Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Yogesh Amin also referred to as Central Surgery on 8 February 2017. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months. The full comprehensive report on the February 2017 inspection can be found by selecting the ‘all reports’ link for Dr Yogesh Amin on our website at www.cqc.org.uk.

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 10 October 2017. Overall the practice is rated as good.

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

• We found there was an effective system for reporting and recording significant events; lessons were shared to make sure action was taken to improve safety in the practice.
• We found there were systems in place for the safe prescribing and monitoring of medicines.
• The practice was clean and tidy and appropriate infection control audits had been conducted to identify and mitigate risks.

• Data from the national GP patient survey showed patients rated the practice consistently higher than others for several aspects of care. Patients reported high levels of satisfaction with the service. One hundred percent of respondents in the national GP patient survey said they had confidence and trust in the last GP they saw compared to the CCG average of 95% and the national average of 95%. Ninety nine percentage of respondents in the national GP patient survey described their experience of making an appointment as good compared with the CCG average of 72% and the national average of 73%.

• Patients praised the practice team. They told us the reception staff were always polite, friendly and helpful and Dr Amin took time to listen to them and consider all their needs explaining their choices and treatment options. They told us they believed he cared about their wellbeing and felt safe.
• The practice had clear leadership and a documented strategy for the service involving the proposed merging of the service with a neighbouring practice.
• We found there were arrangements in place to monitor and improve quality and identify risk.
• Staff had inductions, training opportunities, annual performance reviews and attended staff meetings.
• The practice knew their patients and listened to them. They had an established patient participation group and they told us they felt valued and spoke highly of the service.

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 Yogesh Amin on 8 February 2017. The overall rating for the practice was inadequate. The full comprehensive report on the February 2017 inspection can be found by selecting the ‘all reports’ link for Dr Yogesh Amin on our website at www.cqc.org.uk.

Following the risks identified at the earlier inspection the Commission issued two warning notices on 27 March 2017. The notices detailed breaches of the regulations relating to the care and treatment received by patients and the governance of the practice. The practice was required to be compliant with the regulations by 15 May 2017.

This inspection was an announced focussed inspection carried out on 4 July 2017. This was to confirm that the practice had met the legal requirements in relation to the breaches in regulations that we identified in February 2017 and were detailed within the warning notices served on 27 March 2017. The practice provided records and information to demonstrate that the requirements of the Warning Notices had been met.

Our key findings were as follows:

• There was an effective system for reporting, recording, investigating and learning from significant events.
• The practice maintained appropriate standards of cleanliness and hygiene and addressed risks identified through their infection prevention control audit.

• We found safe and appropriate prescribing of medicines. Appropriate reviews had been conducted for patients receiving high risk medicines and the practice adhered to local guidelines.
• We found appropriate recruitment checks had been conducted for their clinical staff.
• All electrical and clinical equipment had been checked and calibrated to ensure it was safe to use and was in good working order.

• The clinical team had access to and followed current evidence based guidance and standards, including National Institute for Health and Care Excellence (NICE) best practice guidelines.

• The practice had conducted clinical audits and used them to obtain assurance regarding the appropriateness of referrals made to secondary care.
• We found there was clear leadership within the practice by the GP. They were working with neighbouring practices, NHS England and South Kent Clinical Commissioning Group to manage the transition of service on the retirement of the GP.
• The practice had established governance systems in partnership with South Kent Clinical Commissioning Group Medicine Management Team to help them identify risks and respond in a timely and appropriate manner.
• The practice had introduced online appointments and prescribing services to their patients to increase the responsiveness of the service.

However, there were also areas of practice where the provider would benefit from continuing to make improvements:

• Embed governance systems and processes to ensure the timely identification and management of risks.
• Improve clinical audits to better inform improvements to services.

The practice had complied with the warning notices. However, they will remain in special measures until their re-inspection in 2017. Services placed in special measures are 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.

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 Yogesh Amin on 17 March 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the March 2016 inspection can be found by selecting the ‘all reports’ link for Dr Yogesh Amin on our website at www.cqc.org.uk.

After the inspection in March 2016 the practice wrote to us with an action plan outlining how they would make the necessary improvements to comply with the regulations.

The comprehensive inspection carried out on 08 February 2017 found that the practice had responded to some the concerns raised at the March 2016 inspection and had implemented some of their action plan in order to comply with the requirement notices issued. However, we found some actions had not been completed effectively. 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.

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

• The system for reporting and recording significant events had not improved and remained ineffective.

• Significant issues that threatened the delivery of safe care were not identified or adequately managed.

• The practice’s systems, processes and practices did not always keep patients safe. Risks to patients, staff and visitors were not consistently assessed and well managed.

• The practice was unable to demonstrate that action had been taken in relation to issues identified by the infection control audit. This audit also failed to identify all infection control risks to patients, staff and visitors.
• There was an inconsistent approach to delivering care in line with current evidence based guidance.
• Prescription pads and forms were not stored securely or tracked through the practice. Nor was there was a process for managing medicine alerts received from the Medicines and Healthcare products Regulatory Agency (MHRA).
• The practice was unable to demonstrate that an electrical premises check had been carried out or that they had a system for the management of legionella (legionella is a term for a particular bacterium which can contaminate water systems in buildings).
• There was an inconsistent approach to delivering care in line with current evidence based guidance and care plans were not routinely scanned into patients’ electronic records.
• There was limited evidence that the practice had made improvements to quality that was driven by clinical audit activity.
• The practice was unable to demonstrate there was a formal induction process or that all staff, including locum clinical staff, had received an appraisal within the last 12 months.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Results from the national GP patient survey were consistently better than local and national averages.

• The practice told us they valued feedback from patients and were aware of the good results from the GP patient survey. However, they did not proactively seek patients’ feedback.

• The practice had a system for handling complaints. However, patient information leaflets about the complaints procedure were not specific to the practice. Nor had the practice acknowledged, recorded or learnt from verbal complaints or complaints left on the NHS choices website

• Patients said they found it easy to make an appointment with the principal GP and there was continuity of care, with urgent appointments available the same day.

• The practice did not have a website, nor were patients able to book appointments or order repeat prescriptions online.

• There was a staffing structure. However, there remained a lack of clarity about responsibilities across the practice in some key governance areas.
• The practice was unable to demonstrate that significant improvements to clinical governance arrangements had taken place or that current governance arrangements were effective.
• The provider was aware of and complied with the requirements of the duty of candour.
• The practice was unable to demonstrate that there was a focus on continuous learning and improvement within the practice.

The areas where the provider must make improvement are:

• Ensure that there are effective systems and processes to manage, learn and share significant events.

• Ensure there are effective systems and processes for assessing the risk of, and preventing, detecting and controlling the spread of, infections, including those that are health care associated.

• Ensure there are systems and processes for the proper and safe management of medicines including blank prescription forms and pads and alerts from the Medicines and Healthcare products Regulatory Agency (MHRA).

• Ensure all staff have the necessary employment checks.

• Revise risk management to ensure that all risks to patients, staff and visitors are identified and managing in an effective and timely manner. Revise governance arrangements to ensure that documents governing activity are practice specific and all governance processes and practices are effective.

• Ensure there are systems and processes to assess, monitor and improve the quality and safety of the services provided, in line with relevant and current evidence based guidance and standards, in the carrying on of the regulated activity (including the quality of the experience of service users in receiving those services)

• Ensure that recruitment processes for all staff employed by the practice, are established and operated effectively.

• Ensure when actions to make improvements are identified these are carried out in a timely manner.

• Ensure that the practice is proactive in canvassing patient feedback.

The areas where the provider should make improvement are:

• Review the practice’s patient registers such as safeguarding to help ensure these patients receive the care and support they need.

• Review the process for NHS health checks and assessments.

• Continue to review and monitor emergency equipment and emergency medicines to help ensure the practice is able to respond to medical emergencies.

• Review the system for recording patient care plans to help ensure that are accessible in a timely way for all members of staff.

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 patient 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 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 Yogesh Amin also referred to as Central Surgery on 8 February 2017. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months. The full comprehensive report on the February 2017 inspection can be found by selecting the ‘all reports’ link for Dr Yogesh Amin on our website at www.cqc.org.uk.

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 10 October 2017. Overall the practice is rated as good.

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

• We found there was an effective system for reporting and recording significant events; lessons were shared to make sure action was taken to improve safety in the practice.
• We found there were systems in place for the safe prescribing and monitoring of medicines.
• The practice was clean and tidy and appropriate infection control audits had been conducted to identify and mitigate risks.

• Data from the national GP patient survey showed patients rated the practice consistently higher than others for several aspects of care. Patients reported high levels of satisfaction with the service. One hundred percent of respondents in the national GP patient survey said they had confidence and trust in the last GP they saw compared to the CCG average of 95% and the national average of 95%. Ninety nine percentage of respondents in the national GP patient survey described their experience of making an appointment as good compared with the CCG average of 72% and the national average of 73%.

• Patients praised the practice team. They told us the reception staff were always polite, friendly and helpful and Dr Amin took time to listen to them and consider all their needs explaining their choices and treatment options. They told us they believed he cared about their wellbeing and felt safe.
• The practice had clear leadership and a documented strategy for the service involving the proposed merging of the service with a neighbouring practice.
• We found there were arrangements in place to monitor and improve quality and identify risk.
• Staff had inductions, training opportunities, annual performance reviews and attended staff meetings.
• The practice knew their patients and listened to them. They had an established patient participation group and they told us they felt valued and spoke highly of the service.

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