Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Chidananda Barua on 13 March 2017. The overall rating for the practice was good however there were improvements required in the key question safe. The full comprehensive report on the 13 March 2017 inspection can be found by selecting the ‘all reports’ link for Dr Chidananda Barua on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 5 October 2017 to confirm the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspections. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

The practice is now rated good for being ‘safe’. The practice remains rated as good overall.

Our key findings at this inspection were as follows:

• We reviewed a range of documents which demonstrated they were now meeting the requirements of Regulation 12 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014: Safe Care and Treatment.

• The practice now had a robust system in place to act upon patient safety alerts.
• The practice had ensured that risk assessments to the health and safety of service users were now in place.

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 Chidananda Barua on 17 May 2016. The ratings for each of the key questions for the previous inspection was inadequate for ‘safe’ and ‘well-led’, requires improvement for ‘effective’ and ‘caring’ and good for ‘responsive’. The overall rating for the practice was inadequate and the practice was placed in special measures. The full comprehensive report on the May 2016 inspection can be found by selecting the ‘all reports’ link for Dr Chidananda Barua 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 13 March 2017. 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 lacking effective systems to minimise risks to patient safety such as performing risk assessments.
• The practice did not have a robust system in place to ensure all clinical staff received patient safety and medicine alerts.
• Staff were aware of current evidence based guidance.
• 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.
• The provider was aware of the requirements of the duty of candour.

The areas where the provider must make improvement are:

• The service must assess the risks to the health and safety of service users by ensuring relevant risk assessments are in place and a robust system to disseminate patient safety and medicine alerts.

The areas where the provider should make improvement are:

• Cleaning schedules should be completed after cleaning has been performed.
• The practice should keep a copy of all training records for staff.

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 FRCGPChief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Chidananda Barua on 17 May 2016. Overall the practice is rated as inadequate.

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

• Although the practice carried out investigations when there were unintended or unexpected safety incidents, lessons learned were not communicated to practice staff and so safety was not improved.
• Patients were at risk of harm because systems and processes were not in place or effective enough to keep them safe. For example we found areas of concern in respect of safeguarding training, staff recruitment, infection control prevention, medicines management and dealing with emergencies.
• We found evidence that care plans were not a priority in the practice, for example, no care plans had been developed for six out of eight patients on the palliative care register.
• Staff told us they had access to relevant training but documented evidence of attendance was not available.
• Multidisciplinary working was taking place but was generally informal and record keeping was limited or absent.
• Patients were positive about their interactions with staff and said they were treated with compassion and dignity.
• Practice staff reviewed the needs of its local population and engaged with NHS England and the Clinical Commissioning Group to secure improvements to services where these were identified.
• Patients said they found it easy to make an urgent appointment on the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice had not proactively sought feedback from staff around the services provided.
• The practice lacked an overarching governance framework which supported the delivery of the strategy of good quality care.

The areas where the provider must make improvements are:

• Ensure that effective systems are in place to communicate, analyse and learn from incidents.
• Ensure all staff have undertaken safeguarding training.
• Ensure prescription forms and pads are tracked through the practice and held securely as per national guidelines.
• Ensure staff recruitment arrangements to include all necessary employment checks such as Disclosure and Barring checks and professional indemnity arrangements are in place.
• Ensure risks are effectively managed. For example ensure an assessment has been undertaken in relation to managing medical emergencies which considers the need for oxygen and a defibrillator to be kept for use on the premises.
• Ensure infection control is appropriately managed. For example ensure arrangements are in place with regard to infection control audits ensuring actions identified are dealt with, the cleaning of privacy curtains and ensuring sharps boxes are kept out of reach of young children.
• Ensure an accurate record of staff training is maintained and that staff undertake appropriate training.
• Introduce formal governance arrangements including systems for assessing and monitoring health and safety risks and the quality of the service provision.

The areas where the provider should make improvement are:

• There was no system in place to record verbal complaint and comments made.
• There was no plan of how to improve GP survey results.

I am placing this service in special measures. Services 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 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 by adopting our proposal to remove this location or cancel the provider’s registration.

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

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

There was a wide range of health information and health promotion leaflets available for patients.

Patient surveys were undertaken annually and a report was collated. When we spoke with patients comments included: "I have been coming here for years, the reception staff are great", "Nothing is too much trouble" and "Everyone here is great, the Dr has time for you and explains everything".

Patients were seen in an environment which was clean and organised. The practice was located within a purpose built health centre, shared by other GP practices and community health teams.

We sampled six patient electronic records. We found these to be comprehensively maintained. They recorded all consultations, tests ordered and test results.

We noted safeguarding procedures were displayed in waiting areas and consultation rooms. When we spoke with the practice manager and reception staff they had a good understanding of what constituted a safeguarding concern and they were fully aware of how to escalate these concerns.

Although annual appraisals for staff were undertaken, we noted the appraisal format only recorded self evaluation.

Staff we spoke with were aware of whistle blowing, but felt able to raise any concerns should they arise, to either the practice manager or GP.

Patients told us: "All the staff here are very helpful, my X has a range of complex issues and there has never been a problem getting an appointment or speaking with Dr, it gives you confidence".