Archived: Dr Alok Mittal Also known as Markyate Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Alok Mittal also known as Markyate Surgery on 20 January 2017. The overall rating for the practice at that time was inadequate and the practice was placed in special measures for a period of six months. The full comprehensive report on the January 2017 inspection can be found by selecting the ‘all reports’ link for Dr Alok Mittal on our website at www.cqc.org.uk.

This report follows a further inspection undertaken following the period of special measures, and was an announced comprehensive inspection which took place on 28 September 2017. At the inspection we found insufficient evidence of improvement and we identified further serious concerns. Overall the practice is still rated as inadequate.

Our key findings were as follows:

• Patients were at risk of harm because systems and processes were not implemented in a way to keep them safe. For example, we identified continuing deficiencies in respect of acting on safety alerts from the Medicines and Healthcare Products Regulatory Agency (MHRA) and further serious concerns were identified in respect of monitoring patients on high risk medicines, communicating abnormal test results to patients and the processing of referrals.

• Evidence showed that care and treatment was not always delivered in line with recognised professional standards and guidelines. For example, the review of patients with long-term conditions and those with a learning disability.

• Patient outcomes were hard to identify as little or no reference was made to audits or quality improvement. There was no evidence that the practice was comparing its performance to others; either locally or nationally.

• Data from the national GP patient survey showed patients rated the practice lower than others for many aspects of care and they had in some cases got worse since our January 2017 inspection.

• The practice identified and supported patients who were also carers, the number of carers identified had improved since our January 2017 inspection.

• Data from the national GP patient survey showed patients rated the practice significantly below others in respect of access to the service and they had in some cases got worse since our January 2017 inspection.

• Information about how to complain was available and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff.

• We had serious concerns about the overall leadership of the practice and their ability to facilitate and sustain improvement.

The areas where the provider 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.

In addition the provider should:

• Consider ways to improve bowel and breast cancer screening uptake rates to bring in line with local and national averages.

• Consider GP provision for access to a female GP.

This service was placed in special measures in March 2017. Insufficient improvements have been made such that there remains an overall rating of inadequate. 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

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Alok Mittal on 20 January 2017. Overall the practice is rated as inadequate.

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

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events. However, the provider could not demonstrate that patient safety alerts were acted on.
• Risks to patients were assessed and well managed although fire drills had not been practiced.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. Although not all nursing staff had received training in the Mental Capacity Act 2005.
• Clinical audit did not demonstrate quality improvement and there was no program of quality improvement.
• Patient outcomes were below average when compared to local and national averages particularly in relation to the management of long-term conditions and cervical screening.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients 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. However, results from the national GP survey showed that patient satisfaction with access was significantly below average.
• The practice had adequate facilities and was equipped to treat patients and meet their needs.
• The practice had an overarching governance framework however it was ineffective. We also had serious concerns about the overall leadership of the practice.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

• Establish a program of quality improvement to include clinical audit to drive improvement in patient outcomes.
• Establish an effective follow-up system to improve outcomes for patients with long-term conditions and to improve cervical screening uptake.
• Establish a system to ensure antibiotic prescribing and hypnotic prescribing (used in the treatment of insomnia) is monitored and risks to patients mitigated.
• Ensure risks to patients with learning difficulties are assessed, monitored and mitigated.
• Ensure patient safety alerts received from the Medicines and Healthcare Regulatory Agency (MHRA) are acted on to mitigate health and safety risks to patients.

In addition, the practice should:

• Carry out regular fire drills.
• Ensure all clinical staff receive formal training in the Mental Capacity Act 2005.
• Develop care plans for vulnerable patients on the unplanned hosptial admissions register.
• Consider ways to improve patient satisfaction of the service as a result of feedback.
• Consider ways to identify and support more patients who are also carers.
• Develop a strategy to deliver the practice vision.
• Consider ways to improve patient participation in the national screening programmes for bowel and breast cancer.

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