Archived: Dr Subrata Basu Also known as Dr S Basu

Letter from the Chief Inspector of General Practice

We carried out an unannounced comprehensive inspection at Dr Subrata Basu on 8 April 2016. Overall the practice is rated as inadequate.

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

• Appropriate access to health care was not available for patients. A surgery was not available on the afternoon of our inspection and we observed evidence that surgeries were not available on the two afternoons prior to this, on Thursday afternoons and on numerous other occasions.
• Clinical decisions were taken at the practice by unqualified staff which allowed patients to continue to request and receive medication without the review of a clinician.
• Patients were unable to access appointments to meet their needs as they could not book appointments in advance. Appointments and clinics were often cancelled, irrespective of patient need.
• Patients could not access a nurse in the afternoon.
• Appointment slots to see the lead GP were regularly left unfilled despite patients requiring these. When locum GPs supported the practice more patients were seen.
• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example, appropriate recruitment checks on staff had not been undertaken prior to their employment and clinical tasks were not reviewed by a GP.
• Staff at the practice had acted as chaperones for patients without a Disclosure and Barring Service check (DBS) or training. (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable).
• Staff said that complaints and incidents were not always recorded there was no evidence of learning and communication with staff. We were not assured that significant events were acted upon or that all events were recorded.
• Patient outcomes were hard to identify as no reference was made to clinical audits or quality improvement and there was no evidence that the practice was comparing its performance to others either locally or nationally.
• Feedback from patients regarding the practice was below Clinical Commissioning Group (CCG) and national averages. The practice did not have a patient participation group (PPG).
• The practice had limited formal governance arrangements.

The Care Quality Commission issued an urgent notice to suspend the registration of this practice for a period of four weeks from 15 April 2016 to 13 May 2016. We directed the practice to demonstrate to us that they would be able to provide a safe and accessible general practice service for their patients after that time.

The Commission was not assured that an action plan submitted to us by the provider Dr Subrata Basu could demonstrate that the practice would provide a safe and accessible service. As a result the Commission instigated enforcement action to cancel the registration of this provider. Since 18 April 2016 a new provider at Whetley Medical Centre has accepted a contract with the Bradford City Clincial Commissioning Group to provide services to the patients of this practice from the practice address at Whetley Medical Centre, 2 Saplin Court, Bradford.

The practice however, has been placed in special measures due to the shortfalls identified in this inspection. During inspection we found that the following issues had to be addressed:

• Ensure that patients have access to healthcare and that appointments are offered at times to meet the needs of the practice population.

• Implement formal governance arrangements including systems for assessing and monitoring risks and the quality of the service provision. For example regular staff and multidisciplinary team meetings.
• Introduce effective processes for reporting, recording, acting on and monitoring significant events, incidents and near misses.
• Ensure recruitment arrangements include all necessary employment checks for all staff.
• Provide staff with appropriate training, policies and guidance to carry out their roles in a safe and effective manner which are reflective of the requirements of the practice.
• Ensure they are able to respond appropriately to emergency situations and manage the risks associated with this. For example, they must review the provision of a defibrillator, emergency medication and oxygen in the practice.
• Carry out clinical audits including re-audits to ensure improvements have been achieved.
• Review the clinical and non-clinical leadership structure of the practice and ensure there is the leadership capacity and capability to deliver all improvements.
• Review the system for the prescribing and reviewing of medication and ensure that this is reflective of best practice.
• Ensure that safe and appropriate systems and processes are in place to manage the administrative tasks, referrals, recalls and demands associated with a GP surgery.
• Implement formal systems and processes including systems for assessing and monitoring risks to keep people safe. For example the audit of emergency medications, oxygen, vaccines and the provision of a health and safety risk assessment. The provider must ensure that provision is in place for the removal of sanitary waste.
• Implement a system for the correct storage and audit of prescription pads in line with NHS Protect Guidance 2013.

We also found the following issues should be addressed:

• The provider should respond to outcomes from audits. For example, Infection Prevention and Control (IPC) and Fire.

• The practice needs to ensure that it positively engages with patients and improve its services as measured by patient satisfaction scores. The practice should review if it has the right amount of staff with the appropriate skills to meet patient needs.
• The practice should explore ways of involving patients in the governance arrangements of the practice for example through the involvement of a patient participation group (PPG).

Being placed in special measures will enable the practice a period of time to address the issues we have identified. We will inspect this practice again within a six month period in order to determine if improvements have occurred and if these have been sustained.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice