Letter from the Chief Inspector of General Practice

On 10 November 2015 we carried out a comprehensive inspection at P.A.Patel Surgery. Overall the practice was found to be inadequate overall. The practice was placed in special measures and we then completed a follow up comprehensive inspection to check improvements had been made on the 25 July 2016. At this inspection the practice was rated as inadequate. The practice was found to be inadequate in safe, effective and well led and requires improvement in caring and responsive. These inspections were under a former legal entity.

Following the inspection in July 2016 the practice de-registered and re-registered as a new provider in a partnership. The new partnership has a non-clinical partner who is the practice manager who takes a lead role in the practice. This service had been placed in special measures in January 2016.

We then carried out an announced comprehensive inspection at P.A.Patel Surgery on 26 July 2017. Overall the practice is rated as requires improvement.

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

• Risks to staff and patients had been assessed and managed appropriately. The practice had completed all actions from the inspection in July 2016.

• There was an effective system in place for reporting and recording significant events. From the sample of significant events that we reviewed we saw that the practice were open and transparent and that staff from all areas of the practice were reporting and learning from significant events.

• Staff had an understanding of their responsibilities to keep patients safe and safeguarded from abuse.All staff had received safeguarding training relevant to their role.

• Emergency medicines were easily accessible to staff in a secure area of the practice and all staff knew of their location. All the medicines we checked were in date and stored securely.

• There was an effective system for assessing and monitoring the quality and safety of services provided.

• There was a programme of clinical audit that demonstrated quality improvement.

• Practice policies and procedures had been reviewed to ensure that they were up to date and practice specific.

• Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were below local and national averages. The practice had unverified data for 2016/17. However not all areas showed improvement.

• The practice had worked to improve their antibiotic prescribing. We reviewed this and found that this had reduced and that those prescribed were appropriate.

• The practice had regular multidisciplinary meetings to discuss the needs of other patients with complex needs.

• The practice could not provide assurance that all mail was actioned appropriately and from two significant events we reviewed there was evidence to suggest that it was not.

• Data from the national GP patient survey showed patient satisfaction was mixed for several aspects of care. The latest survey in July 2017 showed that in some areas satisfaction had reduced.

• Since our last inspection the practice had attempted to identify more carers. 1% of the practice list were recognised as carers; and there was information available to them for extra support.

• The practice had an effective patient participation group and meetings showed how the practice had listened and responded to patient feedback.

• Annual IPC audits were undertaken and we saw evidence that action was taken to address any improvements identified as a result. For example, chairs were replaced in the waiting area and sharps containers were now wall mounted.

• Patient safety and medicine alerts were shared with their clinical team and discussed. We saw that the practice had a record of all safety alerts that had been received.The practice produced evidence of searches already conducted in response to the alerts received.

• At the time of the inspection the provider was not registered for maternity and midwifery services. The provider said that they would rectify this.

Actions the practice must take to improve:

• Ensure there is an effective system in place to manage and monitor processes to improve outcomes for patients.

• Review the process for incoming mail to ensure that information is acted upon.

• Address the issues highlighted in the national GP patient survey in order to improve patient satisfaction, including those in relation to consultations with GPs.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as good overall.

(Previous rating July 2017 – Requires Improvement)

The key questions were:

Safe - Good

Effective – Requires Improvement

Caring – Requires Improvement

Responsive – Good

Well-led – Good

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Requires Improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

We carried out an announced comprehensive inspection at P.A. Patel Surgery on 14 August 2018 to follow up on breaches of regulations found at the inspection carried out in July 2017.

At this inspection we found:

• The practice had clear systems to manage and reduce the risk of safety incidents occurring. When incidents did happen, the practice learned from them and improved their processes.
• The practice ensured that care and treatment was delivered according to evidence-based guidelines.
• Data from the Quality and Outcomes Framework (QOF) showed; people with long-term conditions, patient outcomes continued to be below the local and national averages.
• Actions taken after the practice carried out their own patient surveys showed some improvement in the satisfaction of patients with the services provided.
• People told us they were involved in their care and treatment, and staff were compassionate, kind, and respected their dignity.
• Patients found the appointment system very easy to use and the recent national GP survey reported 100% of the patients surveyed, could access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• We found a passionate vision to provide a family run service to meet their patient needs.

The areas where the provider must make improvements is:

• Ensure care and treatment is provided in a safe way to patients

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.