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Dr Shabir Bhatti Good Also known as Bermondsey Spa Medical Practice

The provider of this service changed - see old profile

Inspection Summary


Overall summary & rating

Good

Updated 7 December 2017

Letter from the Chief Inspector of General Practice

Dr Shabir Bhatti received a comprehensive inspection on 15 October 2015. The overall rating for the practice was inadequate. The practice was placed in special measures and was found to be in breach of seven regulations. Requirement notices were set for regulations 12, 13, 15, 16, 17, 18 and 19 of the Health and Social Care Act 2008. Since the October 2015 inspection the registered provider of the practice changed from Dr Shabir Bhatti to a partnership of Dr Shabir Bhatti and Dr Bilal Bhatti.

We carried out an announced comprehensive inspection of Dr Shabir Bhatti on 3 November 2016. Significant improvements were found and the overall rating for the practice was good. However, the practice was rated as requires improvement for providing safe services. This was because the provider did not have a defibrillator available at the practice or an appropriate risk assessment to indicate how they would deal with a medical emergency that required one. We also found that procedures for checking medicines and equipment taking on home visits, identifying carers and recording multidisciplinary team meeting discussions required a review.

The full comprehensive report can be found by selecting the ‘all reports’ link for Dr Shabir Bhatti on our website at www.cqc.org.uk.

This inspection was an announced desk-based follow up inspection carried out on 25 October 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation 12 that we identified in our previous inspection on 3 November 2016. This report covers our findings in relation to those requirements and also where additional improvements have been made since our last inspection.

Overall the practice is rated as good. Specifically the practice was now found to be good for providing safe services.

Our key findings were as follows:

  • The practice had access to an automated external defibrillator (AED) for use in medical emergencies.

  • The practice had implemented formal procedures for checking equipment and medicines taken on home visits, to ensure they were safe for use and accessible.

  • Minutes of multi-disciplinary meetings were kept, however they did not contain sufficient contents of the discussions or resulting action points. The practice had reviewed this after the inspection.

  • The practice had implemented a new system for identifying carers which was laid out in their carers’ identification protocol. A carers' notice board had been provided in the waiting area. The practice had currently identified 70 carers which was 0.65% of the practice population.

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

The provider should:

  • Ensure that minutes of multi-disciplinary meetings contain sufficient detail to capture contents of discussions and resulting action points.

  • Ensure ongoing identification of carers so that the needs of carers can be met.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 7 December 2017

The practice is rated as good for providing safe services.

The practice had provided an automated external defibrillator (AED) for use in medical emergencies. The practice had implemented formal procedures for checking equipment and medicines taken on home visits, to ensure they were safe for use and accessible.

Effective

Good

Updated 30 March 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were comparable to local and national averages.

  • Staff assessed needs and delivered care in line with current evidence based guidance.

  • Clinical audits demonstrated quality improvement.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment.

  • There was evidence of appraisals and personal development plans for all staff.

  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 30 March 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice lower than others for several aspects of care, the practice was trying to improve areas identified in national survey results by recruiting additional staff, and had since conducted their own patient survey.

  • Information for patients about the services available was easy to understand and accessible.

  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

  • The practice had worked to identify patients who were carers and provided a range of information to support carers via noticeboards and leaflets.

  • The practice had identified 49 patients who were carers and offered health checks and flu vaccinations to these patients.

Responsive

Good

Updated 30 March 2017

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified. This included the extended hours service which ran from the practice building.

  • The practice had increased the length of appointments for locum GPs from 10 minutes to 20 minutes to ensure patients seeing a new doctor had enough time to discuss their care.

  • Patients did not find it easy to make an appointment with a named GP though most were able to get appointments, with urgent appointments available the same day.

  • The practice had good facilities and was well equipped to treat patients and meet their needs.

  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 30 March 2017

The practice is rated as good for being well-led.

  • There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular governance meetings.

  • A practice manager had been in post since November 2015 and staff told us that the level of managerial support had improved significantly since the last inspection.

  • There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk, though there were still some improvements required.

  • The provider was aware of and complied with the requirements of the duty of candour. The partners encouraged a culture of openness and honesty.

    The practice had systems in place for notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken

  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active.

Checks on specific services

Older people

Good

Updated 30 March 2017

The practice is rated as good for the care of older people.

  • The practice offered proactive, personalised care to meet the needs of the older people in its population.

  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

  • The practice offered health checks for older patients.

  • The practice worked closely with the community matron, district nurses and other partners to provide good care for older patients

People with long term conditions

Good

Updated 30 March 2017

The practice is rated as good for the care of people with long-term conditions.

  • Patients with long-term conditions were invited for annual reviews with a GP.

  • 90% of patients on the diabetes register had a recent blood pressure reading which was within a normal range, which was in line with the local and national average of 91%.

  • 83% of patients with asthma had a review in the last 12 months which was comparable to the local average of 77% and the national average of 76%.

  • 93% of patients with chronic obstructive pulmonary disease (COPD, a lung condition) had a review in the last 12 months which was comparable to the local and national average of 89%.

  • Longer appointments and home visits were available when needed.

  • Patients had a named GP and an annual review to check their health and medicines needs were being met, however the practice was not using care plans for patients with long-term conditions (care plans set out how the care and support needs of each patient within specific groups will be met).

  • For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 30 March 2017

The practice is rated as good for the care of families, children and young people.

  • There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were comparable to local averages for all standard childhood immunisations.

  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

  • 73% of eligible women had attended a cervical screening test in the last five years, this was comparable to the local average of 77% and the national average of 81%.

  • Appointments were available outside of school hours and the premises were suitable for children and babies.

  • We saw positive examples of joint working with health visitors and a baby clinic was available at the practice.

Working age people (including those recently retired and students)

Good

Updated 30 March 2017

The practice is rated as good for the care of working-age people (including those recently retired and students).

  • The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

  • The practice offered early morning and late appointments to meet the needs of working age people.

  • The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

  • The practice worked with a local club which supported vulnerable men.

People whose circumstances may make them vulnerable

Good

Updated 30 March 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

  • The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.

  • The practice offered longer appointments for patients with a learning disability.

  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.

  • The practice supported a local care home and visited when appropriate.

  • The practice held joint a weekly clinic with the local substance misuse service for patients with substance misuse conditions.

  • The practice worked with the local community matron and social services to support vulnerable patients.

  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

  • The practice identified patients with safeguarding concerns through alerts on the clinical system.

  • Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.

People experiencing poor mental health (including people with dementia)

Good

Updated 30 March 2017

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

  • 92% of patients with complex mental health conditions had a care plan completed in the last 12 months which was comparable to the local average of 88% and the national average of 89%.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

  • The practice carried out advance care planning for patients with dementia.

  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

  • The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

  • Staff had a good understanding of how to support patients with mental health needs and dementia.