Letter from the Chief Inspector of General Practice

We previously carried out a comprehensive inspection at Dr AM Deshpande & Dr P Gurjar Practice on 4 May 2016. The practice was rated as inadequate overall. Specifically they were rated as requires improvement for effective, caring and responsive, and inadequate for safe and well-led. The practice was placed in special measures for a period of six months. The full comprehensive report on the inspection can be found by selecting the ‘all reports’ link for Dr AM Deshpande & Dr P Gurjar Practice on our website at www.cqc.org.uk.

This second inspection was undertaken following the period of special measures to review their progress and was an announced comprehensive inspection on 16 January 2017. Overall the practice is now rated as good.

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

• Staff were aware of their responsibilities regarding safety, and the reporting and recording of significant events. There were policies and procedures in place to support this. Any learning identified was shared with staff.
• The practice assessed risks to patients and staff and there were systems in place to manage them.
• Where patients were prescribed medicines requiring monitoring we found that the system in place was effective. There was a system in place for clinical staff to receive, action and disseminate patient and medicine safety alerts.
• The practice had a defibrillator and oxygen, as well as all the medicines expected to be onsite in case of medical emergencies. There was a system in place to check that equipment was in working order and medicines had not expired.
• There was a system in place to record and monitor the issue and use of prescription stationery.
• The practice business continuity plan had relevant contact details to enable staff to take action in the event of a loss of utilities or premises.
• Policies and procedures were up to date and had clear version control and a review date. These were easily accessible to staff.
• Staff had a clear awareness of consent issues including Gillick competencies and Fraser guidelines.
• Appraisal sessions had been booked for administrative staff however following the completion and manager review of preparation forms these were postponed in order for the partners and management team to address some of the issues raised. This included a review of all staff contracts, staff appraisals would be held once this work had been completed.
• There was a portable hearing loop for those with a hearing loss to use.
• There was a system in place to identify and support carers.
• We saw evidence of audits that demonstrated improvements in patient outcomes.
• Views of patients from comments cards and those we spoke with during the inspection were mostly positive. Patients said they were treated with dignity and respect, and they were involved in their care and decisions about their treatment.
• Complaints were investigated appropriately and in a timely manner and learning was shared with all staff.
• The practice had implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from CQC, the local Clinical Commissioning group (CCG) and its own staff.
• The management and staff team structure had had some changes since our previous inspection. There was still further progress to be made however we found that the two practice managers and two partners were working as a team to ensure that the potential risks to patients and staff were being identified and the structure of support and learning within the staffing team was being improved.
• Staff told us they felt supported and able to suggest improvements to the way that the service was run.
• The culture of the practice was friendly, open and honest. It was evident that the practice complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Ensure that non-clinical staff have appraisals.
• Improve patient confidentiality when attending consultations with the practice nurse.

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 previously carried out a comprehensive inspection at Dr AM Deshpande & Dr P Gurjar Practice on 4 May 2016. The practice was rated as inadequate overall. Specifically they were rated as requires improvement for effective, caring and responsive, and inadequate for safe and well-led. The practice was placed in special measures for a period of six months. The full comprehensive report on the inspection can be found by selecting the ‘all reports’ link for Dr AM Deshpande & Dr P Gurjar Practice on our website at www.cqc.org.uk.

This second inspection was undertaken following the period of special measures to review their progress and was an announced comprehensive inspection on 16 January 2017. Overall the practice is now rated as good.

