Dr's P L & S Kaul and Dr G K Gill

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Dr's P L & S Kaul and Dr G K Gill on 5 December 2016. The overall rating for the practice was good with the effective domain rated as requires improvement. The full comprehensive report on the December 2016 inspection can be found by selecting the ‘all reports’ link for Dr's P L & S Kaul and Dr G K Gill on our website at www.cqc.org.uk.

This inspection was a desk based review carried out on 3 October 2017 to confirm that the practice had carried out their plan to make improvements in the areas that we identified in our previous inspection on 5 December 2016. This report covers our findings in relation to those areas and also additional improvements made since our last inspection.

The effective domain is now rated as good and overall the practice remains rated as good.

Our key findings were as follows:

• The practice had purchased disposable curtains for consultation and treatment rooms in July 2017. The cleaning schedule indicated that the curtains were due to be replaced in January 2018.
• The practice had invested in an e-learning training programme, which allowed management to monitor staff training and identify when refresher training was required.
• The GPs had completed fire safety and infection control training.
• Non clinical staff had completed adult safeguarding training.
• The practice had reviewed the results from internal and external patient surveys and identified a number of areas for improvement. Action plans had been put in place to improve patient satisfaction.
• The practice had improved their overall QOF score to around 96% (up from 90%) of the total number of points available. The practice had also taken action to improve performance in specific areas such as diabetes and mental health.

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's P L & S Kaul and Dr G K Gill on 5 December 2016. Overall the practice is 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 an effective system in place for reporting and recording significant events. Lessons were shared to make sure action was taken to improve safety in the practice. Patients received truthful information; apologies and appropriate support were required.

• Risks to patients were generally assessed and well managed; however, some risks were not effectively managed. For example, non-clinical staff did not have a Disclosure and Barring Service check in place or a formal risk assessment completed to demonstrate the decisions not to carry out a DBS. However, staff we spoke with informed us they had considered the role of the non-clinical staff in making this decision as they did not act as a chaperone to patients.

• Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were low in some areas compared to the national average; for example, diabetes related clinical indicators. Audits had been carried out, and were driving improvements in patient outcomes and there was a formal plan which identified target areas for improvement.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained in most areas to provide them with the skills, knowledge and experience to deliver effective care and treatment. However, we saw gaps in the completion of some training.
• Data from the July 2016 national GP patient survey showed patients rated the practice below others for several aspects of care. Patients we spoke with during the inspection provided mixed views on how they rated the practice. Some patients felt that they were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment. However, others did not always feel listened to or involved in their care and 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. The provider was aware of and complied with the requirements of the duty of candour.
• Although urgent appointments were available the same day, some patients we spoke with during the inspection found it difficult to secure an appointment with a named GP. However, results from the national GP patient survey showed patient’s satisfaction with how they could access care and treatment was comparable to local and national averages.
• The practice had good facilities and was well equipped to treat patients and meet their needs. There was evidence of where the practice had responded to the needs of the local population. For example, the practice operated a food bank and there were agreements in place for a local charity to access this provision.
• There was a clear leadership structure and staff felt supported by management. The practice had a number of processes and systems in place to govern activity; however processes were not always effective. For example, recruitment checks; some risks associated with health and safety; and arrangements to respond to a clinical or medical emergency were not being managed or monitored effectively.
• The practice proactively sought feedback from staff and patients, which it acted on. The practice developed actions to address areas of the July 2016 national GP patient survey where satisfaction scores were below average.

The areas where the provider should improvement are:

• Ensure that effective systems are established to ensure staff receive appropriate training to enable them to carry out their role effectively.

• Review the frequency of cleaning/replacing curtains to prevent the spread of infections.

• Continue to review national GP patient survey results and explore effective ways to improve patient satisfaction.

• Review the areas of lower clinical performance with a view to improving patient care and outcomes.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice