Archived: Dr K Dhillon

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr K Dhillon, also known as Eagle Way Surgery on 20 September 2016. This inspection was to follow up on requirement notices served on the provider following an earlier inspection on 22 July 2015.

At that inspection, the practice was rated overall as requires improvement, with requires improvement for providing safe, responsive and well-led services. We found that staff were unclear about their responsibilities to raise concerns, information about safety was not consistently recorded, and medicines were not well managed and that systems to monitor complaints and audits were not effective, amongst other issues. Further, we said that the practice should improve in some areas, including maintaining accurate records of discussions and investigations. It was rated as good for providing effective and caring services.

Following our inspection of 22 July 2015, we asked the provider to send us an action plan detailing how they were going to improve services and further to our recent inspection of 20 September 2016, the practice is now rated as good.

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

• Significant events were raised, discussed and analysed in a uniform and timely manner.

• There were effective systems in place to manage and act upon patient safety and medicine alerts.

• In one of the first aid kits some of the plasters, bandages and antiseptic swabs had expired.

• Some areas of the practice appeared to be in need of deep-cleaning, such as the walls, carpets and curtains in the clinical rooms. This had not been identified and actioned in the infection control audit.

• Not all GPs administering vaccines had undertaken recent refresher training to respond to a patient experiencing anaphylaxis. A GP taking samples for the cytology screening programme had not received recent training to reflect changes in procedures.

• There was no high risk medicines policy and one patient had not had monitoring in accordance with published guidance.

• The practice did not consistently follow its own policy on repeat prescribing.

• Blank prescription stationery was securely stored but the practice were not tracking the issue to their clinical staff.

• There were procedures in place for monitoring and managing risks to patient and staff safety.

• Data for the year 2015/2016 showed that the practice was performing in line with most indicators, although data relating to cervical screening was low, at 13% below local and England average.

• Audits were regularly discussed at practice meetings. In some instances, these were selected to check compliance with NICE guidelines.

• There was a positive relationship with other healthcare professionals, and minutes of meetings evidenced that patients with complex needs were regularly discussed.

• Appropriate and proactive referrals were made to secondary care healthcare specialists where required.

• The practice had identified 38 patients as carers, which amounted to 1.6% of the practice list. However, the practice did not offer an annual health check for carers.

• Patients without an appointment could call into the practice opportunistically. On the day of our inspection, we saw that they were given an immediate appointment and did not wait very long to be seen.

• Morning and afternoon surgeries were extended in accordance with demand.

• The provider had a clear understanding of the practice population, and what action was required to meet their needs.

The areas where the provider must make improvement are:

• Implement an effective system for the monitoring and review of prescribed medicines including those that are high risk.

• Ensure that GPs carrying out cytology procedures have received up to date training.

• Ensure that GPs administering vaccinations are suitably trained to respond to a medical emergency in the event of a patient suffering from anaphylaxis.

The areas where the provider should make improvement are:

• Ensure the contents of the first aid kits are in date and there is a system in place to monitor expiry dates.

• Revise the infection control audit to effectively include and assess the carpets, walls and curtains used in the clinical rooms and take relevant actions.

• Put in place a system to track the issue of prescription stationery around the premises.

• Offer an annual health check to patients who are carers.

• Improve the recall system to encourage relevant patients to attend for cervical screening.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice