Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at NHSTanhouse Clinic on 17 August 2017. The overall rating for the practice good. However, the practice was rated as requires improvement for safe service. The full comprehensive report on the August 2017 inspection can be found by selecting the ‘all reports’ link for NHSTanhouse Clinic on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 7 March 2018 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 17 August 2017. 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:

• The practice had reviewed it process to ensure patient safety alerts such as those from Medicines and Healthcare products Regulatory Agency (MHRA) were received and actioned appropriately.

• The practice had established a system to ensure relevant alerts were communicated to relevant staff at both sites. If there were urgent risks that needed to be communicated to staff they would be escalated by the practice manager either through a telephone call or by visiting the site.

• To meet the needs of the increasing patient list size the practice had recruited extra administration staff and increased clinical sessions.

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 Rajiv Chitre on 20 May 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the May 2016 inspection can be found by selecting the ‘all reports’ link for Dr Rajiv Chitre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 17 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 20 May 2016. This report covers our findings in relation to these improvements made since our last inspection.

Dr Rajiv Chitre has two practices; Dr Rajiv Chitre, 168 Hamstead Road, Handsworth Road, Birmingham and NHS Tanhouse Clinic. The practice has a combined list size of approximately 5500 patients. Patients are able to visit either of the two sites in order to access primary medical services. Both practices are registered individually with CQC and therefore, both sites have individual reports and ratings. However as the practice has one General Medical Services (GMS) contract, a single patient list, a common clinical data system and a shared staff group, the data included in this report reflects both practices.

Overall the practice is now rated as good.

Our key findings were as follows:

• During our previous inspection in May 2016 we saw that some systems or processes were not effective to assess, monitor and mitigate the risks relating to the management of hospital communications, the management of medicines and the implementation of actions following audits. At this inspection we saw that improvements had been made. However, the service could not demonstrate effective management of risks in relation to medicine safety alerts or updates from the Medicines and Healthcare products Regulatory Agency (MHRA).

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.

• Most risks to patients were generally assessed and well managed; however, some risks were not effectively managed. For example, the practice received medical device alerts but could not evidence receipt of any drug safety alerts or updates from the Medicines and Healthcare products Regulatory Agency (MHRA). Following the inspection the practice assured us that action had been taken improve.

• Staff had been trained to provide them with the skills and knowledge 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.
• When we inspected the practice in May 2016 we saw results from the national GP patient survey (July 2016) were below average for some of its satisfaction scores on . The latest results (July 2017) showed improvement in patient satisfaction scores.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with 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.
• During our previous inspection in May 2016 we saw that the practice had a governance framework to support the delivery of the strategy and good quality care. However, these arrangements were not always effective as we had identified areas for improvement. At this inspection we saw that action had been taken to make improvements.

The areas where the provider must make improvement are:

• Ensure care and treatment is provided in a safe way to patients by considering and actioning all relevant patient safety alerts.

The areas where the provider should make improvement are:

• Ensure effective communication processes are in place to effectively manage all risks with due consideration forstaff members working remotely.

• Review staffing needs in light of the increasing patient list size to ensure the service meets patient needs.

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 Rajiv Chitre on 20 May 2016. Dr Rajiv Chitre has two practices; Dr Rajiv Chitre, 168 Hamstead Road, Handsworth Road, Birmingham and NHS Tanhouse Clinic. The practice has a combined list size of approximately 5000 patients. Patients are able to visit either of the two sites in order to access primary medical services. Both practices are registered individually with CQC and therefore, both sites have individual reports and ratings. However as the practice has one General Medical Services (GMS) contract, a single patient list, a common clinical data system and a shared staff group, the data included in this report reflects both practices. 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 reporting and recording significant events.
• 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.

• Some systems or processes were not effective to assess, monitor and mitigate the risks relating to the management of hospital communications, the management of medicines and the implementation of actions following audits.

• 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.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a leadership structure in place but at times lacked clarity as to who was responsible for certain tasks.

• The practice sought feedback which it acted on.

The areas where the provider must make improvement are:

• Introduce robust systems or processes to mitigate the risks relating to the health, safety and welfare of service users. This includes the management of hospital communications, the management of medicines and the implementation of actions following audits.

• A formal strategy must be developed to improve satisfaction scores for GPs in regards to treating patients with care and concern. Systems or processes must be developed to ensure more carers are identified so they can be offered appropriate support.

The areas where the provider should make improvement are:

• Ensure audit cycles are completed.

Ensure all information regarding safety of practice premises is available to minimise any risks identified.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice