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Inspection Summary


Overall summary & rating

Good

Updated 19 April 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Rajiv Chitre on 17 August 2017. The overall rating for the practice was good. However, it was rated requires improvement for providing safe services. The full comprehensive report on the August 2017 inspection can be found by selecting the ‘all reports’ link for Dr Rajiv Chitre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 7 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 17 August 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

  • The practice had reviewed it process to ensure patient safety alerts such as those from Medicines and Healthcare products Regulatory Agency (MHRA) were received and actioned appropriately.

  • The practice had established a system to ensure relevant alerts were communicated to relevant staff at both sites. If there were urgent risks that needed to be communicated to staff they would be escalated by the practice manager either through a telephone call or by visiting the site.

  • To meet the needs of the increasing patient list size the practice had recruited extra administration staff and increased clinical sessions.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 19 April 2018

Effective

Good

Updated 10 October 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were at or above average compared to the national average.
  • The practice was able to demonstrate quality improvement through completed cycles of clinical audits.
  • Staff had the skills and knowledge to deliver effective care and treatment.
  • There was evidence of appraisals and personal development plans for all staff.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.
  • End of life care was coordinated with other services involved.

Caring

Good

Updated 10 October 2017

The practice is rated as good for providing caring services.

  • During our previous inspection in May 2016 data from the national GP patient survey (January 2016) showed patients rated the practice below average for some of its satisfaction scores. At this inspection the practice was able to demonstrate actions taken to improve and the latest data we looked at (July 2017) showed that the practice had achieved improvement.
  • Patients we spoke with on the day said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
  • Information for patients about the services available was easy to understand and accessible.
  • During our previous inspection we saw carers packs were available at the practice but the number of carers registered by the practice was significantly low. At this inspection the practice had improved on the numbers of carers identified.

Responsive

Good

Updated 10 October 2017

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the Clinical Commissioning Group to secure improvements to services where these were identified. For example, the practice was taking part in the primary care commissioning framework (PCCF). As part of this, the practice was expected to offer various services such as end of life care and to improve the management of long term conditions.
  • A Mental Health Counsellor (funded by the CCG) held weekly clinics and offered links to other mental health services (at the branch site).
  • Support was available for those with drug and alcohol addictions. A drugs misuse support worker (funded by the CCG) held clinics to manage and support patient needs.

  • Most 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 premises were located in a converted house that had recently been renovated to offer improved facilities to treat patients and meet their needs.
  • Information about how to complain was available and evidence from seven examples reviewed showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 10 October 2017

The practice is rated as good for being well-led.

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. This was supported with a business strategy and staff were clear about the vision and their responsibilities in relation to it.
  • Staff had received inductions, annual performance reviews and attended staff meetings and training opportunities. There was a focus on continuous learning and improvement at all levels. Staff training was a priority and was built into staff rotas.
  • The partners encouraged a culture of openness and honesty. The practice had systems for being aware of notifiable safety incidents and sharing the information with staff and ensuring appropriate action was taken.
  • The practice proactively sought feedback from staff and patients and we saw examples where feedback had been acted on. The practice engaged with the patient participation group.
  • GPs who were skilled in specialist areas used their expertise to offer additional services to patients.
  • There was a clear leadership structure and staff felt supported by management. The practice had policies and procedures to govern activity and held regular governance meetings.
  • There was a governance framework which generally supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk. However, the management of medicine safety alerts was not always effective.
Checks on specific services

People with long term conditions

Good

Updated 10 October 2017

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

  • Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.

  • Performance for diabetes related indicators was 87% which was in line with the CCG average of 88% and national average of 90%. Diabetic patients were referred to structured learning programmes and a diabetes specialist consultant along with a specialist nurse held bi-monthly clinics for more complex cases. This was as part of the Diabetes Inpatient Care and Education (DICE) programme, a CCG funded area of enhanced care.

  • The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
  • There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
  • Longer appointments and home visits were available when needed. Patients with long term conditions 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.
  • The practice offered a range of services to support the diagnosis and management of patients with long term conditions such as insulin initiation, electrocardiographs (ECGs) and spirometry.

Families, children and young people

Good

Updated 10 October 2017

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

  • From the sample of documented examples we reviewed we found there were systems 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 accident and emergency (A&E) attendances.
  • Immunisation rates were relatively high for all standard childhood immunisations.
  • Priority for appointments was given to sick children. The practice had baby changing facilities and offered a breast feeding friendly service.
  • Appointments were available outside of school hours.
  • The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.

Older people

Good

Updated 10 October 2017

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

  • Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
  • The practice offered proactive, personalised care to meet the needs of the older patients in its population.
  • The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
  • The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. They involved older patients in planning and making decisions about their care, including their end of life care.
  • The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
  • Where older patients had complex needs, the practice shared summary care records with local care services.
  • The practice regularly worked with other health professionals to review patients and to ensure the needs of those with the most complex care needs were being met. For example, patients with end of life care needs or that had an unplanned admission to hospital.

Working age people (including those recently retired and students)

Good

Updated 10 October 2017

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

  • The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, the practice offered extended opening hours on a Monday until 8pm. Extended Saturday opening was available from 9am to 12 noon at the branch site (NHS Tanhouse). This was useful for patients who were unable to attend due to work or other commitments during normal opening hours.
  • 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.
  • A telephone triage service enabled patients who were unable to attend the practice easily to seek clinical advice.
  • Enhanced text messaging service was used to allow for two way interactive patient messaging.
  • The practice offered virtual membership to its patient participation group to encourage feedback from this group of patients.

People experiencing poor mental health (including people with dementia)

Good

Updated 10 October 2017

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

  • The practice carried out advance care planning for patients living with dementia.
  • 100% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months. This was above the CCG average of 84% and the national average of 84%. The exception reporting was 0% compared to the CCG and national average of 7%.
  • 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.
  • The practice also used single point access to manage both routine and urgent referrals for working age adult mental health services.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. A Mental Health Counsellor held weekly clinics at the site and offered links to other mental health services.

People whose circumstances may make them vulnerable

Good

Updated 10 October 2017

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

  • The practice offered longer appointments for patients with a learning disability and health checks were offered to them.
  • The practice held a register of patients living in vulnerable circumstances including those with a learning disability.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.
  • A Drugs Misuse Support Worker held clinics at the practice to manage and support patients’ needs.
  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
  • End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
  • Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.