We carried out an announced comprehensive inspection at Dr Veena Sharma, more commonly known as 240 Wexham Road Surgery in Slough, Berkshire on 19 February 2019 as part of our inspection programme.

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

• 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 found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.

• 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.

• The way the practice was led and managed promoted the delivery of high-quality, person-centre care. Until a practice manager had been appointed, the Senior GP had support from the clinical commissioning group (CCG), a practice manager consultant, external human resources support and existing practice staff.

Whilst we found no breaches of regulations, the provider should:

• Look at methods to continue to improve the uptake of cervical, breast and bowel cancer screening for eligible patients.
• Continue to improve the system in place to promote childhood immunisations in order to increase patient uptake.

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

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 Veena Sharma on 30 August 2016. Dr Veena Sharma was rated requires improvement for providing safe, caring and well-led services and good for the provision of effective and responsive services. The overall rating for the practice was requires improvement. The full comprehensive report on the August 2016 inspection can be found by selecting the ‘all reports’ link for Dr Veena Sharma on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 19 April 2017 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 30 August 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

We have amended the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe, effective, caring, responsive and well led services. Overall the practice is now rated as good.

Our key findings were as follows:

• The practice had effective governance systems and processes in place to identify and mitigate risks. For example, clinical meetings were held monthly to discuss safety alerts, significant events and complaints.

• Practice policies, including the business continuity plan, had been reviewed and updated with appropriate information.

• Emergency equipment and medicines had been relocated to a central, secure area in the practice and all staff were aware of its location.

• Recruitment files contained all necessary employment checks for new staff.

• Nursing staff had received appropriate child safeguarding training and were trained to level two.

• Prescription stationery was tracked to individual practitioners in line with current guidance.

• The practice had improved their processes for identifying carers and were working with the local Healthwatch to engage with and support carers.

• The patient participation group had conducted a patient survey which showed high satisfaction with nurse care and treatment.

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 Veena Sharma on 30 August 2016. This comprehensive inspection was carried out to check that the practice was meeting the regulations and to consider whether sufficient improvements had been made since the previous inspection in November 2015.

Our previous inspection in November 2015 found breaches of regulations relating to the safe, effective, caring and responsive delivery of services. There were also concerns and regulatory breaches relating to the management and leadership of the practice, specifically in the well led domain. The overall rating of the practice in November 2015 was inadequate and the practice was placed into special measures for six months.

During the inspection in August 2016, we found evidence that improvements had been made. However, the practice is rated as requires improvement overall as there had been insufficient time since new systems and processes were implemented to evidence that improvements have been embedded and can be maintained. Specifically it is rated requires improvement for the provision of safe, caring and well led services and good for provision of effective and responsive services. Our improved rating of requires improvement for the provision of well led services reflects the positive development of leadership and management systems to deliver significant progress in improving services across the board for all patient groups. However, improvements are still required.

Overall the practice is rated as requires improvement.

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 not fully assessed and well managed. For example, emergency medicines could be inaccessible if needed in an emergency.

• The business continuity plan and other policies were not comprehensive or reflected current guidelines.

• The practice had not ensured that all recruitment checks had been completed.
• The policy for tracking blank prescription stationery was not being followed
• 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 by GPs but satisfaction for the nursing team was lower.
• 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.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a newly established 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.
• Urgent appointments were available on the day if they were requested.
• The practice evidenced that they had made positive changes to the governance arrangements, however, as systems were newly implemented there was limited to evidence to show that they were fully embedded and effective.
• Data showed patient outcomes were high for the locality.

The areas where the provider must make improvements are:

• Ensure governance systems are fully embedded and maintained within the practice.

• Ensure policies are reviewed to reflect up to date information; risks in relation to the safety of patients are fully assessed and managed; implementing and improving the business continuity plan to ensure the practice is able to maintain services in an emergency or during an event which impacts on the level of service.

• Ensure emergency equipment is regularly checked and emergency medicines are accessible in the event of an emergency.

• Ensure recruitment arrangements include all necessary employment checks for all staff.

• Ensure all nursing staff receive level 2 safeguarding training.

The areas where the provider should make improvement are:

• Ensure prescription stationery is tracked to individual practitioners in line with current guidance and the practice policy.

• Review and improve the identification of carers in order to provide the required support to these patients.

• Continue to monitor and make improvements to address identified concerns with patient feedback regarding care and treatment by nursing staff.

This service was placed in special measures in November 2015. Improvements have been made such that a rating of requires improvement for the delivery of safe, caring and well led services and good for responsive and effective services. This led to an improved rating of requires improvement. 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

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Veena Sharma on 26 November 2015. Overall the practice is rated as inadequate.

Specifically, we found the practice inadequate for providing safe services and being well led. It was also inadequate for providing services for the all the population groups. Improvements were also required for providing effective, caring and responsive services.

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

• Staff understood their responsibilities to raise concerns and to report incidents and near misses. However, significant event reviews and investigations were not thorough enough.
• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example, appropriate recruitment checks on staff had not been undertaken prior to their employment. The management of medicines was not always effective.
• Actions identified to address concerns with infection control had not been taken.
• Two clinical audits had been carried out in the previous 12 months. However, we saw no evidence that a programme of audits was in place. Practice performance related to the quality and outcomes frameworks were relied on drive improvements and improve patient outcomes.

• The practice had no clear leadership structure, insufficient leadership capacity and limited formal governance arrangements.

• The majority of patients said they were treated with compassion, dignity and respect. However, not all felt cared for, supported and listened to.

• Information about services was available but not everybody would be able to understand or access it. For example, the practice had recognised that they had a high number of their practice population whose first language was not English, yet there were a limited number of information leaflets and posters available in other languages.

• Urgent appointments were usually available on the day they were requested.
• The practice had a number of policies and procedures to govern activity, but some were insufficient or not fully embedded in practice.
• The practice had proactively sought feedback from patients and had an active patient participation group.
• Data showed patient outcomes were high for the locality.

The areas where the provider must make improvements are:

• Introduce robust processes for reporting, recording, acting on and monitoring significant events, incidents and near misses.

• Ensure that safeguarding processes are reviewed to reflect current standards for identifying and reporting of incidents.

• Take action to address identified concerns with infection prevention and control.

• Ensure recruitment arrangements include all necessary employment checks for all staff.

• Carry out DBS checks for staff undertaking chaperone duties

• Ensure that a programme of yearly appraisals is implemented and monitor ongoing training requirements and updates for all staff.

• Introduce robust clinical governance processes and practice policies including business contingency plans, risk management, record keeping, identifying and acting on complaints, monitoring the quality of service provision and identifying and implement an ongoing programme of clinical audit.

• Take action to address identified concerns with patient feedback regarding care and treatment.

In addition the provider should:

• Improve processes for making appointments and the availability of non-urgent appointments. 

• Provide practice information in appropriate languages and formats.

On the basis of the ratings given to this practice at this inspection, I am placing the provider into special measures. This will be for a period of six months. We will inspect the practice again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice