Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Dr BS Jassal's Practice on 22 September 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the September 2016 inspection can be found by selecting the ‘all reports’ link for Dr BS Jassal's Practice on our website at www.cqc.org.uk.

This comprehensive follow up inspection was undertaken on 20 June 2017. We found that improvements had been made since the previous inspection and the practice was meeting all regulations. Overall the practice is now rated as good.

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

• There was a positive, transparent approach to safety and an effective system in place for reporting, recording and learning from significant events and other incidents. Staff were aware of the duty of candour.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained and had the skills, knowledge and experience to deliver effective care and treatment.
• The practice carried out clinical audit to identify areas for improvement and acted on the findings.
• The practice had systems in place for multidisciplinary working for example to support care planning and palliative care.
• The feedback we received from patients was positive and this was consistent with other sources of feedback such as the NHS Friends and family test.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints.
• Patient feedback was positive about access to the service. The practice was planning to make further improvements following an audit of the appointment system. Urgent appointments were available the same day.
• The practice was responsive to the needs of its patients, for example, the needs of students who formed 80% of the patient list.
• The practice had a clear leadership structure and staff said they were supported by management. The practice proactively sought feedback from staff and patients which it acted on.

The areas where the provider should make improvement are:

• The practice should continue to actively identify patients who are carers to ensure their needs are met.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Dr BS Jassal's Practice on 22 September 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the September 2016 inspection can be found by selecting the ‘all reports’ link for Dr BS Jassal's Practice on our website at www.cqc.org.uk.

This comprehensive follow up inspection was undertaken on 20 June 2017. We found that improvements had been made since the previous inspection and the practice was meeting all regulations. Overall the practice is now rated as good.

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

• There was a positive, transparent approach to safety and an effective system in place for reporting, recording and learning from significant events and other incidents. Staff were aware of the duty of candour.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained and had the skills, knowledge and experience to deliver effective care and treatment.
• The practice carried out clinical audit to identify areas for improvement and acted on the findings.
• The practice had systems in place for multidisciplinary working for example to support care planning and palliative care.
• The feedback we received from patients was positive and this was consistent with other sources of feedback such as the NHS Friends and family test.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints.
• Patient feedback was positive about access to the service. The practice was planning to make further improvements following an audit of the appointment system. Urgent appointments were available the same day.
• The practice was responsive to the needs of its patients, for example, the needs of students who formed 80% of the patient list.
• The practice had a clear leadership structure and staff said they were supported by management. The practice proactively sought feedback from staff and patients which it acted on.

The areas where the provider should make improvement are:

• The practice should continue to actively identify patients who are carers to ensure their needs are met.

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 B S Jassal’s Practice (Brunel Medical Centre) on 22 September 2016. This was to follow up a comprehensive inspection we carried out on 23 April 2015, during which a breach of a legal requirement set out in the Health and Social Care Act (HCSA) 2008 was found: Regulation 11 HCSA 2008 (Regulated Activities) Regulations 2014 Need for Consent and Regulation 12 HCSA 2008 (Regulated Activities) Regulations 2014 Safe Care and Treatment. Overall the practice was rated as requires improvement (you can read the previous report by selecting the ‘all reports’ link for Dr B S Jassal’s Practice (Brunel Medical Centre) on our website at www.cqc.org.uk).

After the inspection the practice drew up an action plan to improve its performance in response to the findings of the previous inspection. At the follow up inspection we reviewed the practice’s progress in implementing this plan. Although the practice had made improvements in some areas there were still outstanding concerns from our previous inspection and overall the practice remains rated as requires improvement.

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

• There was a system in place to report and record significant events and patient safety alerts. However, the practice could not demonstrate how learning was shared practice-wide.
• Although risks to patients were assessed and managed, we found outstanding actions from our previous inspection regarding recruitment checks and mandatory training.
• Non-clinical staff had not been appraised within the last 12 months.
• The practice had processes in place to keep patients safe and safeguarded from abuse and we saw improvement since our previous inspection for clinical training to an appropriate level. However, not all non-clinical staff had undertaken safeguarding children training relevant to their role and none had undertaken vulnerable adult training.
• There was evidence of clinical audit being carried out, but there was no evidence that a quality improvement programme, including clinical audit, was in place.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care.
• The practice had good facilities and was well equipped to treat patients and meet their needs.

The areas where the provider must make improvements are:

• Ensure recruitment procedures include all necessary employment checks for staff, including locum staff and risk assess whether non-clinical staff require DBS checks.
• Carry out staff appraisals and provide structured opportunities for staff to review their performance with their manager.
• Ensure all staff have completed the mandatory training identified, specifically safeguarding, infection control, fire awareness and information governance.
• Ensure there is an effective system for sharing learning outcomes from significant events and alerts practice-wide.
• Ensure all key policies and procedures are kept up-to-date.
• Develop an ongoing quality improvement programme, including clinical audit, that demonstrates continuous improvement to patient care.
• Formulate a written strategy to deliver the practice’s vision.

In addition the provider should:

• Ensure there is a failsafe process in place to ensure patients receiving high risk medicines are reviewed and managed appropriately.
• Ensure there is a system in place to track blank prescriptions through the practice in line with national guidance.
• Ensure basic life support training includes the use of a defibrillator and staff know the location of the recently procured oxygen, that there are adult and child masks available, it is regularly checked on a schedule with other emergency equipment and a suitable warning sign is placed on the door where it is located. Ensure all panic buttons are accessible to staff in the event of an emergency.
• Continue to encourage the uptake of cervical smear screening.
• Advertise translation services in the waiting room and consider having health-related leaflets available in other languages.
• Continue to review how carers are identified and recorded on the clinical system to ensure information, advice and support is made available to them.
• Provide a meeting forum for non-clinical staff to meet, raise any issues and receive practice feedback.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice