Letter from the Chief Inspector of General Practice

We carried out a focussed, desk based review inspection at Dr VK Chawla's Practice on 11 October 2017. We found the practice to be good for providing safe services and it is rated as good overall.

We previously conducted an announced comprehensive inspection of the practice on 17 November 2016. As a result of our findings, the practice was rated as requires improvement for providing safe services and rated as good for providing effective, responsive, caring and well led services, which resulted in an overall rating of good. At that time, we found that the provider had breached Regulation 18 (1) (Staffing) of the Health and Social Care Act 2008 due to an absence of systems for monitoring the status of staff members’ annual basic life support training.

We undertook this focussed desk based inspection to check that the practice had taken action to meet the legal requirements.

This report only covers our findings in relation to those areas where requirements had not been met. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Dr VK Chawla's Practice on our website at www.cqc.org.uk/location/ 1-523702115.

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

• The practice had taken action to ensure that there were appropriate arrangements in place to monitor the status of clinical staff members' annual basic life support training.

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 VK Chawla's Practice on 17 November 2016. Overall the practice is rated as good. We previously inspected this location on 5 May 2015 at which time it was rated as requires improvement for providing safe services, due to infection prevention and control audits not having taken place. At that time, it was rated as good for providing effective, caring, responsive and well led services; and was rated as good overall. At this inspection, we noted that infection prevention and control concerns had been addressed but that other concerns were identified.

During the planning stage of our inspection, we were advised that the previous lead GP had retired and that the new provider was in the process of updating registration details to reflect the appointment of two new GP partners.

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

• Risks to patients were assessed and well managed with the exception of monitoring arrangements in place to ensure that staff members had undertaken annual basic life support training.
• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect.
• Information about services and how to complain was available and easy to understand.
• GP patient survey scores highlighted that it was difficult to make an appointment with a named GP. The practice had sought to make improvements in this area, for example, by increasing extended hours opening times. Urgent same day appointments were available.

• We noted that only 41% of patients with psychoses had had a comprehensive, agreed care plan documented in the record, in the preceding 12 months (01/04/2014 to 31/03/2015)

• 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.

• Practice management and governance arrangements facilitated the delivery of high-quality and person-centred care.

The areas where the provider must make improvement are:

• Ensure that there are appropriate arrangements in place to monitor the status of staff members' annual basic life support training.

The areas where the provider should make improvement are:

• Continue to look at ways of increasing Patient Participation Group membership so that it reflects the local population profile (a PPG is a group of patients registered with a practice who work with the practice to improve services and the quality of care).

• Work with its Patient Participation Group to monitor how recent improvements to appointments access have impacted on patient satisfaction.

• Continue to monitor performance regarding patients with schizophrenia, bipolar affective disorder and other psychoses who have had a comprehensive, agreed care plan documented in their record.

• Review arrangements for logging verbal complaints so that trends can be identified and used to improve the service.

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 VK Chawla's Practice on 5 May 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing well-led, effective, caring and responsive services. It was also rated as good for providing services for older people, families, children and young people, working age people (including those recently retired and students), people living in vulnerable circumstances, people experiencing poor mental health (including people with dementia) and for people with long term conditions. It was rated as requires improvement for providing safe services.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed, with the exception of those relating to infection control.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• 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.
• Patients said they found it easy to make an appointment with a named GP and that 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 areas where the provider must make improvements are:

• Undertake annual infection prevention and control audits in order to assess and act on possible cross infection risks.

In addition the provider should:

• Develop a systematic approach for using clinical audit cycles to drive improvement in performance and patient outcomes.
• Ensure there is a record of clinical meeting discussions so as to enable reflection on outcomes being achieved and to identity improvement areas.
• Look at ways of increasing the practice’s Patient Participation Group membership so that it reflects the local population profile (a PPG is a group of patients registered with a practice who work with the practice to improve services and the quality of care).

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice