The Care Quality Commission
  • Doctor
  • GP practice

Archived: Dr Yogendra Dutt Sharma Also known as The Surgery

Overall: Requires improvement read more about inspection ratings

The Surgery, Fulmar Drive, Offerton, Stockport, Greater Manchester, SK2 5JL (0161) 483 3363

Provided and run by:
Dr Yogendra Dutt Sharma

All Inspections

7 December 2016

During a routine inspection

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

24 February 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Yogendra Dutt Sharma, The Surgery on 24 February 2016. Overall the practice is rated as Inadequate.

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

  • There was a system in place to report and record significant events, however two members of the clinical nursing team were unaware of the policy or procedure to follow in the event of an incident occurring.
  • Systems and processes to ensure effective governance of the practice were not implemented.
  • Evidence that clinical audit and clinical team meetings were driving improvement in performance to improve patient outcomes was not available.
  • Several policies and procedures to effectively manage and govern the practice were not available.
  • Risks to patients were not appropriately assessed and well managed, specifically in relation to medicines management, recruitment and medical emergencies.
  • Not all systems, processes and practices were embedded to keep patients safe and safeguarded from abuse. Staff spoken with were unclear who the safeguarding lead was and a policy for the protection of children was not available.
  • Arrangements to ensure clinical staff were suitably trained, professionally registered, insured and benefited from ongoing training; supervision and appraisal were not in place.
  • Patients said they were treated with compassion, dignity and respect. They said they felt cared for, supported and listened to. 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 practice had attempted to seek feedback from patients and had a patient participation group.

The areas where the provider must make improvements are:

  • Ensure there are policies and procedures in place for staff guidance and ensure effective governance systems. These should accessible to staff, specific to the practice, dated and reviewed appropriately.
  • Ensure clinical audits and re-audits are undertaken to monitor and improve patient outcomes.
  • Ensure a system is in place to manage, assess and mitigate risks to patients, including those risks around responding to a medical emergency, fire safety and the safe management and disposal of medicines.
  • Ensure an effective system of clinical supervision and peer review is implemented for the nursing staff team and GPs working at the practice including locum GPs.
  • Ensure recruitment arrangements include all necessary employment checks for all staff. This includes the medical indemnity insurance for clinicians and the need for a Disclosure and Baring Service (DBS) check when appropriate, for example when staff perform chaperone duties.
  • Ensure safeguarding policies are available for children and adults and they contain up to date information to guide staff. Ensure all staff have received appropriate safeguarding training and that all staff are aware of who the practice leads are for safeguarding.
  • Ensure all staff receive appropriate training on induction, and effective training at the required intervals in accordance with their role and responsibilities and records of this are maintained. This includes training in basic life support.

In addition the provider should:

  • Ensure the practice gains access to the long term absent practice manager’s business emails and electronic files.
  • Continue to work with the local authority health protection nurse to improve infection prevention and control procedures.
  • Ensure the domestic fridge used to store vaccines is changed to a pharmaceutical fridge in accordance with guidance and best practice.
  • Risk assess access to the staff reception office area by members of the public to mitigate risks to staff and patient information.
  • Ensure a cleaning schedule and log are recorded and systems implemented to audit cleaning undertaken.
  • Ensure rooms used to store documents, journals and equipment are maintained in a tidy manner and this is risk assessed appropriately in light of the close proximity of the gas boiler.

I am placing this practice in special measures

Where a practice is rated as inadequate for one of the five key questions or one of the six population groups the practice will be re-inspected within six months after the report is published. If, after re-inspection, the practice has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group, we will place the practice into special measures. Being placed into special measures represents a decision by CQC that a practice has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice