Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Vishnu Parmar on 19 September 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the September 2016 inspection can be found by selecting the ‘all reports’ link for Dr Vishnu Parmar on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 24 August 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 19 September 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection. Overall the practice is now rated as good.

Our key findings were as follows:

• Staff delivered care and treatment in line with evidence based guidance and local guidelines. Most of the patient outcomes were generally in line with or above local and national averages.
• The practice had a comprehensive understanding of the practice performance including areas for improvement.
• Clinical audits were undertaken and showed improvements in the quality of care provided to patients.
• Feedback from patients was strongly positive about the care they had received, interactions with staff and access to the service. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• 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 overarching governance framework had been strengthened to support the delivery of the practice vision and good quality care. Risks to patients were assessed and an action plan was in place to monitor improvements to the premises.

• The practice offered dispensing services to patients who lived more than one mile (1.6km) away from their nearest pharmacy. Arrangements for managing medicines in the practice minimised risks to patient safety.

There were also areas of practice where the provider needs to make improvements.

The areas where the provider should make improvement are:

• Continue to review and improve on the practice performance and patient outcomes.

• Continue to make improvements in childhood immunisation performance.

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 Vishnu Parmar on 19 September 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 managing significant events. We saw a positive culture in the practice for reporting and learning from medicines incidents and errors.

• Most risks to patients were assessed and generally well managed. However the arrangements for medicines needed improvement.

• The practice offered dispensing services to patients who lived more than one mile (1.6km) away from their nearest pharmacy.

• Patients’ needs were assessed but as exception reporting was high in some areas not all patients received care and treatment in line with current evidence based guidance.

• An understanding of the performance of the practice was maintained. However, the audit programme was not effective and did not demonstrate continuous improvements to patient care.

• Staff worked with other community based health and social care professionals to understand and meet the range and complexity of patients’ needs.

• Most patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• 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.

• Information about services and how to complain was available and easy to understand. Improvements were made as a result of complaints and concerns.

• The governance structure needed strengthening to enable the provider to have effective oversight of quality and risk and to take steps to improve these areas.

• The practice proactively sought feedback from staff, patients and the patient participation group, which it acted on.

• There was a clear leadership structure and staff felt supported by management. Staff were supported with their professional development including training and appraisals.

The areas where the provider must make improvements are:

Ensure care and treatment is provided in a safe way for patients by:

• Either stocking or risk assessing the absence of recommended emergency medicines to mitigate the risk of harm to patients.

• Taking effective steps to review all patients affected by MHRA alerts.

Ensure the systems to enable the provider to assess and monitor quality are effective by:

• Improving the systems for clinical audit including the use of two cycle audits to drive improvements to patient outcomes.

• Review the recall systems and the areas of lower performance in QOF and higher rates of exception reporting.

The areas where the provider should make improvements:

• Consider undertaking a dispensary audit to monitor the quality of the dispensing process and regular clinical audits to monitor the prescribing of controlled drugs.

• Review and monitor the outstanding areas of risk or improvement areas highlighted in the practice’s action and maintenance plan.

• Continue to recruit patient participation group members to ensure they provide a voice for patients and are influential in shaping service provision.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We visited Dr Vishnu Parmar to follow up two areas of non compliance from our previous visit. We did not speak with patients who used the service during this visit, although we spoke with the practice manager and looked at records.

We saw that medication requiring cold storage was kept safely, as a new lockable medication fridge was in place, and the maximum and minimum temperature checked daily and within the required range.

We saw that a system to check and dispose of out of date clinical supplies/medication had been introduced and items were disposed of as required. We saw that the fire yearly wiring check had been carried out and the fire alarm was checked on a weekly basis and the emergency lighting on a monthly basis.

Patients told us they were treated with care and respect. We observed staff interacting positively with patients. Patients told us access to the doctor was never a problem, and they were usually seen either the same day or the next. One patient told us “Can always phone up and get in…always gets you in very, very good”. Patients told us they were listened to and felt their care was personalised and met their needs. One patient commented that there was “Good continuity…know the care is personal, they remember previous treatments”.

We saw systems were in place for the safe keeping and dispensing of medication. Patients told us they had no difficulties in getting their repeat medication on time.

We saw that the building was clean and tidy, and patients and staff had good access to hand washing facilities and to antibacterial gels. There were effective systems in place to reduce the risk and spread of infection. We saw the equipment was maintained and serviced as required.

Patients who used the practice were asked for their views about their care and treatment and they were acted upon. However, only a small number of patients had completed surveys, and the patients we spoke during our visit did not know that surveys had been carried out.

Although the provider had undertaken assessments to identify and assess risk in relation to health, safety and welfare, they had not taken the required action identified in the risk assessments to manage the risk.