The Care Quality Commission
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  • GP practice

Archived: Dr Pushpa Chopra

Overall: Requires improvement read more about inspection ratings

75 Sunnyside Gardens, Upminster, Essex, RM14 3DP (01708) 223156

Provided and run by:
Dr Pushpa Chopra

All Inspections

02 November 2015

During a routine inspection

Letter from the Chief Inspector of General Practice


We carried out an announced comprehensive inspection at Dr Pushpa Chopra on 02 November 2015 and conducted further staff interviews by phone on 05 November 2015. Overall the practice is rated as requires improvement.

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

  • Shortfalls we identified at previous inspections of the practice in June/July 2014 and in September 2014 had been remedied. Other shortfalls were identified at this inspection however.

  • There was an open and transparent approach to safety and a system was in place for reporting and recording significant events.

  • Risks to patients were assessed, with the exception of those relating to legionella.

  • The practice achieved 62.1% of the total Quality and Outcomes Framework (QOF) points available, compared with the Havering Clinical Commissioning Group average of 92.2%. The GP had made an active decision not to participate in the QOF programme. The GP had not put in place alternative audits to demonstrate how the practice was improving outcomes for patients.

  • Clinical audits demonstrated quality improvement, however they were few in number.

  • The majority of patients said they were treated with compassion, dignity and respect, and were involved in their care and decisions about their treatment.

  • Information about services and how to complain was available and easy to understand.

  • Patients said they found it easy to make an appointment with a named GP and that there was continuity of care. Urgent appointments were 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 had proactively sought feedback from patients.

The areas where the provider must make improvements are:

  • Ensure systems are in place to monitor and improve patient outcomes.

  • Ensure patient records fully document the care and treatment that has been provided.

  • Ensure processes are in place so that national guidelines for the monitoring of long term conditions are followed.

  • Ensure all staff who act as chaperones have received a disclosure and barring service (DBS) check.

  • Ensure protocols for repeat prescribing are adhered to.

  • Ensure a legionella risk assessment is in place.

In addition the provider should:

  • Check regularly that prescription pads and Statement of Fitness for Work forms are stored securely at all times to prevent their misuse.

  • Put a system in place so that all patients with a current or past diagnosis of depression have a coded entry that appears on their medical summary and informs a register of patients with current or past depression.

  • Record clearly using appropriate coded entries in the notes where a patient has made an informed choice not to have a recommended treatment.

Where a practice is rated as inadequate for one of the five key questions or one of the six population groups it will be re-inspected within six months after the report is published. If, after re-inspection, it has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group, we will place it into special measures. Being placed into special measures represents a decision by CQC that a practice has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

24 September 2014

During an inspection looking at part of the service

On the day of our visit we did not speak to patients due to the nature of the visit and the time we visited. We found that improvements had been made since our last visit on 15 July 2014. At our last visit, we were concerned that the provider had not ensured that adequate systems were in place to deal with medical emergencies. During this visit we found that the expired oxygen cylinder had been replaced, the defibrillator pads had been replaced and emergency medication was in date.

On 15 July 2014 we identified concerns relating to the management of patients on disease-modifying anti-rheumatic drugs (DMARDS) and communication processes between clinical staff were unclear and could not be evidenced. During this visit, we could track patients who had been referred for different procedures including two week wait. as well as check on whether patients on DMARDs had regular blood tests.

Although progress had been made there were shortfalls. These related to the management of patients on warfarin. It was not always noted in the medical records that the patient was still on warfarin as this was managed by a pharmacy commissioned by the Clinical Commissioning Group (CCG).This posed a potential risk for patients especially if they a was a doctor who did not know their history as there was no record of warfarin prescriptions on the patient record.

27 June and 15 July 2014

During an inspection in response to concerns

We spoke to six patients, two GPs including the principal, two nurses, two administrative staff and the practice manager. We also spoke to healthcare professionals in the community after our visit. People told us that they were happy with the care and treatment they received.

Care and treatment was not always planned and delivered in a way that was intended to ensure people's safety and welfare. Patient's needs were assessed and care and treatment was not always planned and delivered in line with their individual care plan.

Patients were not always cared for in a clean and hygienic environment. The nurse's consultation room was visibly dirty. There were boxes on the floor, blinds were dirty, the examination light was dusty, and the oxygen mask was opened and dusty. Chairs in consulting rooms and the waiting area were covered with fabric and difficult to clean.

There were inadequate systems in place to effectively monitor training needs of all staff, maintenance of the environment, health and fire safety and adherence to infection control policies. Staff awareness of infection control and mental capacity principles was limited. There were inadequate systems in place to monitor and support staff to develop in their current roles. There was no system in place to check whether nurse's registration was up to date.

17 September 2013

During a routine inspection

We spoke with people visiting the surgery on the day of our inspection. They all told us they were happy with the service provided by the medical staff at the practice. One person said 'the doctors and nurses are very good'. Another said 'they are all very friendly and helpful, you don't feel rushed'. People told us the GPs were approachable, listened, and they could ask questions if they needed to.

All the people we spoke with on the day of our inspection told us they had been able to make an appointment which suited them on either a planned or emergency basis. People we spoke with had positive views about the reception staff at the practice. One person said 'the reception staff are very good here, they are very pleasant and helpful'. All those we spoke with said that their privacy and dignity was respected.

People's care was planned and delivered in a way that met their individual needs. We looked at four people's records regarding chronic disease planning, care and advice. There was evidence that plans were discussed with patients and appropriate referrals made. We found that people were protected from the risk of abuse because the provider had procedures in place for safeguarding vulnerable adults and children. Medical staff we spoke with were aware of these procedures. The provider had adequate systems in place to prevent, detect and control the spread of infection. There was also an effective system for dealing with complaints made by people who used the service.