Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Sunil Sood on 27 October 2016. The overall rating for the practice was good. The full comprehensive report on the October 2016 inspection can be found by selecting the ‘all reports’ link for Dr Sunil Sood on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 18 January 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 27 October 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

At the inspection on 27 October 2016, the practice was rated overall as ‘good’. However, within

the key question safe, areas were identified as ‘requires improvement’, as the practice was not

meeting the legislation around ensuring adequate arrangements were in place to ensure care and

treatment to patients was provided in a safe way in relation to the provision of emergency

medicines; and in ensuring patients were fully protected against the risks associated with the recruitment of staff. There were deficiencies in the stocking of emergency medicines and prescription security; in the recording of vaccine fridge temperature checks; and in the recording of recruitment information, in particular in ensuring the documentation of appropriate pre-employment checks. The practice was issued requirement notices under Regulation 12, Safe care and treatment, and under Regulation 19, Fit and proper persons employed.

Other areas identified where the practice was advised they should make improvements within the key question of safe included:

• Review the safeguarding of vulnerable adults’ policy to include information on who to contact externally for further guidance if staff had concerns about a patient’s welfare remove references to organisations such as the PCT which was no longer in existence.

• Ensure the completion of action already initiated to update Disclosure and Barring Scheme (DBS) checks for staff whose checks related to previous employment.

• Ensure training arranged to address current gaps is completed as planned.

At our January 2018 inspection we reviewed the practice’s action plan submitted in response to our previous inspection and a range of supporting documents which demonstrated they are now meeting the requirements of Regulation 12, Safe care and treatment, and Regulation 19, Fit and proper persons employed, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The practice also demonstrated improvement in the other areas of safe care identified in the report from October 2016 which did not affect ratings. These improvements have been documented in the safe section, showing how the registered person has demonstrated continuous improvement since the full inspection.

Areas identified at the October 2016 inspection where the practice was advised they should make improvements within other key questions of caring, responsive and well-led included:

• Review the arrangements for the storage of patient records to mitigate potential security risks.

• Review the system for the identification of carers to ensure all carers have been identified and provided with support.

• Review the presentation of patient information in the waiting area to make it more accessible to patients.

• Review the complaints policy and accompanying leaflet to ensure information on other bodies is up to date and the designated responsible person for handling all complaints in the practice is clearly identified.

• Arrange more systematic review of policies and procedures to ensure they are all tailored specifically to the practice and contain up to date and relevant information about outside bodies.

• Re-establish regular meetings of the patient participation group (PPG).

At our inspection of January 2018 we found all patient records were now securely stored; the system of carers had been reviewed, carers correctly coded in the patient records system and support provided, but further work was necessary as the number of carers now identified was 13 (25 at the previous inspection) which was less than 1% of the practice list; patient information was now more accessible through a dedicated practice noticeboard and TV screen; the complaints policy had been updated appropriately; practice policies and procedures had been reviewed and updated more widely and tailored to the practice but the review arrangements needed to be formalised; and PPG meetings had been re-established.

However, there were also areas of practice where the provider needs to make improvements.

In particular the provider should:

• Review the provision of emergency medicines to include substitute medicine for patients allergic to penicillin in the kit in the nurse’s room and include this in the nurse’s emergency medicines checklist.

• Review further the system for the identification of carers to ensure all carers have been identified and provided with support.

• Continue to review practice policies and procedures and formalise the current review arrangements to facilitate a systematic programme of review.

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 Sunil Sood on 27 October 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 who used services were assessed and managed. However, the systems and processes to address these risks were not implemented well enough to ensure patients were kept safe. There were some deficiencies in particular in medicines management, the practice’s recruitment processes and in staff training.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• 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 improvements were made to the quality of care as a result of complaints and concerns.
• The majority of 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 adequate facilities and equipment 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 had systems in place to ensure compliance with the requirements of the duty of candour.

The areas where the provider must make improvement are:

• Complete and record a risk assessment of the practice’s decision not to stock medicine excluded from the emergency medicines kit. Ensure a record is kept of serial numbers of batch numbers of prescriptions, to secure full monitoring of their use. Make sure daily vaccine fridge temperature checks are recorded in all cases.
• Ensure patients are fully protected against the risks associated with the recruitment of staff, in particular in the recording of recruitment information and in ensuring all appropriate pre-employment checks are carried out and recorded prior to a staff member taking up post.

In addition, the areas where the provider should make improvements are:

• Review the safeguarding of vulnerable adults’ policy to include information on who to contact externally for further guidance if staff had concerns about a patient’s welfare remove references to organisations such as the PCT which was no longer in existence.
• Ensure the completion of action already initiated to update Disclosure and Barring Scheme (DBS) checks for staff whose checks related to previous employment.
• Ensure training arranged to address current gaps is completed as planned.
• Review the arrangements for the storage of patient records to mitigate potential security risks.
• Review the system for the identification of carers to ensure all carers have been identified and provided with support.
• Review the presentation of patient information in the waiting area to make it more accessible to patients.
• Review the complaints policy and accompanying leaflet to ensure information on other bodies is up to date and the designated responsible person for handling all complaints in the practice is clearly identified.
• Arrange more systematic review of policies and procedures to ensure they are all tailored specifically to the practice and contain up to date and relevant information about outside bodies.
• Re-establish regular meetings of the patient participation group (PPG).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice