Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Varendar Winayak and Partner on 15 September 2016. Overall the practice is rated as good.

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

• The practice had a system in place for reporting and recording significant events; however, not all relevant incidents were recorded as significant events, and therefore opportunities to learn from these incidents were sometimes missed.
• Overall, risks to patients were assessed and well managed; however, the practice had not completed a risk assessment of their buddy arrangement with neighbouring practices, which was in place to ensure clinical cover in the case of an emergency.

• 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; however, the practice had no process for recording verbal complaints.
• 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 the duty of candour and we saw evidence that where incidents were correctly recognised as significant events, the duty of candour was complied with.

The areas where the provider must make improvement are:

• They must review their process for recording and reporting significant events to ensure that all staff are aware of the threshold for recording a significant event and that lessons learned are appropriately shared and embedded.

In addition, they should make improvement in the following areas:

• They should review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is made available to them.
• They should ensure that the details of verbal complaints are recorded.
• They should ensure that they implement quality assurance processes, including audit, to drive improvements in patient outcomes.
• They should review their buddy arrangement with neighbouring practices to ensure that any associated risks are assessed and mitigated.
• They should ensure that all staff know how to use the newly purchased defibrillator.
• They should ensure that their security arrangements for prescription pads are adhered to.
• They should ensure that they regularly review uncollected prescriptions.

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 Varendar Winayak and Partner on 15 September 2016. The practice was rated as good overall. A breach of legal requirements was found relating to the Safe domain. After the comprehensive inspection, the practice submitted an action plan, outlining what they would do to meet the legal requirements in relation to the breach of regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During the comprehensive inspection we found that the practice had failed to ensure that all significant events were fully recorded and that lessons were learned from incidents. We also identified areas where improvements should be made, which included reviewing how they identified patients with caring responsibilities, ensuring that details of verbal complaints were recorded, ensuring that audits were used to drive improvement, reviewing their buddy arrangement with a neighbouring practice to ensure that associated risks are identified and mitigated, ensuring that all staff knew how to use the defibrillator, ensuring that they had adequate security arrangements for the storage of prescription sheets and pads, and ensuring that uncollected prescription were reviewed.

We undertook this focussed desk-based inspection on 16 March 2017 to check that the practice had followed their plan and to confirm that they now met the legal requirements. This report covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Dr Varendar Winayak and Partner on our website at www.cqc.org.uk.

Following the focussed inspection, we found the practice to be good for providing safe services.

Our key findings were as follows:

• The practice had an effective system in place for reporting and recording significant events. Learning from significant events was shared with staff in order to make improvements to safety.
• Since the initial inspection, the practice had reviewed its protocol for recording details about patients with caring responsibilities and had identified various opportunities where staff could potentially identify whether a patient was a carer. As a result, the number of patients recorded as carers on their clinical system had increased from 35 patients (approximately 1%) to 441 patients (approximately 11%).
• The practice had an effective system for recording verbal complaints. We saw evidence that all staff were engaged in this process and that complaints were discussed in practice meetings in order that learning could be shared.
• The practice had a programme of audit in place. We saw evidence that this was used to identify areas for improvement and that the impact of changes made were analysed.
• The practice had a reciprocal buddy arrangement with a local small practice, who were available to provide clinical and leadership cover when the partners were absent (for example, during holidays). The practice performed background checks on staff providing cover and had taken all reasonable steps to ensure that they were appropriately trained.
• The practice had purchased a defibrillator following the initial inspection, and we saw evidence that all staff had been trained to use it.
• The practice had arrangements in place to ensure that blank prescription pads and sheets were stored securely, and we saw evidence that all staff had been made aware of these arrangements and their responsibilities in relation to them.
• The practice had a process in place to regularly review prescriptions which had not been collected, and patients were contacted by phone and text message to remind them to collect their prescriptions.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice