This practice is rated as Requires improvement overall. (Previous rating 02/2018 – Inadequate)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires improvement

We carried out an announced comprehensive inspection at Dr Paramjit Wasu’s practice on 6 September 2018. We carried out this inspection to follow up on breaches of regulations we found at our previous inspection.

At this inspection we found:

• The practice had improved its 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 reviewed its handling and storage of medicines since our previous inspection and no longer held a stock of controlled medicines.
• The practice had reviewed its recruitment and training procedures but its induction processes were insufficient to ensure that new clinical staff members demonstrated all required competencies.
• The practice was routinely reviewing the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect. We received positive feedback from local nursing home managers. They consistently reported improvements in the quality of care these patients were receiving.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• The practice did not have effective systems in place to support good governance and management.

The areas where the provider must make improvement are:

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

The areas where the provider should make improvements are:

• The provider should take action to improve its cancer screening coverage rates including cervical screening, breast cancer screening and bowel cancer screening.
• The provider should ensure that all reception staff know how to operate the induction loop system.

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

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

We did not review the ratings awarded to this practice at this inspection. (Previous inspection December 2017 – Inadequate).

We carried out an announced focused inspection at Dr Paramjit Wasu’s practice on 3 May 2018. The purpose of the inspection was to follow up on breaches of regulations identified at our previous inspection on 7 December 2017. Following the December inspection, the practice was placed in special measures and we issued warning notices for breaches of Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance). The practice was required to address these concerns by 28 February 2018.

At this inspection we found:

• The practice had improved its systems for managing controlled drugs in line with the relevant regulations.
• The practice was not however managing all medicines and supplies such as masks and tubing safely.
• The practice did not have adequate systems in place to ensure that prescribing materials were kept securely.
• The practice did not have adequate arrangements to respond to emergencies.
• All staff had received mandatory training including training on safeguarding vulnerable adults and children; health and safety training and fire safety training.
• The practice logged relevant safety alerts. However it did not yet have a system in place to demonstrate how these had been acted on.

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

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

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

Letter from the Chief Inspector of General Practice

This practice is rated as Inadequate overall. (Previous inspection October 2015 – Requires Improvement)

The key questions are rated as:

Are services safe? - Inadequate

Are services effective? – Requires Improvement

Are services caring? - Good

Are services responsive? - Good

Are services well-led? - Inadequate

As part of our inspection process, we also look at the quality of care for specific population groups. The concerns raised in Safe and Well Led affect all of the population groups. The population groups are rated as:

Older People – Inadequate

People with long-term conditions – Inadequate

Families, children and young people – Inadequate

Working age people (including those retired and students – Inadequate

People whose circumstances may make them vulnerable – Inadequate

People experiencing poor mental health (including people with dementia) - Inadequate

We carried out an announced comprehensive inspection at Dr Paramjit Wasu on 7 October 2015. We found breaches of the legal requirements and as a result we issued requirement notices in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014 - Good Governance.

The practice was rated as good for providing caring and responsive services and requires improvement for providing safe, effective and well-led services. Overall the practice was rated as requires improvement.

The full comprehensive report on the October 2015 inspection can be found by selecting the ‘all reports’ link for Dr Paramjit Wasu on our website at www.cqc.org.uk.

We carried out a comprehensive inspection of this service, on 7 December 2017, under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Act.

During the inspection we found that the practice had not responded fully to the concerns raised during the October 2015 inspection. We also found other breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for the practice is now inadequate.

At this inspection we found:

• There was not a transparent approach to safety. The system for learning from significant events was not effective.
• Searches were not being routinely undertaken to identify patients who may be at risk as a result of Medicine and Healthcare products Regulatory Agency (MHRA) alerts.
• The arrangements for managing medicines in the practice did not always keep patients safe. We found controlled drugs with no recording system and out of date medications.
• The practice did not have adequate arrangements to respond to emergencies.
• The practice assessed patients’ needs but was unable to demonstrate they always delivered care in line with current evidence based guidance.
• The practice was unable to demonstrate that clinical audits were driving quality improvements.
• Not all chaperones were trained, DBS checked or risk assessed as to their suitability to the role.
• There were no systems in place to mange prescription security and rooms were routinely left insecure.
• Not all staff had received training in health and safety, infection control, equality and diversity or other mandatory training.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Governance arrangements were not always effectively implemented.
• The practice was unable to demonstrate they had an effective action plan to improve performance.
• There was a leadership structure and staff felt supported by management.
• The practice was unable to demonstrate their management of record keeping was always effective and complete.

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

• Ensure care and treatment is provided in a safe way to patients.
• 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.
• Carry out clinical audits and re-audits to drive quality improvement and improved patient outcomes.
• Dispose of controlled drugs in an appropriate manner or implement the approved methods for securing and recording them.

The areas where the provider should make improvements are:

• Carry out Disclosure and Barring Service (DBS) checks, or risk assessments, for all staff who act as chaperones.
• Carry out regular, documented checks of all emergency medication and equipment.
• Identify and keep a record of patients who are carers to help ensure they are offered appropriate support.
• Ensure verbal complaints are recorded and actions monitored.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate 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 service 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 by adopting our proposal to remove this location or cancel the provider’s registration.

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

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 Paramjit Wasu on 7 October 2015. Overall the practice is rated as requires improvement. The practice was closed for six months from January to July 2015.

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, the procedure for taking appropriate action and sharing learning from significant event analysis required improvement.

• Risks to patients were assessed and well managed.

• There was no evidence of completed clinical audits being undertaken and improvement in performance of patient outcomes as a result.

• The practice had a number of policies and procedures to govern activity, but some were overdue a review.

• Information about the services available was limited, how to access support groups and organisations. We could not see any information about bereavement services.

• Patients said they were treated with compassion, dignity and respect.
• Urgent appointments were usually available on the day they were requested.
• The practice had proactively sought feedback from patients and had an active patient participation group.

The areas where the provider must make improvements are:

• Carry out clinical audits and re-audits to improve patient outcomes.

In addition the provider should:

• Embed access and knowledge of all practice’s governance policies and procedures.

• Ensure that there is a comprehensive business plan in place to deal with major incidents.

• Ensure processes are in place to check medicines are within their expiry date.

• Systems to ensure patients information is kept confidential at all times.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice