Archived: P.A.Patel Surgery

Letter from the Chief Inspector of General Practice

On 10 November 2015, we carried out a comprehensive announced inspection. We rated the practice as inadequate overall. The practice was rated as inadequate for providing safe, caring and well-led services, requires improvement for providing effective services and good for providing responsive services. As a result of the inadequate rating overall the practice was placed into special measures for six months.

We carried out an announced comprehensive inspection at P.A.Patel Surgery on 25 July 2016 to check whether sufficient improvements had been made to take the practice out of special measures. Overall the practice rating remains inadequate.

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

• We could not be assured that patients were always assessed and reviewed appropriately due to a lack of detail in patient records. A new system had been implemented for identifying and recording significant events. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However, the documentation was not always in sufficient detail.
• Data showed patient outcomes were low compared to local and national averages.
• All staff acting as chaperones had received a disclosure and barring service check.
• Although some audits had recently been carried out, there was insufficient evidence to show that they were driving improvements to patient outcomes.
• Data showed patient satisfaction regarding access to services was above local and national averages.
• The practice manager had taken a leadership role and started to implement a more robust governance framework; however it was unclear if there was sufficient clinical leadership to drive improvement in patient outcomes.
• There was no effective system in place to ensure patient safety and medicine alerts were received or actioned.
• Staff understood their responsibilities to safeguard patients from abuse; however not all staff had up to date safeguarding training.
• Risks to patients were assessed and most were well managed, with the exception of risks identified relating to health and safety and infection control.
• Emergency equipment and medicines were available; however some of the emergency medicines were found to be out of date.
• The practice had implemented monthly palliative care meetings to discuss patients receiving end of life care. The practice did not attend multidisciplinary meetings to discuss other patients with complex needs.
• The majority of patients said they were treated with compassion, dignity and respect.
• A complaints toolkit was available to demonstrate how the practice would deal with complaints; however the practice had not received any complaints in the last 12 months. Verbal or informal complaints were not recorded.
• There was a simple staff structure and staff knew their responsibilities; however when some staff were absent, there was no system in place to ensure their duties were covered.

The areas where the provider must make improvements are:

• Record significant events thoroughly to demonstrate that patients affected receive reasonable support and a verbal and written apology.

• Implement an effective system to ensure patient safety and medicines alerts are actioned.

• Ensure that there is effective quality improvement activity in place at the practice to improve patient outcomes.
• Ensure all staff receive up to date and appropriate safeguarding training.
• Ensure a robust system of checks is in place to ensure emergency medicines are in date.
• Ensure all risks identified relating to health and safety and infection control are actioned and managed.
• Ensure clinicians conduct and record patient reviews and assessments in sufficient detail to demonstrate appropriate care and investigations.
• Ensure staff duties are covered when staff are absent.
• Ensure there is sufficient clinical leadership to drive improvement in patient outcomes.
• Ensure verbal and informal complaints are recorded, responded and discussed.

In addition the provider should:

• Work with other health and social care organisations to meet the requirements of patients with complex needs.
• Continue to identify carers and offer these patients additional support.

This service was placed in special measures in January 2016. Insufficient improvements have been made such that there remains a rating of inadequate for providing safe, effective and well-led services. Therefore we are taking 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. 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 six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice