Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Dr Chidananda Barua on 17 May 2016. Overall the practice is rated as inadequate.
Our key findings across all the areas we inspected were as follows:
- Although the practice carried out investigations when there were unintended or unexpected safety incidents, lessons learned were not communicated to practice staff and so safety was not improved.
- Patients were at risk of harm because systems and processes were not in place or effective enough to keep them safe. For example we found areas of concern in respect of safeguarding training, staff recruitment, infection control prevention, medicines management and dealing with emergencies.
- We found evidence that care plans were not a priority in the practice, for example, no care plans had been developed for six out of eight patients on the palliative care register.
- Staff told us they had access to relevant training but documented evidence of attendance was not available.
- Multidisciplinary working was taking place but was generally informal and record keeping was limited or absent.
- Patients were positive about their interactions with staff and said they were treated with compassion and dignity.
- Practice staff reviewed the needs of its local population and engaged with NHS England and the Clinical Commissioning Group to secure improvements to services where these were identified.
- Patients said they found it easy to make an urgent appointment on the same day.
- The practice had good facilities and was well equipped to treat patients and meet their needs.
- The practice had not proactively sought feedback from staff around the services provided.
- The practice lacked an overarching governance framework which supported the delivery of the strategy of good quality care.
The areas where the provider must make improvements are:
- Ensure that effective systems are in place to communicate, analyse and learn from incidents.
- Ensure all staff have undertaken safeguarding training.
- Ensure prescription forms and pads are tracked through the practice and held securely as per national guidelines.
- Ensure staff recruitment arrangements to include all necessary employment checks such as Disclosure and Barring checks and professional indemnity arrangements are in place.
- Ensure risks are effectively managed. For example ensure an assessment has been undertaken in relation to managing medical emergencies which considers the need for oxygen and a defibrillator to be kept for use on the premises.
- Ensure infection control is appropriately managed. For example ensure arrangements are in place with regard to infection control audits ensuring actions identified are dealt with, the cleaning of privacy curtains and ensuring sharps boxes are kept out of reach of young children.
- Ensure an accurate record of staff training is maintained and that staff undertake appropriate training.
- Introduce formal governance arrangements including systems for assessing and monitoring health and safety risks and the quality of the service provision.
The areas where the provider should make improvement are:
- There was no system in place to record verbal complaint and comments made.
- There was no plan of how to improve GP survey results.
I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.
Special measures will give people who use the service the reassurance that the care they get should improve.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice