The Care Quality Commission
  • Doctor
  • GP practice

Archived: Dr Shibopriyo Mukhopadhyay Also known as Ashfield Medical Centre

Overall: Requires improvement read more about inspection ratings

Kings Street, Sutton In Ashfield, Nottinghamshire, NG17 1AT (01623) 559992

Provided and run by:
Dr Shibopriyo Mukhopadhyay

All Inspections

25 February 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Shibopriyo Mukhopadhyay’s practice on 25 February 2016. Overall the practice is rated as requires improvement.

Our previous comprehensive inspection carried out in March 2015 found breaches of legal requirements (regulations) relating to safe, effective, responsive and well led domains. In addition, all population groups were rated as inadequate due to the concerns found in these domains. The overall rating from the March 2015 inspection was inadequate and the practice was placed into special measures for six months.

After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements. At this inspection we found some improvements had been made in relation to safe, responsive and well led domains; however the practice had not made sufficient improvements to comply with two of the regulations they were previously in breach of. This related to safe care and treatment and good governance.

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

  • The practice had improved its systems and processes for assessing and monitoring identified risks to try and ensure patients were kept safe. This included: carrying out suitable checks for staff undertaking chaperone duties and those recently recruited, auditing of infection control practices and increasing the clinical staffing levels.

  • The practice had implemented improvements to the appointment system to enable patients to have easy access to the service. Most patients said they found it easy to make an appointment and there was continuity of care, with urgent appointments available the same day. However, robust arrangements were still required to ensure appropriate GP cover was in place during planned or unplanned absences.

  • The systems for recording, monitoring and reviewing information about safety had been strengthened. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.

  • Improvements had been made to ensure effective care and treatment was provided for patients with diabetes, depression and chronic obstructive pulmonary disease.

  • Some staff did not assess patients’ needs and deliver care in line with current evidence based guidance. For example, the care and treatment of patients identified as requiring a minor surgical procedure had not been provided in a timely way, the quality of note taking was poor and did not demonstrate effective follow up action to determine patient outcomes. Due to these concerns we took urgent enforcement action to minimise any further risks to patients.

  • Improvements were still required to ensure clinical audits and re-audits were undertaken in line with best practice guidance to improve patient outcomes.

  • Clinical performance data showed patient outcomes were at or below the local and national averages.

  • Staff were supported with their professional development; however arrangements for the supervision and appraisal of practice nurses required improvement to ensure they were fully supported by a clinician / GP.

  • Patients told us they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

  • The practice had adopted an “open door” approach for carers to enable them to access support from practice staff as and when required.

  • Patients had access to information about the service in appropriate languages and formats. This included English, Polish, Hindi and Punjabi.

  • The practice had proactively sought feedback from staff and patients including the patient participation group (PPG). The practice worked closely with the PPG to promote patient education on the appropriate use of secondary care services.

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. However, the overarching governance framework did not always support the delivery of good quality care.

The areas where the provider must make improvements are:

  • Ensure clinical audits and re-audits are carried out to improve patient outcomes. Specifically those relating to osteoporosis and minor surgery.

In addition the provider should:

  • Continue to review the availability of non-urgent appointments and adjusting them in response to patient demand.

  • Review and update the practice’s procedures and guidance as planned.
  • Ensure proactive measures are taken to increase the uptake of cancer screening programmes.
  • Ensure proactive identification of carers.

I confirm that this practice has improved sufficiently to be rated Requires Improvement overall. However, the practice has been rated as inadequate for the effective domain and as a result remains in special measures.

We took urgent enforcement action and served an Urgent Notice of decision imposing additional conditions on the provider’s registration in respect of carrying on the regulated activity, surgical procedures, from this location. The below conditions took effect from 3 March 2016 and will remain in force until removed by the Care Quality Commission (the CQC).

New conditions imposed:

1. The service must ensure that Dr Shibopriyo Mukhopadhyay does not carry on any surgical procedures with immediate effect.

2. Clinicians who carry out surgical procedures at the practice must have appropriate and up to date training in carrying out those procedures.

The registered provider must ensure that all persons involved in the delivery of the regulated activity ‘Surgical Procedures’ have received appropriate training which is documented, auditable and evidenced prior to any surgical procedures being carried on.

3. An audit of patients who have had minor surgery since 01 February 2015 must be carried out.

This is to ensure patients have received appropriate care and treatment, and to determine if any follow up actions are needed to ensure patient safety.

Services placed in special measures will be inspected again within six months. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as 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 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. 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

18 December 2015

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced focused inspection of Dr Shibopriyo Mukhopadhyay on 18 December 2015. This inspection was undertaken to follow up a warning notice we issued to the provider as they had failed to comply with the regulations in respect of good governance.

The overall rating for this practice remains as inadequate. The practice will receive a further inspection within six months of the publication date of the initial report at which the ratings will be reviewed as part of a comprehensive inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Dr Shibopriyo Mukhopadhyay on our website at www.cqc.org.uk.

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

  • Improvements had been made to ensure that staff adequately assessed the needs of patients’ with diabetes and depression; and delivered care in line with current guidance.

  • All the patients we spoke with said they were involved in decisions about their care and treatment. They described their experience of making an appointment as good and were able to access a convenient appointment when needed.

  • The practice worked closely with the patient participation group and other organisations to promote patient education on the appropriate use of secondary care services.
  • Data reviewed showed inappropriate attendances at the local accident and emergency service had reduced since our last inspection.
  • The practice had implemented improvements and made changes to the booking and appointment system to enable patients to have easy access to the service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

24 March 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Shibopriyo Mukhopadhyay practice on 24 March 2015. Overall the practice is rated as inadequate.

Specifically, we found the practice was inadequate for providing an effective, responsive and well led service. It required improvement for providing safe services. We rated the practice as good for providing a caring service. We rated all population groups inadequate.

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

  • Patient feedback indicated they experienced significant difficulties accessing both urgent and non-urgent appointments and experienced further delays when waiting for their appointment to start. As a result the numbers of patients attending the walk in centre and accident and emergency (A&E) was higher than other local practices.
  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Systems for recording, monitoring and reviewing information about safety needed strengthening to assure the provider all actions and learning outcomes had been completed.
  • Risks to patients were not always identified, assessed and managed (For example the need for criminal record checks for chaperones, risks associated with infection control and safe staffing levels).
  • Although there was some evidence of clinical audits, we found limited evidence to demonstrate they were driving improvement to patient outcomes.
  • Data showed outcomes for older people, working age and those recently retired were below average for the locality.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • 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. However governance arrangements needed to be strengthened to ensure effective systems were in place to regularly assess and monitor the quality of services provided.

The areas where the provider must make improvements are:

  • Ensure recruitment arrangements include all necessary employment checks. Staff undertaking chaperone duties must have a satisfactory DBS check in place or a risk assessment which clearly demonstrates why this is not necessary.
  • Ensure robust systems are in place to regularly assess, monitor and mitigate the identified risks and quality of services provided to patients. This includes having regard to complaints, comments and views of patient experiences in respect of poor telephone access, the appointment system and staffing levels.
  • Ensure audit cycles are completed in order to demonstrate improvements made to patient outcomes.
  • Ensure the infection prevention and control processes are strengthened to assure the provider that all staff have up to date training and guidance.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

8 January 2014

During a routine inspection

We spoke with five patients, four practice staff and one GP. We also spent time looking at patient records and various policies and procedures.

People were mostly positive about their experiences of using the service. One person said, "I have confidence. Absolutely.' Other patients said they were satisfied with their care and treatment but found the appointment system frustrating. They said, 'I call at 8.30 am and it's engaged, the appointments go so quickly.' Others said staff were attentive but they found it difficult to book a non-urgent appointment to see a GP.

People told us practice staff involved them in discussions about their care and treatment. People said staff explained things to them in a way they were able to understand. From the records we looked at we saw practice staff gave people appropriate information and involved them in discussions about their care and treatment options.

The practice had procedures in place for staff to report any concerns they had about the welfare and wellbeing of people and children using the service. Practice staff had received training and information about how to protect children and vulnerable adults if they suspected they were at risk of abuse, harm or neglect.

The patients had appropriate information about how to make a complaint and their concerns were taken seriously.