This practice is rated as Good overall. (Previous rating May 2017 – Good)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out a comprehensive inspection on 21 September 2016 when we found that patients were at risk of harm because systems and processes were not in place to keep them safe and there was no systematic approach to assessing and managing risks. The governance arrangements within the practice were insufficient and policies were not easily accessible to staff and not all were detailed enough to adequately describe the activity to which they related. There was a lack of understanding around what training was required for staff, including safeguarding training, and several staff had not had an appraisal. The practice was placed into special measures. At our re-inspection on the 10 May 2017 we found the practice had made significant improvements; they were meeting all the required regulations and we took the practice out of special measures.

We carried out a further announced comprehensive inspection at North Preston Medical Practice on 9 October 2018. This inspection was in line with our new methodology to ensure the improvements found at our inspection in May 2017 had been sustained.

At this inspection we found:

• The practice had maintained the systems we saw at our last inspection and had further strengthened those arrangements.
• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes. Learning from incidents was shared with all staff.
• There was a comprehensive meeting structure and support system for clinical staff.
• Staff were given opportunities to develop and staff training was central to the practice development and sustainability.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• There was a clear management structure in place and staff had lead roles in many areas of practice service delivery. The practice team worked well together and practice governance processes were comprehensive.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw one area of outstanding practice:

• The practice made good use of computer systems to strengthen the governance of the practice and to improve patient care. They had worked to populate an online computer system to store, share and maintain practice processes and procedures relating to many areas of the governance of the practice. They had also worked to strengthen the templates used at patient health appointments in order to follow best practice, better document consultations and share information with other services.

The areas where the provider should make improvements are:

• Improve the management of patient urgent, two-week-wait referrals.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr DC Patel and Partners’ practice on 21 September 2016. The practice was rated as inadequate for providing safe and well led services, requiring improvement for effective services, good for providing caring and responsive services and inadequate overall. The practice was placed in special measures for a period of six months.

At our inspection in September 2016 we found that patients were at risk of harm because systems and processes were not in place to keep them safe and there was no systematic approach to assessing and managing risks. While we saw that significant events were analysed and actions identified to mitigate the possibility of the events being repeated, these actions were not consistently implemented. The governance arrangements within the practice were insufficient and policies were not easily accessible to staff and not all were detailed enough to adequately describe the activity to which they related. There was a lack of understanding around what training was required for staff, including safeguarding training, and several staff had not had an appraisal.

The full comprehensive report on the September 2016 inspection can be found at: http://www.cqc.org.uk/location/1-543988133

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 10 May 2017.

Overall the practice is now 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 a system in place for reporting and recording significant events. Actions taken as a result of significant events were reviewed to be effective.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Safeguarding procedures had improved and there was system to identify vulnerable patients although there was no specific register of these patients to facilitate discussion.

• Practice recruitment processes were comprehensive although the practice had not used confidential health questionnaires for new staff.

• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment although two GPs had not attained all of the clinical requirements necessary to undertake patient smears. The practice told us that all GPs were now aware of these requirements and that they were treating this as a significant event as a priority.
• Staff training was well governed and there was a comprehensive record of training to ensure that it was completed appropriately and in a timely way.
• Practice staff had access to a range of policies and procedures although some policies were not practice-specific. The practice was in the process of embedding local and practice information into these policies.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said they found it easy to make an appointment with a GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped 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 was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider should make improvement are:

• Look to re-instate the use of confidential health questionnaires when employing new staff.
• Ensure that the new practice policies and procedures are successfully embedded in the practice.
• Complete the planned cytology significant event analysis to mitigate risks associated with clinicians not attaining clinical competencies.

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 D C Patel and Partners on 21 September 2016. Overall the practice is rated as inadequate.

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

• 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 and actions identified to address concerns with infection control practice had not been taken.

• There was not a systematic approach to assessing and managing risks. For example, a fire risk assessment was not available.

• While we saw that significant events were analysed and actions identified to mitigate the possibility of the events being repeated, these actions were not consistently implemented.

• The governance arrangements within the practice were insufficient. Policies were not easily accessible to staff and not all were detailed enough to adequately describe the activity to which they related.

• There was a lack of understanding around what training was required for staff, including safeguarding training.

• Several staff had not had an appraisal to identify training needs and manage performance, for example the practice could not evidence during the visit that a health care assistant had been appraised in the last three years.

• The practice carried out clinical audit which demonstrated quality improvement.

• Patients were generally positive about their interactions with staff and said they were treated with compassion and dignity.

• We saw that complaints were dealt with in a timely manner and an appropriate apology was offered when required.

The areas where the provider must make improvements are:

• Introduce thorough processes to ensure that learning outcomes identified following significant events, incidents and near misses are acted upon.

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

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

• Implement governance arrangements including systems for assessing and monitoring risks.

• Provide staff with policies and guidance to carry out their roles in a safe and effective manner and which are reflective of the requirements of the practice.

• Ensure staff training is undertaken and appropriately managed to ensure all staff have completed training and have the skills and qualifications to carry out their roles.

The areas where the provider should make improvement are:

• Undertake activity to reinstate and engage with the Patient Participation Group.

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 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.

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