Letter from the Chief Inspector of General Practice

A comprehensive inspection of this service was carried out in July 2015. The provider was found to be in breach of Regulation 12, Regulation 17 and Regulation 19 of the Health and Social Care Act 2008. This was due to identified concerns in the following areas; a lack of systems and processes to identify, assess and mitigate risks to patient and staff safety; a lack of effective recruitment procedures; absence of equipment to deal with certain emergencies and no assessment of the risk this presented; no effective systems to ensure medical consumables were used within expiry dates and a lack of effective systems to assess and prevent the risk of infections. Following this inspection the provider was issued with requirement notices and a warning notice.

Further inspections were undertaken in October and December 2015 to confirm that the provider had complied with warning notices.

We carried out an announced comprehensive inspection at Dr P Oza and Dr R Nam on 24 March 2016. Overall the practice is rated as good.

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

• There were effective systems in place to report and record significant events. The practice demonstrated an open and transparent approach to safety.
• Risks to patients were assessed and well managed throughout the practice.
• Staff assessed the needs of patients and delivered care in line with current evidence based guidelines. Staff had received training to provide them with the skills, knowledge and experience to deliver care and treatment effectively.
• The practice had an understanding of their performance and had undertaken clinical audits to identify areas for improvement.
• Feedback from comments cards and from patients we spoke with demonstrated that they felt 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 as a result of complaints and concerns.
• Most 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.
• There was a clear leadership structure and staff felt supported by management. The practice sought feedback from staff and patients, which it acted on.

However, there were areas where the provider should make improvements. These are:

• The practice should continue to review, assess and monitor their management of patients experiencing poor mental health (including patients with dementia)
• The practice should consider formalising arrangements for nursing cover in the event of unexpected absence to ensure patients needing regular treatment are able to access care.

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 focused inspection of P Oza and Dr R Nam’s practice on 16 December 2015. This inspection was undertaken to follow up a revised warning notice we issued to the provider as they had failed to comply with the law in respect of providing safe care and treatment for patients, specifically in respect of safe infection control management.

The overall rating for this practice remains as ‘requires improvement’. The practice will receive a further inspection within six months of the publication date of the initial report (17 September 2015) at which ratings will be reviewed as part of a comprehensive inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Dr P Oza and Dr R Nam on our website at www.cqc.org.uk

Our key findings across the areas we inspected on 16 December 2015 were as follows:

• The practice had achieved compliance with the warning notice to meet the legal requirements in respect of Regulation 12 Health and Social Care Act (Regulated Activities) Regulations 2014.

• Significant improvements had been achieved in addressing the infection control concerns identified at the comprehensive inspection on 7 July 2015 and the subsequent unannounced visit on 7 October.

• The practice had sought advice from the local CCG’s Infection Prevention and Control Nurse who had assisted the practice manager in undertaking a comprehensive infection control audit. A robust action plan had been developed to address the identified areas of concern.

• The practice has implemented robust cleaning schedules for the practice and these were being monitored effectively. A cleaner now attended the practice each day and completed the scheduled daily, weekly and monthly cleaning tasks.

• There was evidence that the partners had provided leadership in responding to the actions required following the issue of the revised warning notice to ensure compliance with the regulations.

• Additionally, the practice had purchased a data logger for the vaccine refrigerator. It was highlighted at our focussed inspection on 7 October that the practice did not have a data logger and no risk assessment was available to manage vaccine supplies in the event of a refrigerator malfunction.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an unannounced focused inspection of this practice on 7 October 2015.

This inspection was undertaken to follow up a warning notice we issued to the provider as they had failed to comply with the law in respect of providing safe care and treatment for patients.

The overall rating for this practice remains as ‘requires improvement’. The practice will receive a further inspection within six months of the publication date of the initial report at which ratings will be reviewed as part of a comprehensive inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Dr P Oza and Dr R Nam on our website at www.cqc.org.uk

Our key findings across the areas we inspected on 7 October 2015 were as follows:

• There had been improvements in respect of addressing some of the issues raised by the comprehensive inspection
• However, the arrangements for cleaning the practice remain inadequate. This poses a potential infection control risk to patients.
• There was a need for greater leadership from the partners in response to the actions required following the issue of the warning notice to ensure compliance with the regulations.

The areas where the provider must make improvements are;

• Implement robust systems to ensure effective infection control management. This should include provision of an adequate cleaning schedule for the practice with robust monitoring and oversight from the designated infection control lead.

In addition, the provider should;

• Review requirement for a data logger in the vaccine refrigerator, and undertake a risk assessment if this is not to be provided

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

A comprehensive inspection of this service was carried out in July 2015. The provider was found to be in breach of Regulation 12, Regulation 17 and Regulation 19 of the Health and Social Care Act 2008. This was due to identified concerns in the following areas; a lack of systems and processes to identify, assess and mitigate risks to patient and staff safety; a lack of effective recruitment procedures; absence of equipment to deal with certain emergencies and no assessment of the risk this presented; no effective systems to ensure medical consumables were used within expiry dates and a lack of effective systems to assess and prevent the risk of infections. Following this inspection the provider was issued with requirement notices and a warning notice.

Further inspections were undertaken in October and December 2015 to confirm that the provider had complied with warning notices.

We carried out an announced comprehensive inspection at Dr P Oza and Dr R Nam on 24 March 2016. Overall the practice is rated as good.

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

• There were effective systems in place to report and record significant events. The practice demonstrated an open and transparent approach to safety.
• Risks to patients were assessed and well managed throughout the practice.
• Staff assessed the needs of patients and delivered care in line with current evidence based guidelines. Staff had received training to provide them with the skills, knowledge and experience to deliver care and treatment effectively.
• The practice had an understanding of their performance and had undertaken clinical audits to identify areas for improvement.
• Feedback from comments cards and from patients we spoke with demonstrated that they felt 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 as a result of complaints and concerns.
• Most 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.
• There was a clear leadership structure and staff felt supported by management. The practice sought feedback from staff and patients, which it acted on.

However, there were areas where the provider should make improvements. These are:

• The practice should continue to review, assess and monitor their management of patients experiencing poor mental health (including patients with dementia)
• The practice should consider formalising arrangements for nursing cover in the event of unexpected absence to ensure patients needing regular treatment are able to access care.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We spoke with four patients, two relatives, and practice staff. Patients told us they were treated with care and respect and we saw positive interactions between patients and staff. One person said, "Everyone’s lovely. I’ve got no problems here.” They said their views about their care and treatment were listened to and their needs were met.

Patients told us they had no cause to complain about their service. They knew the where to access information on the complaints process if they needed this.

The practice was friendly, well managed and had an open culture where staff said they were comfortable sharing their opinions. One staff member said, “There’s always improvements we could make. We’re all open to this.”