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Dr Jayesh Bhatt Good Also known as Park Medical Centre

Reports


Inspection carried out on 17/05/2018

During a routine inspection

This practice is rated as Good overall. (Previous inspection October 2017 – Requires Improvement)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Dr Jayesh Bhatt, known to patients as Park Medical Centre, on 17 May 2018 to follow up on breaches of regulations identified in our previous inspection in October 2017.

At our previous inspection we told the provider they must make improvement to:

  • 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.
  • Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

We also identified areas where the provider should make improvement including:

  • Advertise translation in waiting area.
  • Take action to increase the proportion of patients who receive appropriate and timely reviews.
  • Assess and take action to increase the uptake of the MMR vaccine

The full comprehensive report from the inspection undertaken In October 2017 can be found by selecting the ‘all reports’ link for Dr Jayesh Bhatt on our website at www.cqc.org.uk.

At this inspection we found:

  • The practice had put in place systems and processes which addressed the concerns raised at our previous inspection.
  • The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
  • The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
  • Staff involved and treated patients with compassion, kindness, dignity and respect.
  • Most patients found the appointment system easy to use and reported that they could access care when they needed it.
  • There was a focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

  • Review the practice policy and procedure for receiving, reviewing, acting on and learning from external safety events as well as patient and medicine safety alerts, ensuring the policy reflects working practice.
  • Consider the requirement for and benefit of having pulse oximeters for use on children.
  • Review cleaning schedules, practices and record keeping ensuring clinical equipment cleaning is recorded and checked in line with other cleaning.
  • Continue to monitor and improve childhood immunisation uptake rates.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Inspection carried out on 12 October 2017

During a routine inspection

Letter from the Chief Inspector of General Practice


We carried out an announced comprehensive inspection at Dr Jayesh Bhatt on 9 June 2016. The overall rating for the practice was requires improvement. The full comprehensive report from the inspection undertaken on 9 June 2016 can be found by selecting the ‘all reports’ link for Dr Jayesh Bhatt on our website at www.cqc.org.uk.

As a result of our findings from this inspection CQC issued a requirement notice for the identified breaches of Regulations 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Breaches identified related to concerns associated with the management of significant events, absence of mandatory training, lack of action being taken to mitigate against infection control risks and deficiencies in arrangements to deal with medical emergencies.

This inspection was undertaken within 12 months of the publication of the last inspection report as the practice was rated as requires improvement for two of the key questions; are services safe? and are services well led? and so requires improvement overall. This was an announced comprehensive inspection completed on 12 October 2017. Overall the practice is now rated as requires improvement.

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

  • Systems to manage clinical correspondence were not effective and printer prescriptions were not stored securely and their use was not monitored. Checks of emergency equipment were not always documented and there were no systems in place which checked clinical staff’s professional registration and to ensure that all staff had adequate indemnity insurance in place. However, risks associated with the premises including fire and infection control were assessed and well managed.
  • There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
  • Staff were aware of current evidence based guidance. Staff had been trained to provide them with the clinical skills and knowledge to deliver effective care and treatment. However, most staff had not received information governance training in the last 12 months and some staff were not receiving regular appraisals.
  • There was minimal evidence of quality improvement work being undertaken.
  • The practice were performing below national and local averages for their management of patients with mental health conditions and only four of the 26 patients on their learning disability register had received an annual review.
  • Results from the national GP patient survey showed patients 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.
  • 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 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 proactively sought feedback from staff and patients, which it acted on. However there were deficiencies in governance which undermined the safe provision of care.
  • The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider must make improvement 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.

  • Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

The areas where the provider should make improvement

  • Advertise translation in waiting area.

  • Take action to increase the proportion of patients who receive appropriate and timely reviews.

  • Asssess and take action to increase the uptake of the MMR vaccine

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection carried out on 9 June 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Dr Jayesh Bhatt on 9 June 2016. Overall the practice is rated as requires improvement.

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

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events however learning was not always clear and patients did not always receive information about the incident.
  • Risks to patients were not always assessed and well managed. For example the practice had not addressed the action points identified in their infection control audit, testing of non-clinical electrical equipment had not been completed for a number of years and one of the oxygen masks had expired. In addition the practice were not undertaking adequate recruitment checks prior to employment including DBS checks and obtaining references for all new staff. The practice’s supply of emergency medicines was not in line with guidelines and the absence of certain medications had not been risk assessed.
  • There were significant gaps in mandatory staff training including safeguarding, information governance, infection control and fire safety. Additionally basic life support training had not been completed by any staff member within the last 12 months. Evidence was provided after our inspection that this had been completed or was scheduled.
  • There was no evidence of care planning for those with long term conditions or who were at the end of their lives. However we saw evidence that care was being delivered in line with current evidence based guidance. Staff had received clinical training to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • 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. However responses to complaints were not entirely in line with current legislation and guidance.
  • The majority of 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.
  • With the exception of infection control issues and emergency equipment the practice had good facilities and was well equipped to treat patients and meet their needs.
  • Though in a number of respects lines of responsibility were clear there was a lack of leadership or effective management in a number of areas; particularly infection control and training and recruitment. The practice proactively sought feedback from staff and patients, which it acted on.

The areas where the provider must make improvement are:

  • Ensure that there is appropriate learning from significant events and that patients are always provided with a written apology and explanation of action taken to address the issues arising from significant events.

  • Put systems and processes in place to ensure that mandatory training is completed at appropriate intervals.

  • Take action to address and monitor all infection control risks.

  • Put robust arrangements in place to ensure that the practice are able to respond effectively to medical emergencies including a risk assessment of required emergency medicines.

The areas where the provider should make improvement are:

  • Consider installing a hearing loop in the reception area.

  • Ensure that all clinical staff are aware of and acting in accordance with the mental capacity act 2005.

  • Undertake regular reviews of the practice’s business plan.

  • Assess the risks associated with non-medical electrical equipment and take appropriate follow up action to ensure those risks are mitigated.

  • Continue to review staffing resources and ensure that sufficient numbers of staff are employed.

  • Ensure that all appropriate pre-employment checks completed prior to new staff commencing employment and that all staff have a completed schedule of induction.

  • Employ strategies to promote and increase breast screening and the number of reviews of patients with Chronic Obstructive Pulmonary Disease (COPD).

  • Ensure that staff are completing care plans for all patients where appropriate and that appropriate action is taken in response to correspondence from other organisations.

  • Consider advertising translation services in the practice waiting area.

Ensure complaints policy and responses comply with current legislation and that systems are in place to ensure compliance with the duty of candour.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice