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Dr Jagtar Chaggar Good Also known as St Pauls Surgery

Inspection Summary


Overall summary & rating

Good

Updated 9 November 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Jagtar Chaggar on 8 December 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the September 2016 inspection can be found by selecting the ‘all reports’ link for Dr Kanjana Paramanathan on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 4 October 2017 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 8 October 2016. 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.

  • During our previous inspection the practice reviews and investigations of incidents or significant events were not thorough enough and lessons learned were not communicated widely to support improvement. At this inspection the practice had reviewed its significant event protocol, developed a more effective process and introduced a learning and analysis element to the significant event investigation template.

  • Patient Group Directions (PGD) were signed by a manager and were up to date at this inspection.

  • When we inspected the practice in December 2016 we saw procedures for prescribing medicines which required regular monitoring were not implemented consistently for all patients’ prescribed high risk medicines. At this inspection we saw that an effective system had been implemented.

  • There were appropriate emergency medicines available in the practice.

  • The practice had addressed areas of high exception reporting for long term disease management (QOF).

  • Audits we looked at referenced quality standards and care pathways. The findings identified improvements in several areas of the referral process. Audits were detailed and had identified areas for improvement which they were acting on.

  • Staff files looked at demonstrated that appraisals had taken place for all staff within the last 12 months.

  • Reviews of some care plans demonstrated reference to guidance and the GP we spoke with was able to demonstrate competency in accessing care plans on the system.

  • Examples of referral letters we looked at were appropriate in formation. Most GPs used a template on the system for referral letters which they then used to make the referral.

  • During our previous inspection we saw that there was no hearing loop in the practice. The practice had considered the installation of a hearing loop and had developed alternative arrangement s to support patients with a hearing impairment in the interim until they moved to new premises

  • The practice had reviewed its management structure and had developed a clear organisational chart detailing line management responsibilities and roles.

  • When we inspected the practice in December 2016 we saw locum GPs did not appear to have engagement in areas such as QOF performance and the management of long term conditions. They were not routinely involved in evidence based guidelines discussions and there was a risk they may therefore not be aware of valuable clinical information. At this inspection we saw evidence that sessional GPs had taken over responsibility in clinical areas such as for diabetes and mental health. Records of meetings we looked at demonstrated their attendance where guidance was discussed.

The areas of practice where the provider should make improvements are:

  • Consider effective ways to ensure patients are made aware of the benefits of health screening programmes.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 9 November 2017

At our previous inspection, we rated the practice as requires improvement for providing safe services. Records did not clearly evidence that learning from incidents had taken place and that action points had been addressed. Reviews and investigations were not thorough enough and lessons learned were not communicated widely enough to support improvement. Patient Group Directions (PGD) were not always signed and authorised appropriately. Procedures for prescribing medicines which require regular monitoring were not implemented consistently for all patients’ prescribed high risk medicines.

We saw evidence that the practice had improved when we undertook a follow up inspection on 4 October 2017. For example:

  • The practice had reviewed its significant event protocol and had introduced a learning and analysis element to the significant event investigation template. The practice had also introduced quarterly significant event audit meetings to discuss learning and trends.

  • We saw that all Patient Group Directions (PGDs) were signed by a manager and were up to date.

  • The practice had reviewed its process for managing patients on high risk medicines. There was a record of all patients on high risk medicines and a designated staff member took on the responsibility of reviewing these patients to ensure effective management. There were alerts on the patient record system and the practice had developed a pathology recall system which added an extra layer of safety which was also reviewed monthly.

  • We saw appropriate emergency medicines were available in the practice. The practice had purchased adrenaline that was suitable to administer to adults, children and infants. The practice had a system to ensure all emergency medicines were up to date and appropriately stored.

Effective

Good

Updated 9 November 2017

At our previous inspection, we rated the practice as requires improvement for providing effective services. Data from the Quality and Outcomes Framework (QOF) showed most outcomes were comparable with or above the national average. However the practice had no plans to address and improve the high exception reporting in respect of the management of patients diagnosed with Chronic Obstructive Pulmonary Disease (COPD). Clinical audits did not demonstrate quality improvement. The system for care planning was not effective and a GP was not able to access these on the clinical system on the day of our visit. There was no clinical oversight of referral letters to secondary care services like hospitals. This included patients referred under the two week wait.

We saw evidence that the practice had improved when we undertook a follow up inspection on 4 October 2017. For example:

  • The practices Chronic Obstructive Pulmonary Disease (COPD) register showed 55 patients of whom 11 (20%) were excluded so far. The practice was aware of these patients and records we looked at showed that they were appropriately excluded.

  • We saw one audit on the (gastrointestinal) referral process which referenced quality standards and care pathways. The findings identified improvements in several areas of the referral process. The practice had also carried out an audit on the use of laxatives in adults. We saw that both audits were detailed and had identified areas for improvement.

  • We looked at six staff files and saw that appraisals had taken place for all within the last 12 months.

  • Care plans we sampled demonstrated that reference to guidance and the GP we spoke with was able to demonstrate competency in accessing care plans on the system. Clinical notes we looked at showed the care plans were appropriate.

  • We looked at examples of referral letters and they contained relevant information. Most GPs used a template on the system for referral letters which they then used to make the referral.

Caring

Good

Updated 9 November 2017

Responsive

Good

Updated 9 November 2017

Well-led

Good

Updated 9 November 2017

At our previous inspection, we rated the practice as requires improvement for providing well-led services. Some staff told us that there was no clear leadership structure and that the roles and responsibilities of the management team were not always clear. There was an overarching governance framework; however clinical audits were not driving improvements in patient care. Locum GPs were not routinely involved in evidence based guidelines discussions and there was a risk they may therefore not be aware of valuable clinical information.

We saw evidence that the practice had improved when we undertook a follow up inspection on 4 October 2017. For example:

  • The practice had reviewed it management structure and had developed a clear organisational chart and had shared this with staff. The organisational chart detailed line management responsibilities and roles. Staff were aware of the line management structure.

  • Audits we looked at referenced quality standards, they were detailed and had identified areas for improvement. We saw the findings were discussed at the clinical meeting.

  • The practice had reviewed its significant event protocol and developed a more effective process.

  • The practice was able to demonstrate understanding of the performance of the practice across all areas. The practice was addressing the high exception reporting for COPD and cervical cytology.

  • Locum GPs had taken over responsibility in clinical areas such as for diabetes and mental health. Records of meetings we looked at demonstrated their attendance to the meetings where issues such as safeguarding, medicines and medicine alerts, significant events and long term conditions were discussed.
Checks on specific services

People with long term conditions

Good

Updated 9 November 2017

The provider had resolved concerns for providing Safe, effective and well-led care identified at our inspection on 8 December 2016 which applied to everyone using this practice, including this population group. As a result, the population group has been rated as good.

Families, children and young people

Good

Updated 9 November 2017

The provider had resolved concerns for providing Safe, effective and well-led care identified at our inspection on 8 December 2016 which applied to everyone using this practice, including this population group. As a result, the population group has been rated as good.

Older people

Good

Updated 9 November 2017

The provider had resolved concerns for providing Safe, effective and well-led care identified at our inspection on 8 December 2016 which applied to everyone using this practice, including this population group. As a result, the population group has been rated as good.

Working age people (including those recently retired and students)

Good

Updated 9 November 2017

The provider had resolved concerns for providing Safe, effective and well-led care identified at our inspection on 8 December 2016 which applied to everyone using this practice, including this population group. As a result, the population group has been rated as good.

People experiencing poor mental health (including people with dementia)

Good

Updated 9 November 2017

The provider had resolved concerns for providing Safe, effective and well-led care identified at our inspection on 8 December 2016 which applied to everyone using this practice, including this population group. As a result, the population group has been rated as good.

People whose circumstances may make them vulnerable

Good

Updated 9 November 2017

The provider had resolved concerns for providing Safe, effective and well-led care identified at our inspection on 8 December 2016 which applied to everyone using this practice, including this population group. As a result, the population group has been rated as good.