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Dr Roshan Khuroo Good Also known as Stockland Green Practice

Inspection Summary


Overall summary & rating

Good

Updated 22 December 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Roshan Khuroo (also known as Stockland Green Practice) on 19 January 2017. The overall rating for the practice was requires improvement. Data taken from the July 2016 national GP patient survey showed areas where patient satisfaction was below local and national averages and the overarching governance arrangements did not support effective management of risks. The full comprehensive report on the January 2017 inspection can be found by selecting the ‘all reports’ link for Dr Roshan Khuroo on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 10 October 2017 to confirm that the practice had carried out their plan to improve in areas we identified in our previous inspection on 19 January 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is rated as good.

Our key findings were as follows:

  • Data from the 2016/17 Quality and Outcomes Framework showed the practice was an outlier for some QOF clinical domains; however, data showed areas of improvement since our previous inspection. Staff were aware of the practice performance and were taking action to improve patient engagement.
  • Since our previous inspection, the practice had reviewed their systems to improve the uptake of national screening programs and had used various methods such as attending local community events and accommodated additional clinics to increase uptake.
  • The 2016/17 Child Health Information data provided by the practice showed improvement in the uptake of childhood immunisations. For example, vaccinations given to under two year olds ranged from 82% to 95%.
  • Although, results from the July 2017 national GP patient survey showed patients’ satisfaction remained below local and national averages; patients’ satisfaction had slightly improved in some areas. For example, satisfaction with accessing the service by phone had improved and comments from patients we spoke with were positive about phone access.

  • Since our previous inspection, the practice had carried out their own patient survey, which showed patients were satisfied with some of the services provided. For example, patients were positive about phone access and experience of making an appointment. However, patients we spoke with during our inspection had mixed views regarding levels of satisfaction. In particular, patients were not always satisfied with consultations.

  • The practice was aware of areas of low patient satisfaction; an action plan was in place and staff continued working to improve areas where satisfaction was below local and national averages.
  • To address concerns relating to staffing levels and appointment availability the practice recruited additional staff and implemented a new rota system.

The provider should make improvements in the following areas:

  • Continue to monitor and ensure on-going improvement to patient satisfaction, such as responses to clinical and non-clinical aspects of survey outcomes.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 13 April 2017

  • There were systems to monitor safety. These included systems for reporting incidents, significant events which included positive learning events, near misses, as well as comments and complaints received from patients. The practice had monthly meetings to discuss lessons learnt and implement action plans. Risk assessments were in place. This included health and safety risk assessments.
  • There was an effective system in place to ensure all alerts were reviewed and acted on appropriately, including alerts received from the Medicines and Healthcare products Regulatory Agency (MHRA).
  • The practice had a system in place for monitoring the use of blank prescription forms and processes were in place for handling repeat prescriptions, this included the monitoring and prescribing of high risk medicines. We saw evidence that an audit had been completed during October 2016 and December 2016 to identify patients on high risk medicines, to ensure guidelines were being followed and patients were being monitored regularly.  

  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse. The staff we spoke with were aware of their responsibilities to raise and report concerns, incidents and near misses.
  • When things went wrong patients received a written apology. They were told about any actions to improve processes to prevent the same thing happening again.
  • We observed the premises to be clean and tidy and we saw completed cleaning specifications to demonstrate that the required cleaning had taken place for each area of the practice.

Effective

Good

Updated 22 December 2017

At our previous inspection on 19 January 2017, we rated the practice as requires improvement for providing effective services, as the uptake of national screenings, childhood immunisations and performance for mental health related indicators was lower than local and national averages. These arrangements had improved when we undertook a follow up inspection on 10 October 2017. For example,

  • The practices attended local community events, reviewed their recall system and accommodated additional nursing sessions on Saturdays to increase the uptake of screening. Data showed improvements in the uptake of cervical screening.
  • The uptake of bowel and breast cancer screening remained below local and national averages. However, the practice continued to opportunistically encourage patients to engage and staff actively followed up non-responders.
  • Data from the 2016/17 Quality and Outcomes Framework (QOF) showed patient outcomes had improved since our previous inspection.
  • Staff were aware of the practice performance and able to demonstrate actions to further improve performance. For example, staff followed established protocols for managing exception reporting and were actively working towards improving the accuracy of their patient list.
  • The practice took an active approach to joint working and engaged well with other health professionals. Unverified data from 2016/17 provided by the practice showed improvement in the uptake of childhood immunisations. For example, vaccinations given to under two year olds ranged from 82% to 95%. 

Caring

Good

Updated 22 December 2017

At our previous inspection on 19 January 2017, we rated the practice as requires improvement for providing caring services as the July 2016 nation GP survey results regarding patients satisfaction with consultations with GPs were lower than the CCG and National averages. Patients’ satisfaction with their involvement in planning their care was also below local and national averages. At that time, the practice was unable to demonstrate that they had reviewed survey results and put actions in place to improve patient satisfaction. These arrangements had improved when we undertook a follow up inspection on 10 October 2017. For example:

  • Data from the July 2017 national GP patient survey showed patients satisfaction had mainly improved since our previous inspection. However, satisfaction remained below local and national averages for areas such as consultations with GPs.
  • Data from an in-house patient survey commenced September 2017 showed patients were satisfied with their consultations.
  • An action plan to address areas of concern was in place and staff continued working to improve patient satisfaction.
  • The practice had reviewed the national GP survey results and had carried out an internal survey to gain further feedback from patients. Unverified data from an internal survey showed patients were satisfied with the services provided. 

Responsive

Good

Updated 31 October 2018

At our previous inspection on 10 October 2017, we rated the practice as requires improvement for providing responsive services as survey results showed low patient satisfaction in areas such as clinical consultations and timely access to services. The practice were unable to demonstrate that they had reviewed survey results or put actions in place to improve patient satisfaction.

When we undertook a fellow up desk-based review on 01 October 2018, published survey data and patient feedback indicated positive changes in patient satisfaction. The practice, and all of the population groups is now rated as good for providing responsive services.

Timely access to care and treatment

When we carried out our October 2017 inspection, published data and patient feedback showed that patients were not always able to access care and treatment from the practice within an acceptable timescale for their needs. At the time of our previous inspection, the practice had developed an action plan and were in the early stages of implementing changes. For example, a new phone system was installed and GPs were doing longer clinics. Since our previous inspection, national survey results published in August 2018 indicated positive improvements in patient’s satisfaction with access to care and treatment. Patient feedback received through completed Care Quality Commission (CQC) comment cards as well as comments placed on NHS Choices web page were aligned with national survey results. At this inspection, we found that:

  • Patients had timely access to initial assessment, test results, diagnosis and treatment.
  • Waiting times, delays and cancellations were minimal and managed appropriately.
  • Patients with the most urgent needs had their care and treatment prioritised.
  • The practices GP patient survey results were mainly above local and national averages for questions relating to access to care and treatment. The practice was aware of the data, and explained that ongoing actions which were in their early stages at the time of our October 2017 inspection, had started to show positive impact on patient’s satisfaction. For example, the practice had a new phone system installed prior to our previous inspection, members of the management team explained that patient satisfaction with phone access has gradually improved over the years.
  • The practice had an active patient participation group who met with the practice every three months. Documents provided by the practice demonstrated active discussions regarding survey results and updates regarding changes to improve phone access such as having three receptionists operating the phone lines during busy periods as well as effective care navigation.

Please refer to the evidence tables for further information.

Well-led

Good

Updated 13 April 2017

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff spoke positively about the team and about working at the practice.
  • There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular governance meetings.
  • There was an overarching governance framework which supported the delivery of the strategy and good quality care.
  • The provider was aware of and complied with the requirements of the duty of candour. The GP provider encouraged a culture of openness and honesty. The practice had systems in place for notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken
  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active and meetings were held every six months. We saw evidence to confirm that the last meeting had been held in November 2016.
Checks on specific services

People with long term conditions

Good

Families, children and young people

Good

Older people

Good

Working age people (including those recently retired and students)

Good

People experiencing poor mental health (including people with dementia)

Good

People whose circumstances may make them vulnerable

Good