This practice is rated as Good overall. (Previous rating July 2017 – 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 The Gadhvi Practice on 5 July 2018 to follow up on breaches of regulations. When we inspected in July 2017 we found that the practice had not put appropriate systems in place to responded and act on patient feedback about access to the service and issued a requirement notice for Regulation 17 HSCA (RA) Regulations 2014 (Good Governance). At this inspection we found that appropriate systems had been put in place to address this.

At this inspection we found:

• Outcomes for the childhood immunisation programme was below the local and national average.
• Outcomes for patients with long term conditions, those on the mental health register and part of the cervical screening programme were below local and national averages.
• Effective systems and processes had been established to improve patient access in line with patient feedback.
• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they could access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

• Review practice systems for identifying and supporting carers.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

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

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Gadhvi Practice on 24 October 2016. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months. The full comprehensive report on the October 2016 inspection can be found by selecting the ‘all reports’ link for The Gadhvi Practice on our website at www.cqc.org.uk.

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 31 July 2017. We found that improvements had been made since the previous inspection. Overall the practice is now rated as good.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events. The practice was aware of the requirements of the duty of candour.
• The practice had clearly defined and embedded systems to minimise risks to patient safety. This was an area of improvement since our previous inspection.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• 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. However feedback from the national GP patient survey about the ease of accessing the service was consistently lower than local and national averages. The practice had identified a number of actions to improve access but these had not yet been fully implemented.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clearer leadership structure in place and staff felt supported by management. The practice proactively sought feedback from staff and patients.

The areas where the provider must make improvement are:

• The practice must establish effective systems and processes to improve patient access in line with patient feedback. Acting on patient feedback is an element of good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvement are:

• The practice should improve its approach to care planning for patients with mental health problems.

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

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Gadhvi Practice on 24 October 2016. Overall the practice is rated as inadequate.

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

• Systems for managing patients laboratory test results did not assure patients safety.

• There was no recording structure or significant events management protocol in place. However, significant events lessons were shared and actions taken to improve safety
• Arrangements for safeguarding were satisfactory but there were gaps in safety systems and processes such as premises and equipment cleaning and maintenance, medicines management and chaperoning.
• Not all risks to patients were assessed and well managed including: staff recruitment checks, control of substances hazardous to health (COSHH) and fire safety.
• The practice did not have adequate arrangements in place to respond to a medical emergency, the first aid kit contents were incomplete or expired, and the defibrillator was shared with another practice, had a low battery and there was no system to ensure it remained fit for use.

• Fail safe systems for patients cervical screening and checking emergency medicines had lapsed and items in the practice had expired or were no longer in sterile packaging, including needles and syringes.
• Data generally showed patient outcomes were comparable to the national average but some exception reporting rates were higher than average and several GP Patient survey scores for patient access and practice nursing were below average. No effective action had been taken to improve.
• The practice had a number of policies and procedures to govern activity but some were undated, incomplete or not implemented. For example, as indicated on pages 14,15, and 16 of this report.
• The practice had no clear leadership and management structure but staff felt supported and knew the values of the practice were to be caring and put patients first.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvements are:

• Establish effective systems for managing risks to patient’s safety including premises and equipment safety, medicines, patient’s laboratory test results including failsafes for cervical screening, and in the event of a medical emergency.
• Establish effective systems and processes to assess, monitor and improve quality with reference to national GP patient’s survey results and including reviewing procedures.
• Ensure patients consent is appropriately sought and recorded.
• Ensure staff are appropriately inducted and trained.
• Implement all necessary employment checks for all staff.

In addition the provider should:

• Review the business continuity plan.
• Improve arrangements for deaf or hard of hearing patients, identification of and supporting carers, and health for checks for patients with a learning disability.
• Seek to further understand or improve its higher exception reporting rates.
• Consider reviewing arrangements for staff DBS checks and Mental Capacity Act training for clinicians.

I am placing this service in special measures. Where a service is rated as inadequate for one of the five key questions or one of the six population groups or overall and after re-inspection has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group, we place it into special measures.

Services placed in special measures will be inspected again within six months. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service.

Special measures will give people who use the service the reassurance that the care they get should improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice