Letter from the Chief Inspector of General Practice

We completed a comprehensive inspection at Dr Perera, Harvey and Sandhu Medical Practice on 13 January 2015. We found the practice to be good in the five key areas that we looked at and gave the practice an overall rating of good.

Our key findings were as follows:

• Systems were in place to ensure that all staff had access to relevant national patient safety alerts. Staff signed to confirm that they had read these documents and they were discussed at clinical staff meetings.

• Infection prevention and control systems were well managed and staff had received appropriate training. Lead roles had been assigned to manage infection control and staff were aware of who held the lead role.

• Staff were friendly, caring and respected patient confidentiality. Patients we spoke with said that all staff were compassionate, listened to what they had to say and treated them with respect. We observed that staff at the reception desk maintained confidentiality and appeared to have a good relationship with patients using the service.

• The practice had a clear vision to deliver high quality care and promote good outcomes for patients. This was evident when speaking with staff and patients during our inspection. There was a clear leadership structure with named staff in lead roles. Staff were aware who they should speak with if they needed guidance or advice. Staff reported that they worked well as a team and could approach the practice manager or GPs if they needed to discuss anything.

However, there were areas of practice where the provider should make improvements.

• Develop the Incident/significant event reporting, recording and monitoring process to ensure trends and lessons learnt are captured and shared internally, and where appropriate externally.
• Review process for recording details of children with a protection plan to ensure records remain updated.
• Develop robust medicine management systems to include records to demonstrate that medication to be used in an emergency is available and within its expiry date, systems to demonstrate that stock checks and stock rotation of vaccinations received at the practice take place and to develop systems for the management and monitoring of prescription pads.
• Ensure that records are available to demonstrate that equipment to be used in an emergency situation is regularly checked and maintained.
• Ensure that recruitment processes are followed so that information required under current legislation is obtained prior to employment.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We previously inspected Drs Perera, Harvey and Sandhu on 17 October 2013. At the time we found that the provider did not have suitable arrangements in place to ensure that staff received appropriate training and support.

We also found that the provider failed to identify and manage the risks to patients or to monitor the standards of care they received.

We judged that this had a moderate impact on patients who used the service. We set compliance actions and told the provider to improve. The provider sent us an action plan following our visit which recorded the actions taken to address the issues raised.

We gave short notice of this inspection so that any disruption to people's care and treatment were minimised. We spoke with three members of staff and looked at records.

We saw appraisal records for staff. We saw that appraisals had been undertaken since our last inspection.

We saw documentary evidence that the practice nurses were registered with the NMC.

We looked at the minutes of clinical staff and practice meetings.

We saw that risk assessments had been undertaken regarding the premises. Action had not been taken to address all issues identified in risk assessments.

We saw a copy of the infection control policy and the last audit undertaken.

During our inspection we spoke with eight patients and seven members of staff.

Patients told us they were treated with respect and that staff protected their right to privacy. A patient told us: "They are good and I have no issues with them".

We saw that patients' views and experiences were taken into account in the way the service was provided. The patients we spoke with provided positive feedback about their care. A patient told us: "So far they have been really efficient".

Staff had received training in safeguarding children and vulnerable adults. They were aware of the appropriate agencies to refer safeguarding concerns to that ensured patients were protected from harm.

We found that staff had not received appropriate training for some of the roles they carried out. There was an unacceptable gap in staff annual appraisals. This meant that they had not been adequately assessed as being competent.

The provider did not have adequate systems in place for monitoring the quality of service provision. We found that measures had not been taken to protect patients from risks of harm. The latest patient survey had been completed in 2011. This demonstrated that comments had not been received to ensure that on-going improvements were made for the benefit of patients.

The senior partner had left the practice July 2013. We advised the new senior partner that we required completed forms for the de-registration of the previous senior partner and registered manager. An application for a new registered manager also needed to be submitted.