Archived: Dr Ajit Pratap Mehrotra Also known as Windsor Medical Centre

Updated 19 May 2016

Dr Ajit Pratap Mehrotra provides primary care services to 2008 patients under a Personal Medical Service Contract. The surgery is also known as Windsor Medical Centre.

The practice is located in purpose built premises with all patient services at ground level, there is wheelchair access and parking for staff and patients.

The majority of patients live within a three mile radius of the practice. The area is in the fourth most deprived decile. Twenty three per cent of patients are from black and minority ethnic (BME) populations and 6% of patients claim disability living allowance.

There are two GPs, one male and one female, two female practice nurses, a female nurse prescriber, a practice manager and an administrative team.

The practice is open between 8.30am and 6.30pm Mondays, Tuesdays, Wednesdays and Fridays.

Appointments are from 8.45am and 11.45am every morning and 4pm to 6pm Monday, Tuesday and Friday. 2.30pm to 4.15pm Wednesday. The practice is closed from 3pm on Thursday afternoons, cover is provided by a neighbouring GP practice. Extended surgery hours are offered from 6.30pm to 7.30pm on Tuesdays and Fridays.

Between 8am and 8.30am staff could contact the GPs by mobile telephone if necessary.

Out of hours services are provided by Local Care Direct and NHS 111

Updated 19 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Ajit Pratap Mehrotra on 13 January 2016. Overall the practice is rated as inadequate.

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

• Not all incidents and significant events had been reported and investigated.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Staff had the clinical skills, knowledge and experience to deliver effective care and treatment. However, staff had not been provided with up to date mandatory training.
• There was no single patient record system as the practice used a combination of electronic and paper clinical records.
• Controlled drugs were stored securely and accurate records kept from 2016. However there were gaps in previous records.
• Risks to patients were were not assessed and well managed. For example, health and safety and legionella risk assessments had not been undertaken.
• Information about services and how to complain was available and easy to understand.
• Data showed patient outcomes were varied compared to the locality and nationally.
• Although some themed reviews had been undertaken, we saw no evidence that audits were driving improvement in performance to improve patient outcomes.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• Data from the national GP patient survey showed 100% said they found the receptionists at the practice helpful.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice had a number of policies and procedures to govern activity, but some were out of date and it was evident some policies were not being implemented by the practice.
• There was a clear leadership structure and staff felt supported by management. The practice sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider must make improvements are:

• Establish governance arrangements including systems for assessing and monitoring risks and the quality of the service provision.
• Ensure that staff have up to date professional registration and indemnity.
• Provide staff with appropriate up to date practice specific policies to carry out their roles in a safe and effective manner which are reflective of the requirements of the practice and local CCG.
• Ensure that staff participate in mandatory training.
• Securely maintain accurate, complete and contemporaneous patient records.
• Ensure there is a process in place for undertaking criminal record checks at the appropriate level for clinical staff.
• Introduce robust processes for reporting, recording, acting on and monitoring significant events, incidents and near misses.
• Ensure quality improvement activities such as clinical audits are undertaken to improve patient outcomes.
• Ensure staff who act as chaperones receive training and understand the role.
• Ensure confidential waste is stored securely for disposal.

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.

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 a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

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

Updated 19 May 2016

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

The provider was rated as inadequate for safety, effective and well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

There were, however, examples of good practice:

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Patients discharged from hospital were contacted by the practice to identify needs. For example, medications or review appointments.
• A practice nurse was the diabetic lead. Over ninety percent of patients with diabetes, on the register, had a record of a foot examination and risk classification compared to the CCG average of 89% and the national average of 88%
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and a structured annual review to check their health and medicines needs were being 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.

Updated 19 May 2016

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

The provider was rated as inadequate for safety, effective and well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

There were, however, examples of good practice:

• 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 relatively high for all standard childhood immunisations.
• 80% of patients with asthma, who were on the register, had received an asthma review in the preceding 12 months compared to the CCG average of 79% and the national average of 75%
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.
• 81% of women aged 25 to 64 had a cervical screening test recorded in the preceding five years compared to the national average of 82%
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, local palliative care nurses, health visitors and school nurses.

Updated 19 May 2016

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

The provider was rated as inadequate for safety, effective and well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

There were, however, examples of good practice:

• 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 percentage of people aged 65 or over who received a seasonal flu vaccination was 69% which was slightly lower than the national average of 73%.
• Older people had care plans where necessary
• Nationally reported data showed that outcomes for patients for conditions commonly found in older people were mixed. 86% of patients with rheumatoid arthritis, on the register, had a face-to-face annual review in the preceding 12 months compared to the CCG average of 90% and the national average of 91%.

Updated 19 May 2016

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

The provider was rated as inadequate for safety, effective and well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

There were, however, examples of good practice:

• 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 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.
• Evening open access clinics were available to working people

Updated 19 May 2016

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

The provider was rated as inadequate for safety, effective and well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

There were, however, examples of good practice:

• 80% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was slightly below the national average of 84%.
• 71% of patients with schizophrenia, bipolar affective disorder and other psychoses had a care plan documented in the record, in the preceding 12 months, agreed between individuals, their family and/or carers as appropriate compared to the CCG average of 89% and the national average of 88%.
• The practice regularly worked with multi-disciplinary teams in the case management of people 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. For example, local carer and Alzheimers support groups
• 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.
• The practice was a registered Dementia Friendly location. Staff had received training to understand the needs of patients with dementia.

Updated 19 May 2016

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

The provider was rated as inadequate for safety, effective and well-led. The concerns which led to these ratings apply to everyone using the practice, including this population group.

There were, however, examples of good practice:

• 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 multi-disciplinary teams in the case management of vulnerable people.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• 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.