Archived: Dr Subrata Basu Also known as Dr S Basu

Updated 23 June 2016

Dr Subrata Basu provides services for 1607 patients. The surgery is situated within the Bradford City Clinical Commissioning group and is registered with CQC to provide primary medical services under the terms of a personal medical services (PMS) contract. This is a contract between general practices and NHS England for delivering services to the local community.

Dr Subrata Basu is registered to provide diagnostic and screening procedures, treatment of disease, disorder or injury and family planning services. They are contracted to provide a range of enhanced services such as childhood immunisations, extended hours access, facilitating timely diagnosis and support for people with dementia and risk profiling and case management.

There is a higher than average number of patients under the age of 39, in common with the characteristics of the Bradford City area. There are fewer patients aged over 40 than the national average. The National General Practice Profile states that 67% of the practice population is from an Asian background with a further 8% of the population originating from black, mixed or non-white ethnic groups.

The provider and full time GP at the practice is Dr Subrata Basu. The practice employs locum cover to support clinics. On the day of our visit the locum GP covering the morning session was female. Dr Subrata Basu was unavailable due to illness.

The practice has a service level agreement with a local NHS Trust for them to provide nursing cover to the surgery. The nurse clinics are three Wednesday mornings per month and a nursing clinic each Friday morning. There are no nursing appointments offered in the afternoons.

The clinical team is supported by a practice manager and a team of administrative staff. The staff team is reflective of the population it serves and are able to converse in several languages including those widely used by the patients, Urdu, Punjabi and English.

The practice catchment area is classed as being within one of the most deprived areas in England. People living in more deprived areas tend to have a greater need for health services.

Dr Subrata Basu is situated within a purpose built health centre which it shares with two other GP practices. It has disabled access and facilities.

The practice leaflet and the NHS choices website advise the following: The reception is open at 8.30am each day and closes at 6.30pm Monday, Wednesday, Thursday and Friday with appointments available between 9am and 11am and 4pm and 6pm. On a Tuesday the reception is open between 8.30am and 6pm and 6.30pm and 7.30pm when the practice is contracted to provide an extended hour’s clinic, this is between 6.30pm and 7.30pm.

However we saw that on some occasions appointments were offered after 11am and one extended hours clinic was offered on a Wednesday.

The practice is not open for clinics on a Thursday afternoon.

When the surgery is closed patients are advised to access the walk in centre at Hillside Bridge Health centre. Patients are also advised of the NHS 111 service.

Updated 23 June 2016

Letter from the Chief Inspector of General Practice

We carried out an unannounced comprehensive inspection at Dr Subrata Basu on 8 April 2016. Overall the practice is rated as inadequate.

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

• Appropriate access to health care was not available for patients. A surgery was not available on the afternoon of our inspection and we observed evidence that surgeries were not available on the two afternoons prior to this, on Thursday afternoons and on numerous other occasions.
• Clinical decisions were taken at the practice by unqualified staff which allowed patients to continue to request and receive medication without the review of a clinician.
• Patients were unable to access appointments to meet their needs as they could not book appointments in advance. Appointments and clinics were often cancelled, irrespective of patient need.
• Patients could not access a nurse in the afternoon.
• Appointment slots to see the lead GP were regularly left unfilled despite patients requiring these. When locum GPs supported the practice more patients were seen.
• 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 clinical tasks were not reviewed by a GP.
• Staff at the practice had acted as chaperones for patients without a Disclosure and Barring Service check (DBS) or training. (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable).
• Staff said that complaints and incidents were not always recorded there was no evidence of learning and communication with staff. We were not assured that significant events were acted upon or that all events were recorded.
• Patient outcomes were hard to identify as no reference was made to clinical audits or quality improvement and there was no evidence that the practice was comparing its performance to others either locally or nationally.
• Feedback from patients regarding the practice was below Clinical Commissioning Group (CCG) and national averages. The practice did not have a patient participation group (PPG).
• The practice had limited formal governance arrangements.

The Care Quality Commission issued an urgent notice to suspend the registration of this practice for a period of four weeks from 15 April 2016 to 13 May 2016. We directed the practice to demonstrate to us that they would be able to provide a safe and accessible general practice service for their patients after that time.

The Commission was not assured that an action plan submitted to us by the provider Dr Subrata Basu could demonstrate that the practice would provide a safe and accessible service. As a result the Commission instigated enforcement action to cancel the registration of this provider. Since 18 April 2016 a new provider at Whetley Medical Centre has accepted a contract with the Bradford City Clincial Commissioning Group to provide services to the patients of this practice from the practice address at Whetley Medical Centre, 2 Saplin Court, Bradford.

The practice however, has been placed in special measures due to the shortfalls identified in this inspection. During inspection we found that the following issues had to be addressed:

• Ensure that patients have access to healthcare and that appointments are offered at times to meet the needs of the practice population.

• Implement formal governance arrangements including systems for assessing and monitoring risks and the quality of the service provision. For example regular staff and multidisciplinary team meetings.
• Introduce effective processes for reporting, recording, acting on and monitoring significant events, incidents and near misses.
• Ensure recruitment arrangements include all necessary employment checks for all staff.
• Provide staff with appropriate training, policies and guidance to carry out their roles in a safe and effective manner which are reflective of the requirements of the practice.
• Ensure they are able to respond appropriately to emergency situations and manage the risks associated with this. For example, they must review the provision of a defibrillator, emergency medication and oxygen in the practice.
• Carry out clinical audits including re-audits to ensure improvements have been achieved.
• Review the clinical and non-clinical leadership structure of the practice and ensure there is the leadership capacity and capability to deliver all improvements.
• Review the system for the prescribing and reviewing of medication and ensure that this is reflective of best practice.
• Ensure that safe and appropriate systems and processes are in place to manage the administrative tasks, referrals, recalls and demands associated with a GP surgery.
• Implement formal systems and processes including systems for assessing and monitoring risks to keep people safe. For example the audit of emergency medications, oxygen, vaccines and the provision of a health and safety risk assessment. The provider must ensure that provision is in place for the removal of sanitary waste.
• Implement a system for the correct storage and audit of prescription pads in line with NHS Protect Guidance 2013.

We also found the following issues should be addressed:

• The provider should respond to outcomes from audits. For example, Infection Prevention and Control (IPC) and Fire.

• The practice needs to ensure that it positively engages with patients and improve its services as measured by patient satisfaction scores. The practice should review if it has the right amount of staff with the appropriate skills to meet patient needs.
• The practice should explore ways of involving patients in the governance arrangements of the practice for example through the involvement of a patient participation group (PPG).

Being placed in special measures will enable the practice a period of time to address the issues we have identified. We will inspect this practice again within a six month period in order to determine if improvements have occurred and if these have been sustained.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 June 2016

The practice is rated as inadequate for services which are safe, effective, caring, responsive and well led which impacts on the care of people with long-term conditions.

• Our GP specialist advisor did not see any evidence of care planning with patients.
• Nursing staff told us they had to insist that diabetic patients were pre-booked into dedicated clinics to enable reviews to be completed.
• Nursing staff were responsible for the review of patients with long term conditions. However we were told that they could not see who was due for review and this was only indicated by a Quality and Outcomes Framework alert (QOF) on the system which appeared when reviews were due. (QOF is a system intended to improve the quality of general practice and reward good practice).
• Management of long term conditions was not pro-active. Nursing staff were not allocated any support or administration time.
• We saw evidence of 20 long term condition reviews and recalls (including smear tests) dating back to January and February that had not been undertaken.
• Recommendations from nursing clinics would often need to be discussed personally with the GP due to the low level of confidence that tasks would be completed if they were sent through the computer system.
• Nursing staff were not aware of any disease registers.

Updated 23 June 2016

The practice is rated as inadequate for services which are safe, effective, caring, responsive and well led which impacts on the care of families, children and young people.

• We did not see any evidence that there were systems to identify and follow up patients in this group who were living in disadvantaged circumstances and who were at risk.
• Immunisation rates were comparable for a number of the standard childhood immunisations. For example 93% of children aged 12 months old had received all three recommended vaccinations compared to a CCG average of 94%. We were told by staff that QOF was the priority of the practice.
• The practice manager told us that children under five were seen by a GP the same day. However we were told by reception staff that when parents rang with concerns regarding children under six months old they would be told to see the health visitor or pharmacist.
• Eight weeks baby checks were not held at the practice and parents were directed to another clinic.

Updated 23 June 2016

The practice is rated as inadequate for services which are safe, effective, caring, responsive and well led which impacts on the care of older people.

• There were limited attempts at meeting the needs of this patient population group.
• Nationally reported data showed that outcomes for patients with conditions commonly found in older people were comparable to CCG and national averages. However in some cases exception reporting (the removal of patients from calculations when patients are unable to attend a review meeting) was very high. The number of patients with atrial fibrillation who were treated with the recommended therapy was 100% with 33% exception reporting. (CCG average 15% national average 11%. It was not clear why this practice had higher exception reporting than other local practices.
• We saw evidence which showed that basic care and treatment requirements were not met, patients could not access healthcare in a way which met their needs for example a GP was not available on a Thursday afternoon.
• The care of older people was not managed in a holistic way. We saw evidence of only two home visits by a GP in 2016. Little attempt had been made to respond to older people’s needs and we were told that home visits would be conducted by the community matron.
• The leadership of the practice demonstrated little understanding of the needs of older people and they were not attempting to improve the service for them.

Updated 23 June 2016

The practice is rated as inadequate for services which are safe, effective, caring, responsive and well led which impacts on the care of working-age people (including those recently retired and students).

• The age profile of patients at the practice is mainly those of working age, students and young children but the services available did not reflect the needs of this group.
• Patients could not book appointments or order repeat prescriptions online.
• Patients could not pre-book appointments.
• Appointments could only be booked by telephone. The practice was contracted for an extended hours surgery on a Tuesday. We saw evidence of one surgery in January and found that patients were not booked into the slots,
• The practice does not have a website.

Updated 23 June 2016

The practice is rated as inadequate for services which are safe, effective, caring, responsive and well led which impacts on the care of people experiencing poor mental health (including people with dementia).

• The practice had not worked with multi-disciplinary teams in the case management of people experiencing poor mental health.
• The practice reported a very small number of patients with mental health issues. For three out of four indicators relating to mental health the practice reported 100% of patients had undergone the recommended checks which was better than CCG or national averages. The practice also reported 48% exception reporting (national average is 11%).
• We did not see any evidence that the practice carried out advance care planning for patients with dementia.
• The practice had not told patients experiencing poor mental health about support groups or voluntary organisations.
• The practice did not have a system in place to follow up patients who had attended accident and emergency (A&E) when they may have been experiencing poor mental health.
• Staff had not received training on how to care for people with mental health needs.

Updated 23 June 2016

The practice is rated as inadequate for services which are safe, effective, caring, responsive and well led which impacts on the care of people whose circumstances may make them vulnerable.

• The practice identified 0.5% of the population as having a diagnosed learning disability and stated that they offered annual health checks to this population.
• The practice did not inform vulnerable patients how to access various support groups and voluntary organisations and leaflets were not available in the waiting area.
• The practice had not worked with multi-disciplinary teams in the case management of vulnerable people.
• Some staff knew how to recognise basic signs of abuse in vulnerable adults and children and had recently completed basic on line training.
• The GP specialist advisor did not see any evidence of care planning during our visit.
• Patients told us that they were not offered self-management care plans.