We carried out an announced comprehensive inspection at Dr Mukesh Pandya’s practice, also known as Savita Medical Centre, on 9 January 2019. We carried out this inspection in response to concerns that one or more of the essential standards of quality and safety were not being met.

At the last inspection in September 2017 we rated the practice as good overall.

At this inspection we have rated this practice as good overall.

We based our judgement of the quality of care at this service is on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We rated the practice as requires improvement for providing effective services because:

• Uptakes rates for childhood immunisations and cervical screening were low.
• Outcomes for patients with some long-term conditions were below local and national averages.

These areas affected the families, children and young people population group, the working age group, and the long-term conditions group.

We rated the practice as good for providing safe, caring, responsive and well-led services because:

• 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.
• Staff dealt with patients with kindness and respect. Feedback from patients we spoke with and CQC comment cards stated staff involved and treated patients with compassion, kindness, dignity and respect.
• The practice organised and delivered services to meet patients’ needs. Although, results from the national GP patient survey showed some patients reported low satisfaction with accessing the service. The practice had reviewed this feedback and implemented changes to improve access to the service. Feedback from patients we spoke with and CQC comment cards showed patients found the appointment system easy to use and noted improvements in accessing appointments.
• The practice was under a new management structure since October 2018. The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

The areas where the provider must make improvements are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The provider should:

• Take action to improve the recording of fire safety checks.
• Implement training for reception staff to assist them in identifying a deteriorating or acutely unwell patient.
• Continue to review and improve patient satisfaction with consultations and access to appointments.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

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 Mukesh Pandya's practice on 9 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 on our website at www.cqc.org.uk.

We carried out an announced comprehensive follow-up inspection on 7 September 2017. This report sets out our findings. The practice had made improvements in response to our previous inspection and overall the practice is now rated as good.

Our key findings were as follows:

• The practice had improved systems for incident reporting and responding to safety alerts. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• Risks to patients were assessed and well managed.
• The practice had reviewed its policies and procedures for safeguarding children and vulnerable adults.
• Performance data showed most patient outcomes tended to be in line with the national average.
• Patient feedback had markedly improved since our previous inspection. The practice now consistently scored in line with the local and national averages for the quality of consultations.
• The practice scored highly with patients on access to the service although the patient list was increasing. Patients were usually able to book an appointment within a week.
• The practice had policies and procedures to govern activity. The principal GP had recently retired from performing clinical duties and had secured regular locums to provide the service.
• The practice had identified priorities for further development. These included putting in place effective succession arrangements and building greater capacity and longer opening times at the branch practice in response to increasing patient demand.

There were areas of practice where the provider should make improvements:

• The practice should continue to embed systems for improving and learning from practice, for example documenting action taken in response to patient safety alerts.
• The practice should continue to embed clinical audit and completed audit cycles as tools for clinical improvement.

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 Mukesh Pandya's practice on 5 February 2015. The overall rating for the practice was requires improvement. The full comprehensive report on the February 2015 inspection can be found by selecting the ‘all reports’ link for on our website at www.cqc.org.uk.

We carried out an announced comprehensive follow-up inspection on 9 September 2016. This report sets out our findings. Although the practice had made improvements in response to our previous inspection, overall the practice remains rated as requires improvement.

Our key findings were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• Most risks to patients were assessed and well managed, although the practice had difficulty providing us with some evidence from key documents on the day.
• The practice had policies and procedures in place on safeguarding. However, the practice was not effectively cooperating with a safeguarding investigation involving the practice.
• Data showed most patient outcomes tended to be in line with the national average. The practice had improved the use of clinical audit since our previous inspection.
• The practice had completed premises improvements since our previous inspection, for example, installing a ramp and accessible entrance to the waiting room.
• Patient feedback was mixed. Patients who participated in the inspection were overwhelmingly positive about the service. However, the practice scored relatively poorly in the national patient survey for the quality of consultations.
• The practice scored highly with patients on access to the service. Patients were usually able to book an appointment within three days and were able to see their preferred GP if they wished.
• The practice had policies and procedures to govern activity and visible leadership in the form of the principal GP. The practice had recently appointed a practice manager. 

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the practice must:

• The practice must safeguard vulnerable adult patients by acting in line with locally agreed policies and procedures. This includes the prompt internal investigation of any allegations of abuse or neglect. The practice must share requested information with the statutory lead safeguarding agency as required.
• The practice manager must have sufficient support and training to be able to carry out their responsibilities safely and effectively.

In addition the provider should:

• The practice should consider whether it requires an additional system to ensure that all safety alerts (both clinical and non clinical) are disseminated and acted on.
• The practice should continue to work to improve its performance on diabetes related indicators.
• The practice should reintroduce a structured induction programme to ensure new members of staff are familiar with key policies, operating protocols and safety procedures.
• The practice should ensure that recommendations from infection control audits are acted on or are risk assessed for appropriate action for example, in the form of an action plan.
• Senior practice staff should ensure that key documents (paper or electronic) are readily available for inspection or review as required.
• The practice should continue to embed clinical audit and completed audit cycles as tools for clinical improvement.
• The practice should ensure that patient participation group members are familiar with the group's terms of reference to reduce the risk of confusion or misunderstanding.
• The practice should investigate its consistently lower than average results on the national patient survey for the quality of consultations.
• The practice should document, discuss and learn from verbal complaints.

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 Mukesh Pandya’ s practice on 5 February 2015. We visited both the main and branch surgeries, both known as Savita Medical Centre. The main surgery is located at 48 Harrow View and the branch surgery is located at 86 Spencer Road, Wealdstone, HA3 7AR. Patients registered with the practice may attend either surgery. Overall we rated the service as Requires improvement.

Specifically, we found the practice to be good for providing responsive services. The practice required improvement for providing safe, effective and caring services and for being well-led. The practice required improvement for its services for older people; people with long-term conditions; families, children and young people; people of working age; people whose circumstances may make them vulnerable; and, people experiencing poor mental health.

Our key findings were as follows:

• The practice had effective systems in place to manage risks associated with incidents staff recruitment, safeguarding and medical emergencies. The practice had effective systems in relation to infection control in the main surgery but infection control procedures in the branch surgery needed improvement.
• Patients had their needs assessed in line with current guidance and the practice had a holistic approach to patient care.
• Feedback from patients and observations throughout our inspection showed the staff were kind and caring although patients had more mixed views about whether they were fully involved and listened to. This was also reflected in the practice’s national patient survey results with scores for involvement being lower on average than other practices locally and nationally.
• The practice was open across both surgery sites for extended hours and scored comparatively well in the national patient survey for its accessibility.
• There were governance systems in place to monitor the safety and the quality of the service although we found some areas where the practice could improve. For example, the practice was not effectively using completed clinical audit cycles as a learning tool.
• The staff worked well together as a team.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Properly investigate performance data and patient feedback which might indicate potential risks to care.
• Ensure that written monitoring checks carried out in the branch surgery, such as, fridge temperature checks are available for review.
• Audit infection control procedures in the branch surgery to ensure these have due regard to national guidance.

In addition, the provider should:

• Enable patients to consult with a female doctor at the practice if they wish.
• Carry out completed clinical audit cycles to ensure improvements are identified and sustained.
• Review the disability access arrangements to the premises. The current arrangement of providing access to the main surgery directly through the doctor’s treatment room is potentially disruptive and uncomfortable for patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice