Archived: Dr Surinder Babbar

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Surinder Babbar (The Courtland Surgery) on 18 January 2017. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months. The full comprehensive report on the 18 January 2017 inspection can be found by selecting the ‘all reports’ link for Dr Surinder Babbar (The Courtland Surgery) on our website at www.cqc.org.uk.

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 10 August 2017. Overall the practice is now rated as requires improvement. Prior to the publication of this report the practice submitted an application to cancel its registration which has been accepted by the CQC.

Our key findings were as follows:

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety and had recently had all staff trained in safeguarding, chaperoning, infection control and fire training.
• All electrical equipment had been portable appliance tested (PAT), a new boiler had been installed, there had been recent Legionella and Control of Substances Hazardous to Health (COSHH) risk assessments.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day, however long waiting times for appointments were mentioned on the day and in the national patient survey and the CQC comment cards.
• 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 had not proactively acted feedback from patients, which it acted on.
• The provider was aware of the requirements of the duty of candour and they had recently trained all staff so they understood the requirements.

However if the provider had still been registered there were areas of practice where the provider needed to make improvements.

In addition the provider must:

• Continue to develop an ongoing programme that demonstrates continuous quality improvements to patient care in a range of clinical areas. This may include clinical audit.

• Consider developing a practice website.

• Assess, monitor and improve patient’s waiting times in view of the low patient survey results.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Surinder Babbar, also known as the Courtland Surgery, on 18 January 2017. Overall the practice is rated as inadequate.

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. We identified multiple concerns in relation to safeguarding, chaperoning, infection control, medicines management, recruitment, fire and health and safety.
• Although staff understood their responsibilities to report incidents there were no processes in place to ensure all significant events, incidents and near misses were identified, recorded, investigated and learning shared or that the process supported the duty of candour (the duty of candour is a set of specific legal requirements that providers of services must follow when things go wrong with care and treatment).
• There was no system in place to ensure patient safety alerts were disseminated and acted upon.
• There was insufficient attention to safeguarding children and vulnerable adults. In particular, not all staff had received training to an appropriate level and policies were not up-to-date.
• We found evidence that the provider did not always maintain an accurate, complete and contemporaneous record in respect of each patient.
• The practice could not demonstrate how it ensured all staff were assessing patient needs and delivering care in line with relevant and current evidence based guidance and standards, including National Institute for Health and Care Excellence (NICE) best practice guidelines.
• The practice had failed to ensure that all staff had the skills, knowledge and experience to deliver effective care and treatment. Some staff were performing duties outside of their responsibility and competence and not all staff had completed identified training.
• The practice did not have a schedule of continuous quality improvement, including complete cycle clinical audits.
• The practice did not review or use performance related data to monitor and improve the quality of service, for example, QOF and prescribing data.
• Patients were positive about their interactions with staff and said they were treated with compassion, dignity and respect.
• Patients said they found it easy to make an appointment and there was continuity of care, with urgent appointments available the same day.
• Staff told us they were respected, valued and supported, particularly by the management in the practice.

The areas where the provider must make improvements are:

• Ensure that premises and equipment are safe and all risks are assessed and mitigated. This includes undertaking risk assessments for fire, premises, Legionella and Control of Substances Hazardous to Health, ensuring compliance with regulations regarding fire detection and warning, and that all electrical equipment is safe and properly maintained.
• Ensure there are processes for identifying, recording, investigating and sharing learning from significant events, incidents and near misses and that processes support the Duty of Candour.
• Ensure there are processes in place for the receipt, dissemination, reviewing and acting upon patient safety alerts.
• Ensure processes are in place to ensure persons providing care or treatment have the qualifications, competence, skills and experience to do so safely.
• Ensure accurate, complete and contemporaneous records are maintained in respect of each patient.
• Ensure policies and procedures to govern activity are practice-specific, up-to-date and accessible to staff.
• Ensure there is a programme of continuous quality improvement to patient care. This may include clinical audit.
• Ensure confidential patient information is stored securely.
• Ensure the security of blank prescriptions forms is in line with guidance.

The areas where the provider should make improvements are:

• Staff should know the location of the recently procured defibrillator and oxygen and be trained in their use. The equipment should be checked on a schedule with other emergency equipment and adult and child masks should always be available with the oxygen.
• Consider improving communication with patients who have a hearing impairment.
• Consider how patients using the accessible toilet facility would alert staff in the event of an emergency.
• Review how carers are recorded on the patient record system to ensure information, advice and support is made available to them.
• Advertise the availability of interpreter services and consider providing information in other languages reflective of the patient population.
• Review the complaints policy and patient complaint information to ensure it is in line with guidance.
• Consider developing a practice website.

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