Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Palit & Partners on 24 February 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 assessed and well managed.
• 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.
• 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 should make improvement are:

• Ensure that the cleaning of all desk top equipment is auditable.
• Ensure that there are robust processes for monitoring and improvement in the dispensary, for example through regular auditing of controlled drugs, dispensing errors and near misses.
• Ensure that the project to safeguard regular review of repeat prescriptions continues to be progressed and embedded into the practices systems and processes.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Palit and Partners on 13 February 2019 as part of our inspection programme. We undertook a second inspection day on the 22 February 2019 to gather additional medicines management evidence.

We based our judgement of the quality of care at this service 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 have rated this practice as requires improvement for providing safe, effective and well-led services and overall. We have rated this practice as good for providing caring and responsive services. The areas identified in effective affected all population groups so we rated all population groups as requires improvement in effective and overall. 

We found that:

• The practice did not provide care in a way that kept patients safe and protected them from avoidable harm. Risks were not always managed in relation to recruitment, fire safety and the management of the water system within the practice.
• There were safe systems in place for the management of medicines within the dispensary, although there was poor management and monitoring of patients on high risk medicines. However, the practice had developed an action plan to improve monitoring immediately after the first day of our inspection.
• There was a system in place to manage safety alerts, although we saw evidence of one 2016 safety alert that had not been actioned. However, the practice took action to address this immediately following our inspection.
• There was no clear system of safety netting patients referred for two week wait appointments where a cancer diagnosis was a possibility and no system to follow up patients who did not attend for a blood test. However, the practice reviewed and changed the systems immediately following our initial inspection to ensure that patients not attending appointments within the two weeks and those not attending for blood tests would be identified.
• There were gaps in staff completion of mandatory training.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• Complaints were managed and responded to appropriately. There was evidence of learning from both complaints and significant events.
• The way the practice was led and managed did not promote the management of risk and staff reported that they did not feel their concerns were always listened to or acted on.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure that care and treatment is provided in a safe way.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care