The Care Quality Commission
  • Doctor
  • GP practice

Dr Rajpreet Millan Also known as Whitwell Surgery

Overall: Good read more about inspection ratings

60 High Street, Whitwell, Hitchin, Hertfordshire, SG4 8AG (01438) 871398

Provided and run by:
Dr Rajpreet Millan

All Inspections

24 September 2019

During a routine inspection

We carried out an announced comprehensive inspection at Dr Rajpreet Millan (also known as Whitwell Surgery) on 28 September 2016. Overall the practice was rated as inadequate and placed into special measures.

We carried out an announced focused inspection at Dr Rajpreet Millan on 15 February 2017. This inspection was undertaken to follow up on a Warning Notice we issued to the provider. We found the practice had complied with the warning notice we issued and had taken the action required to comply with legal requirements.

We carried out an announced comprehensive inspection at Dr Rajpreet Millan on 29 June 2017. This inspection that was undertaken following the period of special measures. Overall the practice was rated as good and the practice was taken out of special measures.

The inspection reports can be found by selecting the ‘all reports’ link for Dr Rajpreet Millan on our website at www.cqc.org.uk.

We carried out an announced comprehensive inspection at Dr Rajpreet Millan on 24 September 2019 following our annual review of the information available to us including information provided by the practice.

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 population groups.

We found that:

  • The practice provided care in a way that kept patients safe and protected them from avoidable harm.
  • Patients received effective care and treatment that met their needs.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • The practice organised and delivered services to meet patients’ needs. 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.

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

  • Implement a process to monitor the management of referral letters.
  • Continue to take steps to improve uptake of child immunisations and women attending for their cervical screening.
  • Continue to review and take steps to improve performance in relation to National GP Patient Survey results.
  • Continue to take steps to review and improve patient confidentiality at the front desk.

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

29 June 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Rajpreet Millan, also known as Whitwell Surgery on 28 September 2016. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months. The full comprehensive report on the September 2016 inspection can be found by selecting the ‘all reports’ link for Dr Rajpreet Millan on our website at www.cqc.org.uk.

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 29 June 2017. Overall the practice is now rated as good.

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

  • There was an open and transparent approach to safety and a system in place for reporting and recording significant events. The practice carried out a thorough analysis of the significant events and completed an action log that was discussed at staff meetings.
  • A log of near misses and errors in the dispensary was kept and discussed at practice meetings.
  • Standard procedures were in place, which covered all aspects of the dispensing process. There was a record kept that had been reviewed and dispensary staff had read them.
  • The practice had clearly defined and embedded systems to minimise risks to patient safety.
  • Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
  • Clinical audits demonstrated quality improvement. There had been three clinical audits undertaken since the previous inspection. All of these were completed audits where the improvements made were implemented and monitored.
  • Essential mandatory training had been identified and staff had access to appropriate training resources. This included infection control, basic life support, fire safety, safeguarding and information governance.
  • 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. Improvements were made to the quality of care as a result of complaints and concerns.
  • 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 principal GP in the practice demonstrated they had taken steps to develop the experience, capacity and capability to run the practice and ensure high quality care.
  • The practice proactively sought feedback from staff and patients, which it acted on. They had formulated a patient participation group (PPG) and completed their own patient survey.
  • 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 should make improvement are:

  • Share the minutes of multi-disciplinary team meetings with other health care professionals.

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

15 February 2017

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an unannounced focused inspection of Dr Rajpreet Millan also known as Whitwell Surgery on 15 February 2017. This inspection was undertaken to follow up on warning notices we issued to the provider and the registered manager in relation to Regulation 12 Safe Care and Treatment and Regulation 17 Good Governance.

The practice received an overall rating of inadequate at our inspection on 28 September 2016 and this will remain unchanged until we undertake a further full comprehensive inspection within six months of the publication date of the initial report.

The full comprehensive report from the September 2016 inspection can be found by selecting the ‘all reports’ link for Dr Rajpreet Millan on our website at www.cqc.org.uk.

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

  • The practice had complied with the warning notices we issued and had taken the action needed to comply with the legal requirements.
  • There was evidence that the principle GP and the practice manager had provided leadership in responding to the actions required following the issue of the warning notices to ensure compliance with the regulations.
  • Systems and processes had been put in place to keep patients safe that included control of substances hazardous to health and legionella.
  • Systems and processes in the dispensary had been improved to comply with best practice and legal requirements.
  • Essential staff training had been completed.
  • Processes had been implemented to ensure the management of safety alerts received and patients receiving high risk medicines.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

28 September 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Rajpreet Millan, also known as Whitwell Surgery on 28 September 2016. Overall the practice is rated as inadequate.

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

  • Patients were at risk of harm because systems and processes were not in place to keep them safe. For example, risks to patients had not been assessed fully. There had been no risk assessments in place to monitor safety of the premises such as control of substances hazardous to health and legionella.

  • Staff working in the dispensary had not all received appropriate training and none of the staff had regular competency checks.

  • Staff had not received essential training in many areas including infection control, fire safety, information governance and safeguarding.

  • Staff understood the process for reporting incidents, near misses and concerns however we found evidence of an incident that the practice was aware of that had not been documented or investigated as a significant event. There was not a log of near misses and errors in the dispensary.

  • There were standard operating procedures (SOPs) in place to govern activity in the dispensary but they were not followed at all times.

  • Patient outcomes were hard to identify as little or no reference was made to audits or quality improvement.

  • Patients were positive about their interactions with staff and said they were treated with compassion, dignity and respect. They were involved in their care and decisions about their treatment.

  • Information about services and how to complain was available and easy to understand.

  • 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.

  • The practice had good facilities and was equipped to treat patients and meet their needs.

The areas where the provider must make improvements are:

  • Follow formalised processes for reporting, recording, acting on and monitoring significant events, incidents and near misses. Implement processes to ensure effective communication within the practice, including forums to ensure learning is discussed and shared. Put systems in place to ensure all clinicians are kept up to date with National Institute for Health and Care Excellence (NICE), patient safety alerts, MHRA alerts and other best practice guidelines and record actions taken in response to them. Formalise the system for checking the monitoring of high risk medicines ensuring all patients receiving high risk medicines are monitored appropriately and within recommended timescales.

  • Ensure action is taken to address identified concerns in relation to infection prevention and control. Ensure all clinical staff receive vaccinations in line with current national guidance.

  • Implement formal governance arrangements including systems for assessing and monitoring risks and the quality of the service provision. This includes carrying out risk assessments in relation to control of substances hazardous to health (COSHH), and legionella. Ensure risk assessments are completed for the dispensary in relation to security and the additional checks required for the dispensing of certain high risk medicines. Complete a risk assessment to determine if a Disclosure and Barring Service (DBS) check is required for non-clinical staff in particular those performing the chaperone role.

  • Carry out clinical audits including re-audits to ensure continuous clinical improvements.

  • Ensure that all staff employed are supported by receiving essential training relevant to their role.Ensure a process to monitor the competency of staff who work in the dispensary. Ensure the standard operating procedures (SOPs) which cover the dispensing process are relevant and followed and cover all areas of the dispensary.

  • Further develop the patient participation group (PPG) and engage with the virtual PPG to gather feedback from patients.

The areas where the provider should make improvement are:

  • Introduce a system to follow up and record on the patient electronic record if a child misses a hospital appointment.
  • Ensure the minimum and maximum temperature of the medicines fridges are recorded at regular intervals.
  • Ensure prescription processes comply with NHS Protect security of prescriptions and a system is introduced to monitor the use of all prescriptions.
  • Keep a record of photographic identification of staff in their staff files.
  • Continue to identify and support carers and have an alert on the patient record to inform GPs and staff that they are a carer.
  • Carry out fire drills at regular intervals.
  • Implement processes to ensure communications with the Out of Hours Provider and record in patient records.

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

28 January 2014

During a routine inspection

During our inspection we spoke with four patients and communicated with two by email, five members of staff and a community nurse.

When patients received care or treatment they were asked for their consent and their wishes were listened to. One patient told us: "Normally I accept the recommended treatment". We found that when minor surgery had been carried out that written consent had been requested from patients before the surgery had commenced.

We saw that patients' views and experiences were taken into account in the way the service was provided and that they were treated with dignity and respect. The patients we spoke with provided positive feedback about their care. A patient told us: "It's good, I never have a problem".

Patients received their medicines when they needed them and their medicines were regularly reviewed by the doctor. The surgery included a dispensary for medicines to reduce travel time for patients.

Staff had received training in safeguarding children and vulnerable adults. They were aware of the appropriate agencies to refer safeguarding concerns to that ensured patients were protected from harm.

The provider had an established system in place for monitoring the quality of service provision. There was an established system to regularly obtain opinions from patients about the standards of the services they received. This meant that on-going improvements could be made by the practice staff.