Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Ravi Latthe’s practice on 28 April 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, caring, responsive and well led services. We found that the practice was good for providing services to older people, people with long term conditions, families, children and young people, the working age population and those recently retired, people in vulnerable circumstances and people experiencing poor mental health.

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

• There were reliable systems in place for the safe storage and use of medicines and vaccines within the practice.
• Staff had received training appropriate to their roles. Patients’ needs were assessed and care was planned and delivered following best practice guidance.
• Patients said they were treated with compassion, dignity and respect and involved in decisions about their treatment.
• Information about services and how to complain was available for patients and easy to understand.
• Patients said they found it easy to make an appointment with a named GP and urgent appointments available the same day.
• The practice had an open culture and staff felt supported and listened to.

There were also a number of areas of practice where the provider should make improvement. Importantly the provider should:

• Ensure that receptionists are clear about their responsibilities when acting as chaperones, particularly in relation to where to stand when intimate examinations take place.
• Ensure that all policies and procedures in place to govern activity are reviewed in a timely manner and updated as appropriate.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We undertook this follow up visit in response to concerns that we had identified during our previous inspection of the service in July 2013. Our visit was discussed and arranged with the provider in advance so that any disruption to people’s care and treatment were minimised.

At our previous inspection we found that appropriate standards of cleanliness and hygiene were not in place in relation to the premises. We also identified that the provider did not have appropriate arrangements for the safekeeping of medication. At the time of the inspection we judged that this had a moderate impact on people who used the service and asked the provider to take action. Following the inspection in July 2013, the provider sent us an action plan which recorded the actions they were taking to address the issues raised.

During this inspection we spoke with four members of clinical and administrative staff including the provider (who was also a GP at the practice) and the practice manager.

We saw that the provider had made some progress in maintaining appropriate standards of cleanliness and hygiene in relation to the premises. However, further work was still needed. The condition and décor of the practice and some of the furniture meant that they could not be adequately cleaned. The practice was not proactive in identifying infection control risks and systems in place were not consistently robust to ensure infection control risks were minimised.

The provider had made some improvements to ensure the safe management of medicines within the practice. However, policies and procedures in place did not give staff sufficient information to ensure a consistent approach was used for the disposal of medicines or vaccinations held at the practice.

We visited Dr Latthe’s surgery to establish that the needs of people using the service were being met. On the day of the inspection we spoke with three patients, four staff members, the GP and the practice manager. The people we spoke with were all complimentary about the service. Patients told us that they received care, treatment and support that met their needs. One patient told us, “I come here because the service I get is as good as any private health care”.

Staff must be appropriately supported, trained and supervised in delivering care and treatment to people who used the service. Staff told us they had annual appraisals and that training was available. This including training in protecting vulnerable adults and children. All of the staff we spoke with said they felt supported in their role.

Cleaning schedules at the surgery were not robust. The current system in place did not protect patients from the risk of cross infection.

Emergency medication held at the practice was available should an emergency situation arise, however it was not secure against unauthorised access.

Quality monitoring systems were in place at the practice. Patients were invited to comment on the quality of the service via a satisfaction survey.