All inspections: Dr Paramjit Wasu - Care Quality Commission

We carried out an announced inspection at Dr Paramjit Wasu on 3 August 2021. Overall, the practice is rated as Good.

Safe - Good

Effective - Good

Caring - Good

Responsive - Good

Well-led - Good

At an inspection in June and July 2019 the practice was rated inadequate for all key questions and rated inadequate overall. It was placed into Special Measures. Focussed inspections took place in February and July 2020. At both of those inspections we found improvements had been made.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Dr Paramjit Wasu on our website at www.cqc.org.uk

Why we carried out this inspection

This inspection in July/August 2021 was a comprehensive inspection which looked at all five of the key questions, to follow up on the concerns identified at the previous inspections and to check whether or not the improvements previously identified had been maintained.

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

Conducting staff interviews using video conferencing
Completing clinical searches on the practice’s patient records system and discussing findings with the provider
Reviewing patient records to identify issues and clarify actions taken by the provider
Requesting evidence from the provider
A short site visit

Our findings

We based our judgement of the quality of care at this service on a combination of:

what we found when we inspected
information from our ongoing monitoring of data about services and
information from the provider, patients, the public and other organisations.

We have rated this practice as Good overall and Good for all six population groups.

We found that:

The practice provided care in a way that kept patients safe and protected them from avoidable harm. We found the practice had clear systems and processes in place to keep people safe. This included those related to infection control, risk management, record keeping, medicines management and significant event management.

Patients received effective care and treatment that met their needs. We found patients’ needs were assessed and care and treatment was delivered in line with legislation and guidance. Patient notes were appropriately recorded and quality assurance processes were in place. Staff had undergone the requisite training for their role.

Staff dealt with patients with kindness and respect and involved them in decisions about their care. Evidence we collected and feedback we received about the practice from patients and staff about how they were treated at the practice was largely positive.

The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. Appropriate steps were taken to ensure the practice continued to be accessible to patients whilst ensuring Patients could access care and treatment in a timely way.

The way the practice was led and managed promoted the delivery of high-quality, person-centre care. There had been leadership changes since the previous inspection. The new leadership demonstrated they had the capacity and skills to deliver high quality sustainable care. The overall governance of the practice had improved and there were effective risk and performance management processes in place.

I am taking this service out of special measures. This recognises the significant improvements that have been made to the quality of care provided by this service.

We found no breaches of regulations.

Whilst we found no breaches of regulations, the provider should:

Review and improve their achievement in childhood immunisations.
Review and improve their achievement in cervical screening.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced focused inspection of Dr Paramjit Wasu on 7 July 2020 to check whether the practice had addressed the issues we identified at our previous inspection on 10 February 2020. This report covers our findings in relation to those specific areas and does not change the current ratings held by the practice.

The full report of the 10 February 2020 inspection and all previous inspections can be found by selecting the ‘all reports’ link for Dr Paramjit Wasu on our website at www.cqc.org.uk.

We based our judgement of the quality of care at this service on a combination of:

What we found when we inspected;
Information from our ongoing monitoring of data about services; and
Information from the provider, patients, the public and other organisations.

At this inspection on 7 July 2020 we found the provider had made improvements since our last inspection, although there were still weaknesses in the overall governance and some systems and processes were not yet fully embedded.

Our key findings were as follows:

Safeguarding policies had been updated and were accessible to staff and the practice’s child protection and vulnerable adults registers had been reviewed.
Appropriate recruitment checks had been completed and the practice had copies of necessary employment documents.
Appropriate standards of cleanliness and hygiene were met.
Since the previous inspection the practice had cancelled their registration as a Yellow Fever Centre.
The Royal College of General Practitioners (‘RCGP’) had been supporting the lead GP to maintain clear patient records and our review of records demonstrated improvement in this area.
The practice had effective systems to monitor urgent two-week wait referrals and cervical screening results.
Patient Group Directions (‘PGDs’) were appropriately signed and in date.
Emergency medicines and equipment were appropriately stored and were checked on a regular basis.
There was a system for recording and acting on safety alerts.
We found there were still some gaps in relation to staff training and supervision.
The practice, with external support, had introduced new processes for managing risks, issues and performance.
The overall governance arrangements had improved since the last inspection, although systems and processes were not fully embedded.
Many of the changes to the practice’s systems and processes had been made recently and with significant input and direction from the RCGP, so there was limited evidence at the time of our inspection that this improvement would be sustained over a significant period of time and that the improvement was being driven by practice leaders.

Details of our findings and the evidence supporting our findings are set out in the evidence table.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced focused inspection at Dr Paramjit Wasu on 10 February 2020 to review the improvements made following the inspection on the 25 June and 23 July 2019.

We based our judgement of the quality of care at this service on a combination of:

what we found when we inspected
information from our ongoing monitoring of data about services and
information from the provider, patients, the public and other organisations.

We found that:

The practice had made some improvements such as demonstrating they understood what to do should a patients health deteriorate within the practice.
Staff were now aware of their responsibilities in relation to cold chain monitoring.
There were arrangements in place for monitoring emergency equipment.

However, there were still areas where insufficient improvements had been made:

The practice did not have adequate infection control systems in place.
Staff did not always have the information they needed to deliver safe care and treatment.
The practice did not have systems for the appropriate and safe use of medicines.
The practice did not have an effective system to learn and make improvements when things went wrong.
Patients’ needs were not always assessed and care and treatment was not always delivered in line with current legislation, standards and evidence-based guidance.
There were significant gaps in patient care and treatment.
The practice was unable to demonstrate that all staff had the skills, knowledge and experience to carry out their roles.
Leaders could not demonstrate that they had the capacity and skills to deliver high quality sustainable care.
The overall governance arrangements were ineffective.
The practice did not have clear and effective processes for managing risks, issues and performance.
The practice did not always act on appropriate and accurate information.
The practice did not have effective arrangements in place to ensure emergency medicines were immediately accessible the case of an emergency.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced comprehensive inspection at Dr Paramjit Wasu on 25 June 2019 and a second site visit was carried out on 23 July 2019 as part of our inspection programme. At this inspection we followed up on breaches of regulations identified at a previous inspection on 6 September 2018.

We have previously carried out several inspections at this practice:

On 15 October 2015 we carried out a comprehensive inspection. The practice was rated as requires improvement overall. More specifically, it was rated as requires improvement for being safe, effective and well-led and was rated good for providing caring and responsive services.
On 7 December 2017 we carried out a comprehensive inspection. The practice was rated as inadequate overall. We rated the practice as inadequate for being safe and well-led. It was rated as requires improvement for being effective and as good for being caring and responsive. Following that inspection, we issued the practice with warning notices primarily in relation to failings identified in its management of medicines and controlled drugs. The practice was placed in special measures.
On 5 May 2018 we carried out a focused inspection to check that the practice was safely managing medicines, including controlled drugs. The practice was no longer keeping a stock of controlled drugs but its management of emergency medicines was unsafe and we issued further warning notices.
On 6 September 2018 we carried out a comprehensive follow up inspection. The practice was rated requires improvement overall. We rated the practice as requires improvement for being effective and well-led.

We based our judgement of the quality of care at this service on a combination of:

what we found when we inspected
information from our ongoing monitoring of data about services and
information from the provider, patients, the public and other organisations.

We have rated this practice as inadequate overall.

We rated the practice as inadequate for providing safe services because:

The practice did not have clear systems, practices and processes to keep people safe.
The practice did not have adequate infection control systems in place.
There were gaps in systems to assess, monitor and manage risks to patient safety.
Staff did not always have the information they needed to deliver safe care and treatment.
The practice did not have systems for the appropriate and safe use of medicines.
The practice did not have an effective system to learn and make improvements when things went wrong.

We rated the practice as inadequate for providing effective services because:

Patients’ needs were not always assessed and care and treatment was not always delivered in line with current legislation, standards and evidence-based guidance.
There were significant gaps in patient care and treatment.
The monitoring of outcomes of care and treatment was not operating effectively.
The practice was unable to demonstrate that all staff had the skills, knowledge and experience to carry out their roles.
Some performance data was significantly below local and national averages.

These areas affected all population groups so we rated all population groups as inadequate .

We rated the practice as inadequate for providing well-led services because:

While the practice had made some improvements since our inspection on 6 September 2018, it had not appropriately addressed the Requirement Notice in relation to the governance systems and processes. At this inspection we also identified additional concerns that put patients at risk.
Leaders could not demonstrate that they had the capacity and skills to deliver high quality sustainable care.
The practice vision was not supported by a credible strategy to provide high quality sustainable care.
The overall governance arrangements were ineffective.
The practice did not have clear and effective processes for managing risks, issues and performance.
The practice did not always act on appropriate and accurate information.
We saw little evidence of systems and processes for learning, continuous improvement and innovation.

These areas affected all population groups so we rated all population groups as inadequate.

We rated the practice as good for providing caring and responsive services because:

Staff dealt with patients with kindness and respect and involved them in decisions about their care.
The practice respected patients privacy and dignity.
The practice organised and delivered most services to meet patients’ needs.

This service was placed in special measures in December 2017 and following a further inspection in September 2018 was rated requires improvement overall. In this fourth inspection we found that insufficient improvements have been made such that there remains a rating of inadequate for a population group/core service, key question or overall. The service will be kept under review and if needed could be escalated to urgent enforcement action.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

This practice is rated as Requires improvement overall. (Previous rating 02/2018 – Inadequate)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires improvement

We carried out an announced comprehensive inspection at Dr Paramjit Wasu’s practice on 6 September 2018. We carried out this inspection to follow up on breaches of regulations we found at our previous inspection.

At this inspection we found:

The practice had improved its 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 had reviewed its handling and storage of medicines since our previous inspection and no longer held a stock of controlled medicines.
The practice had reviewed its recruitment and training procedures but its induction processes were insufficient to ensure that new clinical staff members demonstrated all required competencies.
The practice was routinely reviewing 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. We received positive feedback from local nursing home managers. They consistently reported improvements in the quality of care these patients were receiving.
Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
The practice did not have effective systems in place to support good governance and management.

The areas where the provider must make improvement are:

Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

The provider should take action to improve its cancer screening coverage rates including cervical screening, breast cancer screening and bowel cancer screening.
The provider should ensure that all reception staff know how to operate the induction loop system.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

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

Please refer to the detailed report and the evidence tables for further information

We did not review the ratings awarded to this practice at this inspection. (Previous inspection December 2017 – Inadequate).

We carried out an announced focused inspection at Dr Paramjit Wasu’s practice on 3 May 2018. The purpose of the inspection was to follow up on breaches of regulations identified at our previous inspection on 7 December 2017. Following the December inspection, the practice was placed in special measures and we issued warning notices for breaches of Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance). The practice was required to address these concerns by 28 February 2018.

At this inspection we found:

The practice had improved its systems for managing controlled drugs in line with the relevant regulations.
The practice was not however managing all medicines and supplies such as masks and tubing safely.
The practice did not have adequate systems in place to ensure that prescribing materials were kept securely.
The practice did not have adequate arrangements to respond to emergencies.
All staff had received mandatory training including training on safeguarding vulnerable adults and children; health and safety training and fire safety training.
The practice logged relevant safety alerts. However it did not yet have a system in place to demonstrate how these had been acted on.

The areas where the provider must make improvements as they are in breach of regulations 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.

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

Letter from the Chief Inspector of General Practice

This practice is rated as Inadequate overall. (Previous inspection October 2015 – Requires Improvement)

The key questions are rated as:

Are services safe? - Inadequate

Are services effective? – Requires Improvement

Are services caring? - Good

Are services responsive? - Good

Are services well-led? - Inadequate

As part of our inspection process, we also look at the quality of care for specific population groups. The concerns raised in Safe and Well Led affect all of the population groups. The population groups are rated as:

Older People – Inadequate

People with long-term conditions – Inadequate

Families, children and young people – Inadequate

Working age people (including those retired and students – Inadequate

People whose circumstances may make them vulnerable – Inadequate

People experiencing poor mental health (including people with dementia) - Inadequate

We carried out an announced comprehensive inspection at Dr Paramjit Wasu on 7 October 2015. We found breaches of the legal requirements and as a result we issued requirement notices in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014 - Good Governance.

The practice was rated as good for providing caring and responsive services and requires improvement for providing safe, effective and well-led services. Overall the practice was rated as requires improvement.

The full comprehensive report on the October 2015 inspection can be found by selecting the ‘all reports’ link for Dr Paramjit Wasu on our website at www.cqc.org.uk.

We carried out a comprehensive inspection of this service, on 7 December 2017, under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. The inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Act.

During the inspection we found that the practice had not responded fully to the concerns raised during the October 2015 inspection. We also found other breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for the practice is now inadequate.

At this inspection we found:

There was not a transparent approach to safety. The system for learning from significant events was not effective.
Searches were not being routinely undertaken to identify patients who may be at risk as a result of Medicine and Healthcare products Regulatory Agency (MHRA) alerts.
The arrangements for managing medicines in the practice did not always keep patients safe. We found controlled drugs with no recording system and out of date medications.
The practice did not have adequate arrangements to respond to emergencies.
The practice assessed patients’ needs but was unable to demonstrate they always delivered care in line with current evidence based guidance.
The practice was unable to demonstrate that clinical audits were driving quality improvements.
Not all chaperones were trained, DBS checked or risk assessed as to their suitability to the role.
There were no systems in place to mange prescription security and rooms were routinely left insecure.
Not all staff had received training in health and safety, infection control, equality and diversity or other mandatory training.
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 and easy to understand.
Governance arrangements were not always effectively implemented.
The practice was unable to demonstrate they had an effective action plan to improve performance.
There was a leadership structure and staff felt supported by management.
The practice was unable to demonstrate their management of record keeping was always effective and complete.

The areas where the provider must make improvements as they are in breach of regulations 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.
Carry out clinical audits and re-audits to drive quality improvement and improved patient outcomes.
Dispose of controlled drugs in an appropriate manner or implement the approved methods for securing and recording them.

The areas where the provider should make improvements are:

Carry out Disclosure and Barring Service (DBS) checks, or risk assessments, for all staff who act as chaperones.
Carry out regular, documented checks of all emergency medication and equipment.
Identify and keep a record of patients who are carers to help ensure they are offered appropriate support.
Ensure verbal complaints are recorded and actions monitored.

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

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Paramjit Wasu on 7 October 2015. Overall the practice is rated as requires improvement. The practice was closed for six months from January to July 2015.

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

Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However, the procedure for taking appropriate action and sharing learning from significant event analysis required improvement.

Risks to patients were assessed and well managed.
There was no evidence of completed clinical audits being undertaken and improvement in performance of patient outcomes as a result.

The practice had a number of policies and procedures to govern activity, but some were overdue a review.
Information about the services available was limited, how to access support groups and organisations. We could not see any information about bereavement services.

Patients said they were treated with compassion, dignity and respect.
Urgent appointments were usually available on the day they were requested.
The practice had proactively sought feedback from patients and had an active patient participation group.

The areas where the provider must make improvements are:

Carry out clinical audits and re-audits to improve patient outcomes.

In addition the provider should:

Embed access and knowledge of all practice’s governance policies and procedures.
Ensure that there is a comprehensive business plan in place to deal with major incidents.
Ensure processes are in place to check medicines are within their expiry date.
Systems to ensure patients information is kept confidential at all times.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice

Archived: Dr Paramjit Wasu

All Inspections

3 August 2021

During a routine inspection

07 July 2020

During an inspection looking at part of the service

10 Feb 2020

During an inspection looking at part of the service

25 June 2019 and 23 July 2019

During a routine inspection

6 Sept 2018

During a routine inspection

3 May 2018

During an inspection looking at part of the service

7 December 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP)

7 October 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP)