This practice is rated as Good overall. (Previous inspection October 2017 – rated overall Good)

The key questions 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/focused inspection at Location name on 2 May 2018. This was to follow up on breaches of regulations. At the previous inspection in October 2017, the practice was found to be in breach of Regulation 12 HSCA (RA) Regulations 2014 Safe Care and Treatment, as they had not provided staff training for the use of the defibrillator and they had not identified and recorded significant events. At this inspection we found that these matters had been addressed.

At this inspection we found:

• The practice had 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 did not have a system for recording safety alerts received from organisations such as the Medicines and Healthcare Products Regulatory Agency (MHRA).
• 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. However outcomes for patients with diabetes was lower than the national average.
• 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 areas where the provider should make improvements are:

• Consider how they keep track of safety alerts
• Continue to review the results of the childhood vaccination programme.
• Continue to review the results of the cervical smear programme.
• Review complaints policy to include 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 Niranjan’s Practice (Victoria Medical Centre) on 11 and 18 May 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the May 2016 inspection can be found by selecting the ‘all reports’ link for Dr Niranjan’s Practice (Victoria Medical Centre) on our website at www.cqc.org.uk.

We rated the practice good for providing a caring and responsive service and requires improvement for providing an effective and well led service. The practice was found inadequate for providing a safe service and was issued with requirement notices for regulation 12 HSCA (RA) Regulations 2014, safe care and treatment due to a lack of staff training for areas such as safeguarding and chaperoning. The practice also received a requirement notice for regulation 17 HSCA (RA) Regulations 2014 good governance due to no significant events recording procedure, no adult safeguarding policy and infection prevention and control procedures were in need of update.

We carried out an announced comprehensive inspection at Dr Niranjan’s Practice (Victoria Medical Centre) on 16 January 2017. Overall the practice was rated as requires improvement. The practice received requirement notices for Regulation 12 (safe care and treatment) and Regulation 17 (good governance) HSCA (RA) Regulations 2014 due to the absence of a defibrillator without an appropriate risk assessment in place, not putting plans in place to address poor patient outcomes, and not identifying and supporting carers.

We carried out a further announced comprehensive inspection on 11 October 2017. Overall the practice is rated as good.

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

• Some risks to patients were not always being managed effectively. For example, the practice had purchased a defibrillator since the last inspection in January 2017 but had not trained staff in its use.
• There was a system for recording significant events; however we were not assured that all events were being recorded. The GP gave an example of an event where a fax to hospital for a patient referral had gone missing but this was not recorded in the significant events log.
• Data showed some outcomes for patients with diabetes and mental health were low compared to the national average. There was evidence of some improvement however and the practice had produced an action plan to ensure further improvement.
• When we inspected in January 2017 there was no schedule in place for the cleaning of handheld clinical equipment such as spirometer, nebulizer or ear irrigator. This has still not been implemented.
• The practice had a system in place to identify and support patients who were also carers but numbers were low.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Reviews and investigations were carried out. Patients always received an apology.
• Clinical audits had been carried out, and there was evidence that they were driving improvements to patient outcomes.
• Patients said they were treated with compassion, dignity and respect. They felt cared for, supported and listened to.

• Information about services was available in formats where everybody would be able to understand or access it

• The practice had a number of policies and procedures to govern activity.

The areas in which the practice must make improvements are:

• Ensure care and treatment is provided in a safe way to patients

The areas where the provider should make improvements are:

• Continue to monitor and improve outcomes for patients with diabetes and mental health, and the number of children receiving childhood immunisations.

• Ensure carers are identified and that systems are put in place to support them.

• Continue to look at ways to improve the scores from the national patient survey by making improvements

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 Niranjan’s Practice (Victoria Medical Centre) on 11 and 18 May 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the May 2016 inspection can be found by selecting the ‘all reports’ link for Dr Niranjan’s Practice (Victoria Medical Centre) on our website at www.cqc.org.uk.

We rated the practice good for providing a caring and responsive service and requires improvement for providing an effective and well led service. The practice was found inadequate for providing a safe service and was issued with requirement notices for regulation 12 HSCA (RA) Regulations 2014, safe care and treatment due to a lack of staff training for areas such as safeguarding and chaperoning

The practice also received a requirement notice for regulation 17 HSCA (RA) Regulations 2014 good governance due to no significant events recording procedure, no adult safeguarding policy and infection control procedures were in need of update.

We carried out an announced comprehensive inspection at Dr Niranjan’s Practice (Victoria Medical Centre) on 16 January 2017. Overall the practice is rated as requires improvement.

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

• Risks to patients were not always being managed effectively. For example, the practice did not have a defibrillator and had not risk assessed whether this was needed. A risk assessment was in place at the time of our inspection in May 2015 but this had been discarded by the practice.
• Data showed some outcomes for patients with diabetes and mental health were low compared to the national average.
• The practice did not keep a record of prescription pads in order to provide an audit trail.
• Portable electrical equipment testing was out of date.
• There was no schedule in place for the cleaning of handheld clinical equipment such as spirometer, nebulizer or ear irrigator.
• The practice did not have a system in place to identify and support patients who were also carers.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Reviews and investigations were carried out. Patients always received an apology.
• Clinical audits had been carried out, and there was evidence that they were driving improvements to patient outcomes.
• Patients said they were treated with compassion, dignity and respect. They felt cared for, supported and listened to.
• The practice had a number of policies and procedures to govern activity.

The areas where the provider must make improvements are:

• Ensure a defibrillator is available for use in an emergency or an appropriate risk assessment is in place.

• Ensure that it monitors and improves outcomes for patients with diabetes and mental health, and the number of children receiving childhood immunisations.

• Ensure systems are in place to identify and support patients who are also carers.

In addition the provider should:

• Produce a schedule for the cleaning of handheld clinical equipment.
• Log prescription pads to ensure an audit trail is available.
• Carry out Portable Appliance Testing (PAT) to ensure it is up to date.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Appropriate checks were undertaken before staff began work. At that last inspection we found the service did not operate an effective recruitment procedure and was unable to demonstrate that all of the people it employed were suitable and of good character. At this inspection we found improvements had been made.

People who used the service understood the care and treatment that was being provided for them. They said doctors spent enough time with them to understand their issues. Comments included, "the doctor takes time to listen", "I don't feel rushed" and "the doctor looks at you and is very attentive".

People said they were satisfied with the standards of support and treatment they received. Comments included "the doctor is very, very good", "(the doctor) is always there and ready to help me out" and "this one is very good. He checks you properly".

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. People said they felt safe and comfortable using the service.

The service did not operate an effective recruitment procedure and was unable to demonstrate that all of the people it employed were suitable and of good character.

People we spoke with were not aware of the service's complaints policy. They said they had not had cause to make a complaint but they believed if they did make a complaint, it would be taken seriously. One person said "I would tell the receptionist but I'm just happy with the service" and another said "I would tell Dr Niranjan if I was not happy and I feel he would take me seriously".

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr N Niranjan’s Practice on 11 and 18 May 2015. Overall the practice is rated as requires improvement.

When referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

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

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However, we found safety was not a sufficient priority. Information about safety was not always recorded, monitored, appropriately reviewed and addressed. Consequently there was little evidence of learning from events or action taken to improve safety.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• 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. However, The practice handled complaints verbally with no supporting written documentation to aid learning, development and improvement.
• 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.
• 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.

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

Importantly the provider must:

• Ensure all significant events, complaints are recorded and there is evidence of learning from the event.
• Ensure an adult safeguarding policy is put in place and that non-clinical staff receive child protection, adult safeguarding training. Chaperone training needs to be provided for those staff acting as chaperones.
• Ensure all policies are up to date and relevant.

The provider should:

• Ensure that complaints are recorded appropriately; lessons are learnt and shared with staff.
• Ensure a Patient Participation Group (PPG) is established.
• Ensure a legionella risk assessment is undertaken.
• Provide a system for patients to book appointments online.
• Take action to improve immunisation rates for children.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice