Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Atul Arora on 22 March 2016. As a result of our findings during that visit the provider was rated as requires improvement for providing safe and well-led care, and it was rated as requires improvement overall. The full comprehensive inspection report from that visit was published on 30 June 2016 and can be read by selecting the ‘all reports’ link for Dr Atul Arora on our website at www.cqc.org.uk.

The provider submitted an action plan to tell us what they would do to make improvements and meet the legal requirements. We undertook an announced focused follow-up inspection on 20 December 2016 to check that the provider had followed their plan, and to confirm that they had met the legal requirements. As a result of our findings during that visit the provider was rated as inadequate for safe and well-led and rated inadequate overall and placed into special measures. The full follow up report was published on 27 April 2017 and can be found by selecting the ‘all reports’ link for Dr Atul Arora 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 27 September 2017. Overall the practice is now rated as good.

Our key findings were as follows:

• Risks to patients and other service users were assessed and well managed, specifically in relation in relation to fire safety, Legionella infection, and health

  and safety.

• The practice was suitably equipped to manage medical emergencies.

• There were systems and processes in place to monitor medicines; all emergency medicines were in date.

• All staff members were up to date with role specific training.

• All practice policies had been reviewed and updated.
• Nursing staff had been given legal authority to administer medicines.
• The practice was able to demonstrate that they had obtained evidence of immunisation for several key staff.
• Governance arrangements operated effectively.
• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• 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 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.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

However, there were areas where provider should make improvements.

The provider should:

• Deliver training to staff so they are aware of which children are considered vulnerable.

• Review how all complaints are recorded.

• Deliver training to non-clinical staff so they are aware of the requirements of the Mental Capacity Act.

• Continue to review and improve how patients with caring responsibilities are identified and recorded on the clinical system to ensure that information, advice and support is made available to them.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by the 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 Dr Atul Arora on 22 March 2016. As a result of our findings during that visit the provider was rated as requires improvement for providing safe and well-led care, and it was rated as requires improvement overall. The full comprehensive inspection report from that visit was published on 30 June 2016 and can be read by selecting the ‘all reports’ link for Dr Atul Arora on our website at www.cqc.org.uk.

During that visit our key findings were as follows:

• Risks to patients and other service users were not always well assessed or well managed. This was in relation to fire safety, Legionella infection, and health and safety.
• The provider was not suitably equipped to manage medical emergencies.
• There were no systems in place to monitor medicines, and we found some emergency medicines that were out of date.
• Several members of staff had not completed key training.
• The provider could not demonstrate that they had obtained evidence of immunisation for several key staff.
• Nursing staff had not been given the proper legal authority to administer medicines.
• Practice policies had not been reviewed or updated.
• Governance arrangements did not operate effectively.

The full comprehensive report was published on 30 June 2016 and can be found by selecting the ‘all reports’ link for Dr Atul Arora on our website at www.cqc.org.uk.

The provider submitted an action plan to tell us what they would do to make improvements and meet the legal requirements. We undertook this announced focused follow-up inspection at on 20 December 2016 to check that the provider had followed their plan, and to confirm that they had met the legal requirements. Overall the practice is now rated as inadequate; this report only covers our findings in relation to those areas where requirements had not been met.

Our key findings across all the areas we inspected in December 2016 were as follows:

• The provider had not addressed core issues which could improve the quality and safety of the service; we found that they had not made sufficient improvements in the six months between publication of their report and this inspection.
• The provider did not provide us with evidence to demonstrate any medical indemnity insurance in place for two clinical and one non-clinical member of staff. This was addressed after our inspection.
• There was no evidence of the immunity status or requirements of a clinical member of staff or the cleaner. This was addressed for the clinical staff member after our inspection.
• Risks relating to recruitment, fire safety and Legionella infection were still not being managed effectively to ensure patient safety. After the inspection the provider took steps to begin addressing some of these risks.

• The provider had improved its system for managing medicines but this was still not effective.
• Systems implemented to give the nurse legal authorisation to administer certain vaccines were not effective. This was addressed when we brought it to the provider's attention.
• Some policies were still not fit for purpose.

• Training was still outstanding. We requested but were not provided with evidence of mental capacity act training for three GPs, up-to-date fire safety awareness training for the practice manager (this was completed after the inspection), safeguarding children or adults for several clinical and non-clinical staff, infection control and information governance for a GP (these were completed by the GP after the inspection). The provider told us that all outstanding training had been completed after the inspection, but they did not send evidence to demonstrate this for all relevant staff.

• Succession planning had not been formalised for a leading member of staff. This was addressed after the inspection.
• The provider had purchased and installed oxygen and a defibrillator to ensure that they were suitably equipped to manage medical emergencies, but there was no system in place to monitor the condition of the defibrillator. After the inspection the provider told us they had taken steps to begin to address this.
• The provider conducted regular fire drills to ensure that staff practiced the fire evacuation procedure.
• The provider had not made improvements to identifying patients with caring responsibilities.

There are areas where the provider needs to make improvements. Importantly, they must:

• Assess, monitor and improve the quality and safety of the services provided in the carrying on of the regulated activities, including any risks relating to the health, safety and welfare of service users and any others that may be at risk.

• Ensure that medicines and equipment are appropriately managed, and nursing staff have the necessary authorisations in place to administer medicines.

• Ensure recruitment checks are conducted prior to the employment of new staff.

• Ensure that persons employed receive appropriate training to enable them to carry out the duties they are employed to perform.

• Ensure that relevant records for persons employed are obtained and suitably maintained, and all practice policies are fit for purpose.

In addition the provider should:

• Review and improve how patients with caring responsibilities are identified and recorded on the clinical system to ensure that information, advice and support is made available to them.

I am placing this practice in special measures. Practices placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of 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 to varying the terms of their registration within six months if they do not improve. The practice 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 by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

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 Atul Arora on 22 March 2016. As a result of our findings during that visit the provider was rated as requires improvement for providing safe and well-led care, and it was rated as requires improvement overall. The full comprehensive inspection report from that visit was published on 30 June 2016 and can be read by selecting the ‘all reports’ link for Dr Atul Arora on our website at www.cqc.org.uk.

The provider submitted an action plan to tell us what they would do to make improvements and meet the legal requirements. We undertook an announced focused follow-up inspection on 20 December 2016 to check that the provider had followed their plan, and to confirm that they had met the legal requirements. As a result of our findings during that visit the provider was rated as inadequate for safe and well-led and rated inadequate overall and placed into special measures. The full follow up report was published on 27 April 2017 and can be found by selecting the ‘all reports’ link for Dr Atul Arora 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 27 September 2017. Overall the practice is now rated as good.

Our key findings were as follows:

• Risks to patients and other service users were assessed and well managed, specifically in relation in relation to fire safety, Legionella infection, and health

  and safety.

• The practice was suitably equipped to manage medical emergencies.

• There were systems and processes in place to monitor medicines; all emergency medicines were in date.

• All staff members were up to date with role specific training.

• All practice policies had been reviewed and updated.
• Nursing staff had been given legal authority to administer medicines.
• The practice was able to demonstrate that they had obtained evidence of immunisation for several key staff.
• Governance arrangements operated effectively.
• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• 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 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.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

However, there were areas where provider should make improvements.

The provider should:

• Deliver training to staff so they are aware of which children are considered vulnerable.

• Review how all complaints are recorded.

• Deliver training to non-clinical staff so they are aware of the requirements of the Mental Capacity Act.

• Continue to review and improve how patients with caring responsibilities are identified and recorded on the clinical system to ensure that information, advice and support is made available to them.

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

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice