Ashton Gardens Surgery

Updated 11 March 2022

Dr Aaron Patel is located at Chadwell Heath Health Centre, Ashton Gardens, Chadwell Heath, Romford, RM6 6RT. The practice is well served by local buses and is within easy reach of multiple railway stations providing direct access into Central London. Parking is available on site as well as on surrounding streets. At the time of our inspection we were told that the organisation, currently a single-handed practice, intended to become a partnership in the near future.

Other staff working at the practice include a practice manager; a locum GP, a locum pharmacist, a practice nurse, a health care assistant and reception/administration staff. The practice also had support of staff from the local Primary Care Network (Network two) including a clinical pharmacist, a social prescriber, a physiotherapist, a health and wellbeing coach, a care co-ordinator and a mental health practitioner.

The practice provides NHS primary care services to approximately 3300 patients and operates under a Primary Medical Services (PMS) contract. This is a contract between general practices and NHS England for delivering services to the local community. The practice is part of the Barking and Dagenham GP Federation and the NHS North East London Clinical Commissioning Group (CCG).The practice was registered with the Care Quality Commission in October 2013 to carry out the following regulated activities: diagnostic and screening procedures and treatment of disease, disorder or injury.

The practice reception is open Monday-Friday between 8:00am-6:30pm and appointments are available between these times. Patients may book appointments by telephone or in person. When the practice is closed, patients are directed to contact the local out of hours service and NHS 111. Out of hours services, after hours and at weekends are provided by Havering GP Access Hub and the Hub may be contacted via a dedicated appointment booking telephone line or by calling NHS 111.

Information published by Public Health England shows that deprivation within the practice population group is in the fifth decile (five of 10). The lower the decile, the more deprived the practice population is relative to others. According to the latest available data, the ethnic make-up of the practice area is 55.8% Asian, 22.3% White, 15.5% Black, 4.3% Mixed, and 2.1% Other.

Updated 11 March 2022

We carried out an announced inspection at Dr Aarron Patel. A remote clinical records review was undertaken on 13 December 2021 and interviews with staff were held remotely on 7, 8 & 9 December 2021. Due to risks associated with the Covid-19 pandemic our visit to the practice premises was delayed until 10 February 2022. Overall, the practice is rated as Requires Improvement.

Safe - Requires Improvement

Effective - Good

Caring – Good

Responsive – Good

Well-led - Requires Improvement

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Dr Aarron Patel on our website at www.cqc.org.uk

Why we carried out this inspection

We undertook an announced inspection to follow up on issues of concern that had been raised with us. We previously carried out announced inspections at Dr Aaron Patel in 2016 and 2017 and the practice was rated good overall and in safe, effective, well-led and caring key questions and requires improvement in responsive. Following our previous inspection on 25 September 2018, the practice was rated Good overall and for all key questions.

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

• Conducting staff interviews using video conferencing.
• Requesting staff feedback using surveys.
• Completing clinical searches on the practice’s patient records system and discussing findings with the provider.
• Reviewing patient records to identify issues and clarify actions taken by the provider.
• Requesting evidence from the provider.
• A short site visit.

Our findings

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as Requires Improvement

We found:

• Appropriate recruitment and monitoring checks had not been undertaken for all staff.
• Systems in place to monitor emergency equipment needed to be improved.
• There was not sufficient oversight of risk management activities related to the practice premises undertaken by the building managers, particularly fire risks and the fire policy contained out of date information.
• There was limited evidence of improvement to patient care stemming from quality improvement activity.
• Treatment of patients that had an acute exacerbation of asthma and were provided with rescue packs needed to be reviewed and improved.
• The practice supplied information which indicated that appointment availability had increased in recent months but acknowledged that the phone system generated difficulty for patients trying to access appointments.
• Rates of childhood immunisations and cervical screening were below target although the practice outlined plans in progress to improve uptake.

However, we also found that:

• There were appropriate safeguarding systems in place.
• The practice took appropriate action in response to significant events and patient safety alerts.
• Quality of care provided to most patients whose records we reviewed was of a good standard.
• Patient feedback available indicated that the practice respected patients’ dignity and treated them with respect.
• There were systems in place to act on patient feedback and respond to complaints.
• Staff reported marked improvement in patient care and governance since new clinical leadership had been employed at the practice. Yet staff were not confident that this improvement would be sustained unless these members of staff became partners in the practice. We were told that an application to change the practice from a single handed GP to a partnership was in progress.

We found breaches of regulations. The provider must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The provider should:

• Increase quality improvement activity which aims to improve the quality of clinical care being delivered to patients.
• Arrange for regular all staff meetings.
• Maintain additional leadership capacity to ensure that improvements made to care and treatment outlined by staff are sustained.
• Act on the findings of staff and patient feedback on the limitations of the current telephone system, following through on its planned replacement and monitor the impact on patient care
• Continue with work to improve uptake of childhood immunisations and cervical screening.
• Review the systems for following up patients who have an acute exacerbation of asthma and for administering rescue packs .

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care