This practice is rated as Good overall. (Previous rating October 2016 – Good)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Dr Mokashi.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice had systems in place to review and assess significant events and complaints, with annual reviews taking place.
• Patient Group Directions (PGDs), which allow nurses to administer medicines in line with legislation, had not been updated to reflect changes in staff. However, this was resolved on the day of the inspection.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• Clinical audits were effective and maintained by clinicians to drive patient education and to follow national guidance.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.
• The practice had an established and well attended Patient Participation Group (PPG).
• Patients found the appointment system easy to use and most reported that they were able to access care when they needed it.

The areas where the provider should make improvements are:

• Improve the electronic audit trail for responding to missed appointments of vulnerable children and adults.
• Develop an uncollected repeat prescription process.
• Formalise training requirements for GPs in immunisations and vaccinations.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Mokashi on 5 October 2016. Overall the practice is now rated as good.

The practice had been previously inspected on 19 January 2016. Following this inspection the practice was rated inadequate with the following domain ratings:

• Safe – Inadequate
• Effective – Requires improvement
• Caring – Requires improvement
• Responsive – Good
• Well-led – Inadequate

The practice was placed in special measures.

Our key findings from the most recent inspection were as follows:

• Following the inspection on the 19th January the practice enrolled in the Royal College of General Practitioners (RCGP) special measures peer support programme. The programme involves a six month support package, working closely with the practice’s clinicians and senior staff to develop improvement solutions, provide peer support and in depth reviews and solutions of services.
• The practice had a clearly defined process for the monitoring and checking of all patients test results. All high risk medicines were regularly monitored by a clinician and were no longer on repeat prescriptions these patients had been fully audited and received clinical guidance and support.
• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events with learning outcomes documented.
• 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.
• The practice had developed a programme of continuous quality improvement through clinical and internal audits, and these were used to monitor quality and to make improvements.
• Risks to patients were assessed and well managed.
• There was a clear leadership structure. The practice proactively sought feedback from staff and patients, which it acted on. The practice had an active patient participation group (PPG).
• 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 provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvements are:

• Develop a formal significant event reporting form.
• Add the full address of the Parliamentary and Health Service Ombudsman( PHSO) in the complaints policy.
• Keep reviewing and maintain the appointment system, including telephone access for patients.
• Review and increase the carers numbers in the practice.

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 FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Mokashi on 19 January 2016. Overall the practice is rated as inadequate.

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

• Patients were at risk of harm because systems and processes were not consistently in place to keep them safe. For example, there was no clinical accountability in the running of the minor surgery clinics with no quality assurance systems in place.
• There was no clear process for the monitoring and checking of patients’ test results.
• The practice had no clear clinical processes or monitoring of high risk medicines.
• The practice had no infection control process, or any record of annual audits having taken place.
• There was no record that staff had received regular mandatory training. We also identified staff who were chaperones that had not received any formal training to carry out this role.
• The practice had a number of policies to govern activity; however there was an inconsistent approach throughout the practice.
• The practice did not hold any records to show whether staff were immunised against infectious diseases for example Hepatitis B.
• Most patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• Information about services and how to complain was available and easy to understand.

The areas where the provider must make improvements are:

• Introduce quality assurance processes for reporting, recording, acting on and monitoring of medicine management including area of high risk medicines, and infection control.
• Ensure infection control process and procedures are fully implemented.
• Introduce quality assurance processes in acting on and in the monitoring of histology and test results.
• Ensure that staff receive appropriate training and supervision to enable them to carry out the duties they are employed to do, including chaperone training and a record of training undertaken must be maintained.
• Ensure staff have regular appraisals
• Implement processes and update current practice policies to reflect the practice and staff roles accurately.

In addition the provider should:

• Implement a Patient Participation Group (PPG) in order to identify and act on patients’ views about the service.

• Immunisation of clinical staff should be in line with current guidelines.

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 so a rating of inadequate remains 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.

Special measures will give people who use the practice the reassurance that the care they get should improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice