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Dr Jitendrakumar Trivedi Good Also known as Shreeji Medical Centre

Inspection Summary


Overall summary & rating

Good

Updated 19 April 2017

Letter from the Chief Inspector of General Practice

At our previous comprehensive inspection at Dr Jitendrakumar Trivedi, more commonly known as Shreeji Medical Centre in Slough, Berkshire on 22 June 2016 we found a breach of regulations relating to the provision of safe services. The overall rating for the practice was good. Specifically, the practice was rated requires improvement for the provision of safe services, outstanding for the provision of effective services and good for the provision of caring, responsive and well-led services. The full comprehensive report on the June 2016 inspection can be found by selecting the ‘all reports’ link for Dr Jitendrakumar Trivedi on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 5 April 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulations that we identified in our previous inspection in June 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

We found the practice had made improvements since our last inspection. Using information provided by the practice we found the practice was now meeting the regulations that had previously been breached. We have amended the rating for this practice to reflect these changes. The practice is now rated good for the provision of safe, caring, responsive and well led services. The practice remains rated as outstanding for the provision of effective services.

Our key findings were as follows:

  • The practice had introduced a system for tracking and monitoring the use of blank prescription forms and pads. This system was now in line with national guidance. Completed actions included the installation of printer locks to prevent unauthorised access to blank prescription forms.

  • The practice had reviewed existing arrangements regarding the awareness of consent. We saw the consent policy had been shared and awareness training discussed in staff meetings which were attended by non-clinical and clinical staff including regular and locum staff. Furthermore, the practice had arranged full access to all the consent correspondence to be accessible to all staff including within the revised locum induction pack, which must be read prior to working at the practice.

  • The practice had established and was now operating safe systems to assess, manage and mitigate the risks identified relating to fire safety. This included documented fire evacuation drills and a review of evacuation procedures.

  • Further steps had been taken steps to increase the number of identified patients with caring responsibilities within the practice population. The practice had identified 27 patients, who were also a carer; this was an increase from 11 identified carers at the June 2016 inspection and amounted to approximately 0.5% of the practice list. We saw each month the practice was identifying more carers and advising them of the various avenues of support available from the practice. To further increase the identification of carers, the practice actively promoted carers awareness through practice videos (including videos in different languages spoken within the community) alongside posters and leaflets available in the waiting room. The practice had held further carers meetings where information was shared about resources for carers, including financial support and healthcare resources.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 19 April 2017

The practice had taken appropriate action and is now rated as good for the provision of safe services.

Our last inspection in June 2016 identified concerns relating to how the practice managed and monitored the use of blank prescription forms and pads.

We also saw concerns regarding how the practice managed fire safety. Although the practice had up to date fire risk assessments and carried out regular fire drills, these drills were not recorded and there was no list of which staff attended.

Using information provided by the practice we found the concerns had been addressed:

  • The practice had introduced a system for tracking and monitoring the use of blank prescription forms and pads. This system was now in line with national guidance.

  • The practice had established and was now operating safe systems to assess, manage and mitigate the risks identified relating to fire safety. This included documented fire evacuation drills and a review of evacuation procedures.

Effective

Outstanding

Updated 14 September 2016

The practice is rated as outstanding for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average.
  • Data showed that the practice was performing highly in some areas when compared to practices locally. For example, flu immunisation figures were high compared to locality figures and the practice had disseminated learning about how to increase flu immunisation uptake to other practices.

  • The practice used innovative and proactive methods to improve patient outcomes and worked with other local providers to share best practice. For example, rates for unplanned admissions and A and E attendances were the lowest in the locality and the practice had shared protocols with other GPs to disseminate good practice.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • Most staff were aware of guidance relating to mental capacity. One member of clinical staff was not aware of this guidance, but said that they would ask the lead GP for advice if unsure.
  • There was evidence of appraisals and personal development plans for staff.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 14 September 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice higher than others for some aspects of care and lower for other aspects. The practice described measures it had taken to address the feedback from this survey. More recent feedback from patients obtained during the inspection was very positive about the care received.

  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
  • We found many positive examples to demonstrate how patients’ choices and preferences were valued and acted on.
  • Information for patients about the services available was easy to understand and accessible.
  • We saw staff treated patients with kindness and respect.
  • The practice had identified a small percentage of patients who were carers.

Responsive

Good

Updated 14 September 2016

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified. For example, they offered additional appointments as part of the Prime Minister’s Challenge Fund.

  • Feedback from patients on the day of the inspection was that they found it easy to make an appointment with a 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.
  • The practice worked closely with other organisations and with the local community in promoting services to meet patients’ needs. For example, the practice supported members of the PPG to deliver health related information and education to local communities and provided health promotion on local and Asian radio stations.
  • There were innovative approaches to providing integrated patient-centred care which took into account the needs of patients from different backgrounds. The practice provided written health information in a number of languages, practice staff spoke a number of languages, and interpreters were available.
  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example, the practice was aware of the needs of diabetic patients during Ramadan and provided advice on diabetes management for these patients which acknowledged religious and cultural considerations. Performance for diabetes related indicators was higher than the national average.
  • Patients can access appointments and services in a way and at a time that suits them. For example, staff told us that the lead GP gave his mobile number to patients nearing the end of their lives or requiring palliative care. He stated that this meant that he could be contacted quickly if needed for support out of surgery hours. The GP told us this also enabled him to quickly complete the necessary paperwork if a patient died in order that arrangements could be made by relatives in line with cultural and religious needs.
  • Information about how to complain was available and easy to understand, and the practice responded quickly when issues were raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 14 September 2016

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. Staff were clear about the vision and their responsibilities in relation to it.
  • 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. This included arrangements to monitor and improve quality and identify risk.
  • The provider was aware of and complied with the requirements of the duty of candour. The lead GP 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 practice had a very engaged patient participation group which influenced practice development.
  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

Older people

Good

Updated 14 September 2016

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

  • The practice offered proactive, personalised care to meet the needs of the older people in its population.
  • One of the GPs was a physician specialising in elderly medicine and had expertise in this area.
  • The practice had developed plans to offer an in house clinic for falls prevention which were described in detail on the day of the inspection.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

People with long term conditions

Good

Updated 14 September 2016

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

  • GPs and nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
  • Performance for diabetes related indicators was higher than the national average. For example, the percentage of patients on the diabetes register, with a record of a foot examination and risk classification within the preceding 12 months was 99% compared to a national average of 88%. The practice used patient contracts in multiple languages which provided information about the condition and the need for regular appointments and the role of patients in managing their own care through partnership with the practice. The practice was aware of the needs of diabetic patients during Ramadan and provided advice on diabetes management for these patients which acknowledged religious and cultural considerations.
  • The practice provided clinics for patients with prediabetes and carried out audits to review care.
  • Longer appointments and home visits were available when needed.
  • All these patients 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.

Families, children and young people

Good

Updated 14 September 2016

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

  • There were systems in place 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 A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations.
  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
  • The practice’s uptake for the cervical screening programme was 84% over the past 5 years, which was higher than the national average of 81%. Appointments were available outside of school hours and the premises were suitable for children and babies.
  • We saw positive examples of joint working with midwives, health visitors and school nurses. For example, the practice offered opportunistic immunisations to patients attending for midwife appointments.

Working age people (including those recently retired and students)

Good

Updated 14 September 2016

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

  • The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
  • 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.
  • The practice used the electronic prescription service so patients did not need to visit the practice to collect their prescription.
  • The practice offered a virtual and face to face Patient Participation Group (PPG) so that people who had work commitments could participate and provide their views.

People whose circumstances may make them vulnerable

Good

Updated 14 September 2016

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

  • The practice held a register of patients living in vulnerable circumstances including those with a learning disability.
  • The practice offered longer appointments for patients with a learning disability.
  • The practice had provided 100% of patients with a learning disability an annual health check.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.
  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
  • Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff 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.

People experiencing poor mental health (including people with dementia)

Good

Updated 14 September 2016

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

  • 94% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is better than the national average of 84%.
  • Performance for mental health related indicators was better than the national average. For example, the percentage of patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 100% compared to the national average of 88%.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
  • 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.
  • Staff had a good understanding of how to support patients with mental health needs and dementia.