Archived: Dr Sunil Mayor Also known as Bath Road Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Sunil Mayor on 8 January and a follow up visit on 3 February 2015. Two visits were carried out as the second of these was to assess compliance with a previously issued Warning Notice. Overall the practice is rated as Inadequate.

Specifically, we found the practice inadequate for providing safe, effective and well-led services. It was also inadequate for providing services for the Older people, People with long-term conditions, Families, children and young people, Working age people (including those recently retired and students), People whose circumstances may make them vulnerable and People experiencing poor mental health (including people with dementia). It required improvement for providing a caring and responsive service.

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 patient test results were not actioned in a timely manner.
• The practice had ineffective leadership structure, insufficient leadership capacity and limited formal governance arrangements.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• Data showed a number of patient outcomes were at or slightly below average for the locality.
• Patients said they were usually able to get same day urgent appointments, however the practice lacked continuity of care and it was difficult to make an appointment with a GP of their choice.
• Most patients felt they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand however not all patients were aware how to complain, and not all staff were aware the practice had a complaints book .

• The practice held regular practice meetings for non-clinical staff, however there were no regular meetings involving clinical staff.

The areas where the provider must make improvements are:

• Clarify the leadership structure and ensure there is leadership capacity to deliver all improvements.
• Ensure patient test results are actioned in a timely manner, and all letters received by the practice relating to patient care are seen by a GP.
• Ensure vulnerable patients, such as those with mental illness or learning disabilities are offered an annual health check.
• Ensure clinical audit cycles are completed and are used to drive improvements in patient care.
• Ensure the practice assesses the risk of, and takes steps to prevent, detect and control the spread of, infections, including providing access to hand washing facilities where tests which carry a high risk of infection are carried out;carrying out infection prevention and control audits; providing in date sterile gloves, ensuring single use equipment is only used once, and ensuring sharps bins are appropriately stored.
• Ensure the proper and safe management of medicines including appropriately signed Patient Group Direction; sufficient quantities of emergency medicines and staff awareness of where these are stored; and that staff responsible for medicine refrigerator temperature checks know what action to take should the thermometer read under or over the recommended temperature.
• Ensure all staff receive training appropriate to their role; that they are enabled to review and understand key policies and procedures such as the whistleblowing policy and induction policy, and they receive appropriate support, professional development, supervision and appraisal.
• Ensure all clinical staff are given the opportunity to be involved in practice meetings for their own support and development, receive relevant practice information including clinical updates and contribute to the improvement of patient care.
• Ensure recruitment practices comply with the regulations.

In addition the provider should:

• Introduce a system for the review of data from audits and QOF to support learning and promote development of the practice.
• Ensure all patients identified as in need of an annual health check are offered one.
• Formalise plans to address patient concerns regarding continuity of care.
• Ensure all repeat prescription requests can be audit trailed for as long as the prescription remains uncollected.
• Implement a system for recording the serial numbers of blank prescription forms issued to which GPs to ensure there is an appropriate audit trail.
• Develop and implement a patient consent policy.
• Translate key information into the prevalent language for the practice population.
• Ensure information on how to complain is easily accessible for patients and that all staff are aware of the complaints book.
• Ensure patient confidentiality is protected by ensuring patients cannot be overheard during treatment and / or consultations.
• Include safeguarding as a standing agenda item for practice meetings.
• Ensure patients are made fully aware of the out of hours service, and information on the out of hours service is consistent across the practice leaflet, website and telephone answer message.

Where, as in this instance, a provider is rated as inadequate for one of the five key questions or one of the six population groups it will be re-inspected no longer than six months after the initial rating is confirmed. If, after re-inspection, it has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group, we will place it into special measures. Being placed into special measures represents a decision by CQC that a service has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

On the basis of the ratings given to this practice at these inspections, I am placing the provider into special measures. This will be for a period of six months. We will inspect the practice again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice