Archived: Dr Yogendra Dutt Sharma Also known as The Surgery

Updated 2 March 2017

Dr Yogendra Dutt Sharma, The Surgery Fulmar Drive, Offerton, Stockport, SK2 5JL is part of the NHS Stockport Clinical Commissioning Group (CCG). Services have been provided until 30 November 2016 by Dr Yogendra Dutt Sharma under a general medical services (GMS) contract with NHS England.

However, as of the 1 December 2016 the NHS England contract was with two GPs already registered with the CQC at Heaton Moor Medical Group. They had commenced the process to apply to register the practice with the CQC.

The practice had approximately 1600 patients on their register.

Dr Sharma, the CQC registered provider was not currently providing clinical care and had not done so for over two years. The GP cover had been provided previously by locum GPs before the new contract holder was in place. Dr Yogendra Dutt Sharma no longer employed any staff who worked at the practice.

The GPs supporting Dr Sharma employ staff who worked flexibly across the four GP surgeries within the Heaton Moor Medical Group.

Information published by Public Health England rates the level of deprivation within the practice population group as eight on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. Male life expectancy at 80 years is better than the local and national average and female life expectancy at 83 years reflects the local and national averages.

The practice’s patient population has a lower rate of long standing health conditions (51% compared to 53% locally and 54% nationally) and there is a lower rate of unemployment at 1% compared to 5% locally and nationally.

The practice opens Monday to Friday from 8am until 6.30pm except for Wednesdays when the practice closes at 1pm. The practice also closes 1pm to 2pm each day. During these periods of closure patients ringing the practice are diverted to one of the other practices within the contract holders’ group of GP surgeries. Patients also have the opportunity to attend appointments at the other three locations where extended opening is provided weekdays from 7.30am and until 8pm Monday to Thursday.

The practice building is a 28 year old purpose built single storey building. It provides level access. Disabled facilities are available. There is car parking space close to the surgery. The new NHS contract holder (Heaton Moor Medical Group) have plans in place to upgrade and refurbish the practice and this includes providing a ramp outside from the car park to the main entrance into the building.

When the practice is closed patients are asked to contact NHS 111 for Out of Hours GP care.

Updated 2 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Yogendra Dutt Sharma, The Surgery Fulmar Drive, Offerton, Stockport, SK2 5JL on 7 December 2016. Overall the practice is rated requires improvement.

Following a comprehensive inspection in February 2016, the practice was rated as inadequate for providing safe, effective and well-led services, and as requires improvement for providing responsive service and good for providing caring services. Overall the practice was rated as inadequate.

We issued three warning notices and one requirement notice under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and placed the practice in special measures as a result.

Following the inspection in February 2016, the Clinical Commissioning Group (CCG) supported the provider to improve the service by facilitating a joint working arrangement with GP partners from another registered practice. This arrangement was implemented from 1 October 2016.

At the time of this inspection (December 2016), Dr Yogendra Dutt Sharma, the registered provider was no longer contracted with NHS England to provide primary medical services at the surgery, Fulmar Drive. The NHS England contract as of the 1 December 2016 was between two GPs partners from a local GP practice (Heaton Moor Medical Group). The new NHS contract holder had commenced their application to register this practice with the CQC as part of their existing registration at Heaton Moor Medical Group.

The Dr Yogendra Dutt Sharma, the registered provider had not yet submitted his application to cancel his registration with the CQC.

At this inspection, we discussed with Dr Yogendra Dutt Sharma the action taken to improve the quality of care and treatment provided at the practice. Dr Sharma confirmed that GPs from Heaton Moor Medical Group had been supporting the practice since 1 October 2016 to ensure patients received safe care. He also confirmed that the improvements we found at this inspection were because of the work undertaken by the GPs and practice manager from Heaton Moor Medical Group.

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

• The GPs supporting Dr Sharma, the registered provider, had implemented systems, policies, procedures and processes to ensure effective governance of the practice.
• The GPs were actively assessing the service provided, and were prioritising and responding to the risks and gaps identified in patient care.
• Significant gaps in patient medication reviews had been identified. An audit of repeat prescribing had identified some areas of serious concerns with patients being prescribed medicines with no record of a corresponding healthcare need. For example, 60 patients were prescribed thyroxine but did not have any record of thyroid-stimulating hormone (TSH) blood test used to check the dosage and effectiveness of the medicine. The GPs supporting the registered provider had taken action to address this.
• The Quality and Outcomes Framework (QOF) data for 2015/16 showed a significant drop by over 13% in achievement compared to the previous year. This was approximately 20% lower than the local and national averages. Unverified data provided in January 2017 by the GPs supporting the registered provider demonstrated significant improvements in QOF achievements. A nurse practitioner was working at the practice, alongside the GPs to improve the quality and quantity of patients requiring chronic disease management.
• Evidence of clinical audit had not been available. However the supporting GPs had undertaken four first cycle clinical audits between October and November 2016 to assess the quality of care that been delivered to patients.
• With support of the GPs action had been taken to minimise risks to patients including those in relation to medicine management, responding to medical emergencies and staff recruitment.
• Following liaison with health visitors, school nurses and the local safeguarding unit, a children’s safeguarding register was now recorded, coded and accessible to the practice team.
• Staff training plans were being implemented to ensure staff were trained appropriately. This included training in safeguarding.
• Patients said they were treated with compassion, dignity and respect. We saw that staff treated patients with kindness and respect, and maintained confidentiality.
• Urgent appointments were available on the day they were requested and routine appointments were available within a couple of days of request. The GPs supporting the registered provider provided a range of services over four locations in Stockport and could offer patients access to appointments at any of these locations. In addition patients now had access to minor surgery, out of hours phlebotomy and specialist diabetic nurse appointments.
• A record of who were members of the patient participation group (PPG) had not been available nor was evidence of previous consultation with the PPG. However the supporting GPs were inviting patients to join their PPG.
• Patients said they found it easy to make an appointment with the GP, with urgent appointments available the same day.

The areas where the practice must make improvements are:

• Ensure the continued review of the whole service provided and continue to implement remedial action in response to identified gaps in the quality of care that has been provided to patients.
• Ensure the continued implementation of systems for reviewing and supporting patients with long term conditions and needs that are more complex.

The areas where the practice should make improvements are:

• Continue with the planned integration of the patient record system.
• Continue with patient medication reviews to ensure that medicines are prescribed appropriately in line with guidance and the required monitoring checks such as blood tests are undertaken.
• Implement the planned programme of building refurbishment and up grading.
• Continue to promote and develop the patient participation group for the practice

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by the new contract holders for this service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 2 March 2017

The practice is rated as requires improvement for the care of people with long-term conditions.

The practice was rated requires improvement for two of the key questions. The concerns that led to these ratings apply to everyone using the practice, including this population group.

• Quality and Outcomes Framework (QOF) date for 2015/16 showed that the registered provider performed poorly when compared to the local and national averages. However unverified data provided by the supporting GPs for 2016/17 showed significant improvements.
• The GPs and the practice manager supporting the registered provider were actively assessing the service provided, and prioritising and responding to the risks and gaps identified following this assessment. The assessment had identified that records of basic health checks were missing in patient records and or there were coding issues. (Coding is a way to record clinical activity that is logged effectively within a computer database). Reviews of patients were being undertaken rapidly to identify and minimise any potential risks to patients.
• The GP lead for medicines lead had identified significant gaps in patient medication reviews. The audit of repeat prescribing had identified some areas of serious concerns with patients being prescribed medicines with no record of a corresponding healthcare need.

Updated 2 March 2017

The practice is rated as requires improvement for the care of families, children and young people.

The practice was rated requires improvement for two of the key questions. The concerns that led to these ratings apply to everyone using the practice, including this population group.

However:

• The GPs supporting the registered provider had identified that systems to identify and follow up children living in disadvantaged circumstances and who were at risk of abuse were not place. The GP lead for safeguarding children identified that there was no safeguarding register for children. In response to this, urgent requests were sent out to health visitors, school nurses and the local safeguarding hub in Stockport. As a result, a register was now established listing those children considered at risk.
• The GP lead for safeguarding children had a plan in place to hold regular safeguarding meetings commencing in January 2017.
• Immunisation rates were lower than the Clinical Commissioning Group (CCG) and England rates for all standard childhood immunisations.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.
• Quality and Outcome Framework (QOF) 2015/16 data showed that just fewer than 16% of patients with asthma on the register had an asthma review in the preceding 12 months compared to the Clinical Commissioning Group and England average of 75%. The supporting GPs provided data in January 2017 for the year 2016/17 that showed that 68% of patients with asthma had a review in the preceding 12 months.
• Data for 2015/16 showed the practice’s uptake for the cervical screening programme was 77%, which was below the CCG and the national average of 81%. This also showed a slight deterioration on the previous year’s results. The GPs now providing the service anticipated that this would improve, and there was improved access to a female sample taker. 

Updated 2 March 2017

The practice is rated as requires improvement for the care of older people. The practice was rated requires improvement for two of the key questions. The concerns that led to these ratings apply to everyone using the practice, including this population group.

However:

• The GPs supporting the registered provider now offered proactive, personalised care to meet the needs of the older people in its population.
• They were responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• Plans were established to participate in local neighbourhood, palliative care and multi-disciplinary team meetings starting January 2017.

Updated 2 March 2017

The practice is rated as requires improvement for the care of working-age people (including those recently retired and students). The practice was rated requires improvement for two of the key questions. The concerns that led to these ratings apply to everyone using the practice, including this population group.

However:

• The GPs supporting the registered provider were aware of the needs of the working age population. The practice was now able to offer different types of appointments at different locations to suit the needs of individual patients. Examples included open access phlebotomy appointments available at one the group’s surgeries and other surgeries offered extended opening times from 7.30am each weekday morning and until 8pm Monday to Thursday.
• Plans were in place to provide online services for patients including booking and cancelling appointments. 

Updated 2 March 2017

The practice is rated as requires improvement for the care of people experiencing poor mental health (including people with dementia). The practice was rated requires improvement for two of the key questions. The concerns that led to these ratings apply to everyone using the practice, including this population group.

However:

• Data from 2015/16 showed that 100% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was above the Clinical Commissioning Group (CCG) of 85% and the England average of 84%.
• 100% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan recorded in the preceding 12 months, which was higher than the CCG average of 92% and the England average of 89%.
• The GPs supporting the registered provider worked regularly with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia and implemented a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

Updated 2 March 2017

The practice is rated as requires improvement for the care of people whose circumstances may make them vulnerable. The practice was rated requires improvement for two of the key questions. The concerns that led to these ratings apply to everyone using the practice, including this population group.

However:

• The GPs supporting the registered provider had identified that systems to identify patients who may be considered vulnerable were not place. The GP lead for safeguarding adults had plans in place to build the register by reviewing the patient registered with a learning disabilities, dementia and or a mental health illness.
• Longer appointments for patients who were vulnerable and those with a learning disability were available.
• The GPs supporting the registered provider provided evidence that their staff team were trained and knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.