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

• Staff were aware of their responsibilities regarding safety, and the reporting and recording of significant events. There were policies and procedures in place to support this. Any learning identified was shared with staff.
• The practice assessed risks to patients and staff and there were systems in place to manage them.
• Where patients were prescribed medicines requiring monitoring we found that the system in place was effective. There was a system in place for clinical staff to receive, action and disseminate patient and medicine safety alerts.
• The practice had a defibrillator and oxygen, as well as all the medicines expected to be onsite in case of medical emergencies. There was a system in place to check that equipment was in working order and medicines had not expired.
• There was a system in place to record and monitor the issue and use of prescription stationery.
• The practice business continuity plan had relevant contact details to enable staff to take action in the event of a loss of utilities or premises.
• Policies and procedures were up to date and had clear version control and a review date. These were easily accessible to staff.
• Staff had a clear awareness of consent issues including Gillick competencies and Fraser guidelines.
• Appraisal sessions had been booked for administrative staff however following the completion and manager review of preparation forms these were postponed in order for the partners and management team to address some of the issues raised. This included a review of all staff contracts, staff appraisals would be held once this work had been completed.
• There was a portable hearing loop for those with a hearing loss to use.
• There was a system in place to identify and support carers.
• We saw evidence of audits that demonstrated improvements in patient outcomes.
• Views of patients from comments cards and those we spoke with during the inspection were mostly positive. Patients said they were treated with dignity and respect, and they were involved in their care and decisions about their treatment.
• Complaints were investigated appropriately and in a timely manner and learning was shared with all staff.
• The practice had implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from CQC, the local Clinical Commissioning group (CCG) and its own staff.
• The management and staff team structure had had some changes since our previous inspection. There was still further progress to be made however we found that the two practice managers and two partners were working as a team to ensure that the potential risks to patients and staff were being identified and the structure of support and learning within the staffing team was being improved.
• Staff told us they felt supported and able to suggest improvements to the way that the service was run.
• The culture of the practice was friendly, open and honest. It was evident that the practice complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Ensure that non-clinical staff have appraisals.
• Improve patient confidentiality when attending consultations with the practice nurse.

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

During our inspection in April 2014, we found the service did not have adequate prevention and infection control processes in place and staff had not received training. The practice nurse received no clinical supervision, and risk assessments were absent or incomplete.

On our return we checked that the compliance actions set following our inspection in April 2014 had been completed. We met with the practice manager and spoke with staff. We found an annual infection control audit had been completed and staff had received appropriate training. The practice nurse was receiving regular clinical supervision and individual training records were maintained for each member of staff.

We found a prevention and infection control audit had been conducted and risk assessments had been revised to ensure they were accurate. Where actions remained outstanding it was not always clear who these had been allocated to or when they had been completed.

During our inspection we looked at the five areas we had previously found to be non-compliant in December 2013. The provider submitted an action plan stating they would achieve compliance by the end of March 2013. On our return we found the provider had introduced procedures for obtaining and recording consent from people receiving surgical treatments. The provider had also developed an information pack to support people with learning disabilities to access and understand health services.

We found where people had failed to accept invitations for health screenings these were followed up by the GP's and alternative dates offered.

We looked at how staff were supported to deliver care safely. All staff had received an annual appraisal and clinical supervision arrangements had been introduced for the GP's, but not for the practice nurse.

We found the premises were clean but people may not be fully protected from the risk of infection because appropriate guidance had not been followed.

We found that risk assessments were incomplete or inaccurate. However, the results of the patient survey showed that a majority of people who used the service rated the practice as good, very good or excellent.

We found during our inspection that people had good timely access to medical care. Staff asked people for their consent prior to providing care and treatment. However, they did not record consent in respect of people receiving minor surgery. Assessments and treatment were clearly recorded on their health file. Where referrals to specialist services had been made these were not always coordinated in a way that was intended to ensure people's safety and welfare.

We looked at how staff were supported to deliver care safely. We found there were no supervision arrangements in place for clinical staff to ensure decisions were being made by the appropriate person in a timely way. Administrative staff had not received an annual appraisal or training in the management of patient records.

We found that the premises were clean but people were not protected from the risk of infection because appropriate guidance had not been followed. A patient survey was being conducted at the time of the inspection to capture patient views but there were no regular assessments or monitoring of the service.

People told us the reception staff were polite and helpful. They found it easy to get an appointment and felt listened to by their GP. Treatment choices were explained to them and they were involved in decisions.