29 March 2016
During a routine inspection
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Dr Khalid Choudhry on 29 March 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.
- Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective 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.
- Patients said they did not always find 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 well equipped to treat patients and meet their needs.
- There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
- The practice had an active patient participation group in place who met on a regular basis.
- Risks to patients were assessed and well managed with the exception of those relating to Legionella.
- There was no process in place to ensure appropriate checks were undertaken to ensure members of the nursing team were registered with the Nursing and Midwifery Council (NMC).
- The provider was aware of and complied with the requirements of the duty of candour.
The areas where the provider must make improvement are:
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Ensure a process is in place to assess and monitor risks in relation to Legionella.
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Review governance arrangements to ensure systems and processes are in place for gaining assurance that members of the nursing team are registered with the Nursing and Midwifery Council (NMC).
The areas where the provider should make improvement are:
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Ensure all policies and procedures are reviewed and updated.
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Ensure all members of staff complete the appropriate level of safeguarding training.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice