practice had not submitted a notification to the Care Quality Commission as required under the Care Quality Commission (Registration) Regulations 2009.

The provider must:

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

The provider should:

• Provide protected learning time to support staff to complete their training.
• Carry out regular, planned fire safety drills.
• Update the business continuity plan to include appropriate contact numbers for services or staff.
• Review the Care Quality Commission (Registration) Regulations 2009 to support their understanding of incidents that are notifiable to the Care Quality Commission.

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 inspected Dr. Sunita Bhalchandra Kulkarni practice (also known as Stoke Health Centre) on 17 November 2014. We inspected this surgery as part of our new focused, comprehensive, inspection programme. This practice had not been inspected before. We looked at how well the practice provided services for specific groups of patients. These included; older patients, patients with long-term conditions, families, children and young people, working age patients (including those recently retired and students), patients living in vulnerable circumstances and patients experiencing poor mental health (including people with dementia). The overall rating for this practice was good.

Our key findings were as follows:

• There was a clear management structure to support and guide staff to deliver safe, responsive and effective care to patients.
• There were good governance and risk management measures in place.
• The practice had a clear vision and strategy in place.
• The practice had employed a pharmacist in July 2014 to complete long term conditions medication reviews, helping patients to make the most of medicines and to reduce unplanned admissions to hospital.
• The practice took time to listen to the views of their patients and ran an active Patient Participation Group and any actions identified were implemented and used to improve the service.
• Patients told us they were treated with compassion, dignity and respect and they were involved in care and treatment decisions.

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

The provider should:

• Ensure staff attain the appropriate level of training in safeguarding adults and children according to their role.
• Ensure senior staff are aware of the arrangements in place within their Business Continuity Plan.
• Carry out improvement measures to ensure the suitability of the GP examination room for patients and to enable wheelchair accessibility, in the event that the nurses’ consultation room was fully booked.
• Reduce the probability of accidental interruption of electricity supply to the vaccine fridge, such as installing a switchless socket or clearly labelling the vaccine refrigerator plug with a cautionary notice such as, do not unplug or switch off.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice