Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Mohammed Ehsan’s Practice on 5 December 2016. The overall rating for the practice was good. The full comprehensive report on the December 2016 inspection can be found by selecting the ‘all reports’ link for Dr Mohammed Ehsan on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 14 September 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 inspection on 5 December 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice remains rated as good. At the previous inspection we rated the practice as requires improvement for providing safe care and treatment as the registered person did not do all that was reasonably practicable to assess, monitor, manage and mitigate risks to the health and safety of services users. The practice had not ensured they held sufficient stocks of emergency medicines and some Patient Group Directions (PGDs) which allowed nurses to administer medicines were not signed by the GP. We also found that not all staff could access practice policies and staff who carried out cleaning of the premises did not receive specific training for this role.

At this inspection we found significant improvements had been made and the practice is now rated good for providing safe care and treatment.

Our key findings were as follows:

• The practice now held sufficient stocks of emergency medicines to treat patients in the event of a medical emergency.

• All patient group directions (PGDs) in place were now signed by both the practice nurse and GP.

• Practice policies including significant event forms were available in hard copy formats as well as electronically and staff knew how to access these.

• The practice’s business continuity plan had been updated and was now fit for purpose.

• At our previous inspection, the practice identified 18 patients as carers. At this inspection, 259 patients were identified as carers; this represented 8% of the practice list size.

• The practice kept a log which demonstrated the defibrillator was checked monthly to ensure it is in good working condition.

• There was a notice in the reception area which informed patients of the translation and interpreting service.

• Following the last inspection, a new first aid kit was purchased which was fit for use and contained all necessary items.

• The staff responsible for cleaning the practice had completed Control of Substances Hazardous to Health (COSHH) training.

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 Mohammed Ehsan on 5 December 2016. Overall the practice is 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 an effective system in place for reporting and recording significant events.
• Risks to patients were not always effectively assessed and well managed. For example, the provider had failed to adequately assess and mitigate the risks to patients when considering which emergency drugs they should hold.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. However, staff carrying out cleaning at the practice had not received training to ensure they could do so safely.
• 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 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 and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

• Ensure all Patient Group Directions (PGDs) are signed by the GP.

• Ensure they held sufficient stocks of emergency medication to treat patients in the event of a medical emergency.

The areas where the provider should make improvement are:

• Ensure a copy of the practice policies and significant event form are accessible to all staff.

• Ensure contents of the first aid kit are checked regularly to ensure they are available and fit for use.

• Checked the defibrillator regularly to ensure it is in good working condition.

• Review the business continuity plan to ensure it includes emergency contact numbers for staff, details of the buddy practice and that a copy is available off site.

• Advertise the translation service to patients.

• Encourage patients who are carers to identify themselves.

• Ensure staff who clean the practice have appropriate training to support this role.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

We spoke to members of the Patient Participation Group and people visiting the surgery on the day of our inspection. People told us they were happy with the service provided by the GP at the practice. One person said the GP is ‘very good’ and another said ‘he always gets things done.’

People told us that the GP was approachable and they could ask questions if they needed to. We found that people's care was planned and delivered in a way that met their individual needs and that the practice co-operated with other healthcare professionals and services.

We also found that people were protected from the risk of abuse because the provider had procedures in place for safeguarding vulnerable adults and children and staff we spoke with were aware of these procedures.

People we spoke with told us that they were always able to get an appointment quickly and did not have problems getting an emergency appointment.

We found that people's privacy and dignity was respected in every case.

The provider had effective recruitment procedures in place to ensure only suitable staff were employed at the service.