Letter from the Chief Inspector of General Practice

The practice of Dr Anita Sharma was inspected on 5 March 2015. This was a comprehensive inspection. This means we reviewed the provider in relation to the five key questions leading to a rating on each on a four point rating scale. We rated the practice as good in respect of being safe, effective, caring, responsive and well-led.

Our key findings were as follows:

The practice has a system in place for reporting, recording and monitoring significant events. Significant incidents and events are used as an opportunity for learning and improving the safety of patients, staff and other visitors to the practice.

The practice has systems in place to ensure best practice is followed. This is to ensure that people’s care, treatment and support achieves good outcomes and is based on the best available evidence.

Information we received from patients reflected that practice staff interact with them in a positive and empathetic way. They told us that they were treated with respect, always in a polite manner and as an individual.

Patients spoke positively in respect of accessing services at the practice. A system is in place for patients who require urgent appointments to be seen the same day.

We saw areas of outstanding practice including:

The practice patient participation group (PPG) had been active in the area of health promotion at the practice. They were very involved in helping to plan and facilitate regular health promotion events at the practice.

The practice had established links with local voluntary and third sector groups. For example the practice had established links with Age UK Oldham to promote health programmes for the recently retired. The practice had also worked closely with a local mosque to develop a health education programme.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider should:

The electronic patient records system alerted the GPs and other clinical staff when a safeguarding issue or safeguarding plan had been identified and developed for adult patients. The electronic patient records system did not however provide such alerts when a safeguarding issue or safeguarding plan had been identified and developed for children. Whilst this information was in the patients record to maximise the awareness of clinical staff the alert system should be extended to include children where safeguarding issues or a safeguarding plan have been identified or developed.

Whilst we acknowledge that the practice clinical team is relatively small and staff had a clear understanding of how to keep children and vulnerable adults safe it was not clear who the clinical lead was in respect of safeguarding at the practice. To ensure staff are clear on where they can access support regarding safeguarding matters, the practice should identify a clinical safeguarding lead and communicate who this person is to all staff.

The vast majority of prescriptions issued at the practice were computer generated. A system was in place to ensure the security of prescription forms against theft and misuse. One of the GPs was occasionally using a pre-printed prescription pad. The prescription pad had been issued to the GP in 2012 and was stored securely. It was not evident that a record was made of the serial numbers of the prescriptions on this pad. To maximise the security of prescription forms against theft and misuse the provider should ensure their prescription security checks include any pre-printed prescription pads.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

This practice is rated as requires improvement overall. (Previous inspection March 2015 – Good)

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Requires improvement

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Requires improvement

People with long-term conditions – Requires improvement

Families, children and young people – Requires improvement

Working age people (including those recently retired and students – Requires improvement

People whose circumstances may make them vulnerable – Requires improvement

People experiencing poor mental health (including people with dementia) - Requires improvement

We carried out an announced comprehensive inspection at Dr Anita Sharma on 28 March 2018 as part of our inspection programme.

At this inspection we found:

• The practice discussed significant events in meetings. However these events were not all documented and suggested improvements not monitored

• Training and supporting staff had not been a priority and training records had not been kept up to date. It was unclear what training had taken place.

• The practice until recently had used paper records and paper policies. This meant clear guidance was not readily available for staff and not all records were easy to locate. However, this had been identified by the new practice manager.

• Following the two practice nurses and the practice manager leaving, a new practice nurse and new practice manager had recently started work. They were working to identify and solve issues relating to previous ways of working.

• There was a patient participation group (PPG) who was working with the new practice manager to identify where improvements to the practice could be made.

• Staff involved and treated patients with compassion, kindness, dignity and respect.

• Patients found the appointment system easy to use and reported that they were usually able to access care when they needed it.

The areas where the provider must make improvements are:

• The provider must ensure care and treatment is provided in a safe way to patients.

• The provider must establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

• The provider must ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

• The provider must ensure recruitment procedures are established and operated effectively so only fit and proper persons are employed. The provider must ensure specified information is available regarding each person employed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice