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Archived: Dr P K Mohanty and Partners Requires improvement

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Reports


Inspection carried out on 30/05/2019

During a routine inspection

We carried out an announced comprehensive inspection at PK Mohanty & Partners, known as the Witham Health Centre on 30th May 2019 as part of our inspection programme. This practice was previously rated requires improvement when we carried out inspections in April 2017 and in March 2018.

At the previous inspections, we found breaches of the regulations in relation to the management of high-risk medicines, the availability and storage of emergency medicines, learning from significant events and low patient satisfaction in relation to the GPs working at the practice.

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations.

We have rated this practice as requires improvement overall.

We rated the practice as good for providing caring, responsive and well led services because:

  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
  • The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

We rated the practice as requires improvement for safe services because:

  • On the day of the inspection we found that checks for the high-risk medication Lithium were not being carried out.
  • Although safety alerts were received and distributed these were not acted upon.
  • There was no book for the recording of controlled drugs.
  • Fire training was outdated for some staff.
  • No infection control audit had been carried out.
  • PAT Testing had expired.
  • The training for infection control had expired for the infection control lead.

We rated the population groups long-term conditions, working age people and those experiencing poor mental health as requires improvement because:

  • The clinical outcome indicators for 2017/2018 for people with long term conditions and those experiencing poor mental health was below local and national averages. Although the unverified data from 2018/2019 showed an upward trend in some areas these figures were still below the national averages and there had been a downward trend since our initial inspection in 2017.
  • Cancer data was lower than local and national averages in some areas.

The cumulative effect of rating three population groups in this way meant that the effective domain was rated as requires improvement.

The areas where the practice must make improvements are:

  • Ensure care and treatment is provided in a safe way to patients.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the practice should make improvements are:

  • Ensure training of staff is kept up to date including fire and infection control.
  • Continue to monitor and review the prescribing of antibiotics and hypnotics and all high-risk medicines.
  • Continue to strengthen and monitor improvement relating to patient satisfaction.
  • Monitor and review bowel cancer screenings and the number of new cancer cases treated which resulted from a two week wait (TWW) referral.
  • Review current systems and process to identify carers to ensure they receive appropriate support.
  • Review the guidance and legislation in relation to the storage and issue of controlled drugs in use at the practice, to ensure they are being followed.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BmedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care.

Inspection carried out on 27 March 2018

During an inspection looking at part of the service

We carried out an announced comprehensive inspection at Dr P K Mohanty and Partners on 26 April 2017. The overall rating for the practice was requires improvement. The full comprehensive report on the 26 April 2017 inspection can be found by selecting the ‘all reports’ link for Dr P K Mohanty and Partners on our website at www.cqc.org.uk.

This inspection was a focused inspection carried out on 27 March 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 26 April 2017. We also looked at the areas where we recommended that the practice should improve. This report covers our findings in relation to those requirements.

Overall the practice remains rated as requires improvement.

Our key findings were as follows:

  • The approach to safety systems and the reporting of significant events was open and honest. The learning from such events was now being shared with staff.
  • A new monitoring system implemented ensured patients received appropriate monitoring for diabetes, other long term conditions, and for patients taking high risk medicines.
  • The practice now stocked appropriate emergency medicines; however they did not store them within the correct temperature range to provide assurance that they were safe to be used.
  • There was now a system to review complaints to identify themes and trends.
  • The practice had not improved patient satisfaction in relation to the GPs working at the practice and there had been limited action taken to improve the data since the last inspection.

However, there are areas of practice where the provider must make improvements.

Importantly, the provider must:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. Medicines must be stored within the correct temperature range to provide assurance that they were safe to be used.

At our previous inspection on 26 April 2017, We rated the practice as requires improvement for caring services because the patient satisfaction score in the national GP survey was low. The practice had introduced patient survey’s, with the patient participation group, and staff. The practice had acted on concerns raised. However the National GP survey data remained significantly low, consequently, the practice is rated as requires improvement for providing caring services due to their response to concerns.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 26 April 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr P K Mohanty and Partner on 11 April 2017. Overall the practice is rated as requires improvement.

  • There was an open approach to safety and a system in place for reporting and recording significant events. However, there was a lack of evidence to demonstrate that the learning had been shared with all staff.

  • The practice had clearly defined and embedded systems to minimise risks to patient safety.

  • The practice maintained appropriate standards of cleanliness and hygiene. The infection control lead had received appropriate training.

  • The monitoring of patients taking high-risk medicines did not always follow guidance.

  • Not all long term condition management identified by national guidance had been actioned in a timely and appropriate way.

  • 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.

  • Where low levels of satisfaction were reported with the GPs the practice had shared their findings with their patient participation group and agreed to undertake individual performance reviews, the findings of which would be used to improve service delivery.

  • Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns. There was no analysis of complaints to identify themes and trends.

  • Patients we spoke with said they found it easy to make an appointment with a named 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 must make improvements are:

  • Stock all recommended emergency medicines or undertake a risk assessment if they are not required.

  • Ensure patients taking high-risk medicines are reviewed in line with guidance.

  • Ensure that relevant staff have received feedback from learning identified from the analysis of significant events and complaints.

In addition the provider should:

  • Continue to make improvements in relation to the performance of the GPs at the practice in relation to the satisfaction rates in the national GP patient survey.

  • Analyse complaints to identify themes and trends in order to improve services at the practice.

  • Ensure that patients with diabetes receive appropriate management and review.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice