We carried out an announced focussed inspection at Dr Raina Patel (Guywood Practice) on 24 April 2019. Following concerns received and a Care Quality Commission annual regulatory review we inspected the key questions of safe, effective and well led and utilised information from our previous inspection findings for the key questions of caring and responsive. Our inspection team was led by a CQC inspector and included a GP specialist advisor and a CQC pharmacist.

At the last inspection carried out 18 July 2016 we rated the practice as good overall.

Our judgement of the quality of care at this service is based 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 good overall and good for all population groups.

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

• The practice did not always have safe and effective systems and processes to manage medicines, safety alerts and equipment.

We found that:

• People who used the service were generally protected from avoidable harm and abuse, however management of medicines, safety alerts and equipment were not always safe.
• Patients received effective care and treatment that met their needs.
• 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.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

There were areas where the provider must make improvements:

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

There were areas where the provider should make improvements:

• Develop systems to increase management oversight of some activities, for example, professional registration, safety alerts, consent issues, medicines management and testing of electrical equipment.
• Continue to increase audit, both clinical and non-clinical within a structured programme.

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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

Letter from the Chief Inspector of General Practice

This is a focused desk top review of evidence supplied by Dr Raina Patel -The Guywood Practice, for one area only, fit and proper persons employed, within the key question safe.

We found the practice to be good in providing safe services.

Overall, the practice is rated as good.

The practice was inspected on 20 April 2016. The inspection was a comprehensive inspection under the Health and Social Care Act 2008. At that inspection, the practice was rated ‘good’ overall. However, within the key question safe, fit and proper persons employed was identified as ‘requires improvement’, as the practice was not meeting the legislation at that time; Regulation 19 HSCA (RA) Regulations 2014 fit and proper persons employed.

At the inspection in April 2016 we found that; not all staff who carried out this role had evidence

available to demonstrate they had received a Disclosure and Barring Service (DBS) check. (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable).

The practice supplied an action plan and a range of documents which demonstrated they are now meeting the requirements of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Fit and proper persons employed.

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 Raina Patel, The Guywood Practice on 20 April 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, with the exception of those relating to recruitment checks.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained so they had 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. No formal written complaints had been received in the previous 12 months; however evidence showed that some issues identified by patients were reviewed as significant events. Improvements were made to the quality of care if required as a result of these.
• 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.

We saw four areas of outstanding practice:

• The practice had surveyed patients who were children and young people for their views of the GP surgery and how they felt about the treatment and information they received. As a result they had implemented an action plan to improve how the practice communicated to children and young people.
• The practice had a system of peer review for all secondary care referrals. Data supplied by the practice showed the peer review process impacted positively on the number of referrals they made for patients. For example, the practice referred approximately 150 patients per 1000 for their first outpatient appointment between February 2015 and 2016 compared to the CCG average of approximately 210 patients per 1000.
• The GP had initiated a local scheme with the third sector providers such as AgeUK to seek patient specific ways to support vulnerable people with their physical and mental health care needs. Vulnerable patients benefiting from the pilot scheme included patients with a learning disability and those experiencing a bereavement.
• The practice had won three ‘awards’ from the Health Protection and Control of Infection Unit at Stockport Council in 2015-16 for being the highest achieving practice in administering the influenza vaccine to patients considered at risk, to patients over the age of 65 and to children of all ages.

The areas where the provider must make improvements are:

• Ensure recruitment arrangements include all necessary employment checks for all staff including clinical staff and staff who carry out the role of chaperone should have evidence of a Disclosure and Barring Service check.

In addition the provider should:

• Implement a planned programme of clinical audit and re-audit.
• Undertake a periodic analysis of significant events and complaints to identify themes and trends so that appropriate action can be taken if required.
• Record a log of complaints, including informal issues or concerns with information of the action taken by practice staff to provide an audit trail and to demonstrate the practice’s openness to apologise when things go wrong.
• Maintain an up to date record of staff induction training and a staff training matrix to reflect the training provided.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice