The Care Quality Commission
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  • GP practice

Archived: Dr Ankur Chopra

Overall: Good read more about inspection ratings

Roebuck House, Hastings, East Sussex, TN34 3EY (01424) 452802

Provided and run by:
Dr Ankur Chopra

Important: The provider of this service changed. See new profile

All Inspections

4 October 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

The Dr Ankur Chopra practice was initially inspected in October 2015. It was rated inadequate for safe and well-led services and inadequate overall. It was placed into special measures and warning notices were issued. In March 2016 we carried out a focussed inspection of the areas covered by the warning notices and found that they had not been met. As a result a condition was imposed on the practice. During the period the practice was in special measures we took appropriate enforcement action.

We carried out an announced comprehensive inspection on 1 February 2017. On this occasion the practice was rated as requires improvement overall, inadequate in the well-led domain, requires improvement in the safe domain and good in the effective, caring and responsive domains. Additionally, further breaches of the legal requirements in relation to Good Governance were found and so we issued a warning notice. The practice therefore remained in special measures. On the 16 May 2017 we re-inspected the practice and found that they had met the requirements of the warning notice

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 4 October 2017.

Overall the practice is now rated as good.

Our key findings across all the areas we inspected 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.
  • 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 were better than the national averages. They 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.
  • 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. During the period of special measures the practice had employed external support to develop and implement improvement plans. It had worked with other local providers to improve services and outcomes for patients. The practice proactively sought feedback from staff and patients, which it acted on.
  • The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by the service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

16 May 2017

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

Dr Chopra’s practice was initially inspected in October 2015. It was rated inadequate for safe and well-led services. The practice was rated as requires improvement in effective and as good in caring and responsive. As a result the practice was placed into special measures and warning notices were issued. In March 2016 we carried out a focussed inspection of the areas covered by the warning notices and found that they had not been met. As a result a condition was imposed on the practice to ensure there was sufficient, effective and co-ordinated management support for the practice to achieve compliance with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and to sustain that compliance.

A further inspection was carried out on 6 July 2016 to assess whether the practice had improved and resolved the issues leading to breaches of the regulations. The practice was again rated as inadequate overall and for safe and well-led services, requires improvement for responsive services and good for effective and caring services. Further enforcement action was proposed, but following the provision of evidence and written representations from the practice it was agreed that a further comprehensive inspection would take place to assess whether the practice had made sufficient improvement before proceeding with the enforcement action.

We carried out an announced comprehensive inspection at Dr Ankur Chopra on 1 February 2017. On this occasion the practice was rated as requires improvement overall, inadequate in the well-led domain, requires improvement in the safe domain and good in the effective, caring and responsive domains.

Additionally, breaches of the legal requirements were found because the provider had failed to assess, monitor and improve the quality and safety of the services provided or to assess, monitor and mitigate the risks relating to the health, safety and welfare of service users and others who may be at risk which arise from the carrying on of the regulated activity. Therefore a warning notice was served in relation to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 17 Good Governance.

Following the comprehensive inspection, the practice advised us what they would do to meet the legal requirements in relation to the breaches and how they would comply with the legal requirements, as set out in the warning notices.

We undertook this announced focused inspection on the 16 May 2017, to check that the practice had followed their plan and to confirm that they now met the legal requirements in relation to the warning notices. This inspection does not alter the practice’s current ratings as it is still in special measures. A further comprehensive inspection is planned to take place within six months of the previous comprehensive inspection at which the practices rating will be re-assessed.

During this inspection the practice provided records and information to demonstrate that the requirements of the warning notice had been met. You can read the report from our last comprehensive and focussed inspections by using the link for Dr Ankur Chopra on our website at www.cqc.org.uk.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

1 February 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

Dr Chopra’s practice was inspected in October 2015. It was rated inadequate for safe and well-led services. The practice was rated as requires improvement in effective and as good in caring and responsive. As a result the practice was placed into special measures and warning notices were issued. In March 2016 we carried out a focussed inspection of the areas covered by the warning notices and found that they had not been met. As a result a condition was imposed on the practice to ensure there was sufficient, effective and co-ordinated management support for the practice to achieve compliance with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and to sustain that compliance.

A further inspection was carried out on 6 July 2016 to assess whether the practice had improved and resolved the issues leading to breaches of the regulations. The practice was again rated as inadequate overall and for safe and well-led services, requires improvement for responsive services and good for effective and caring services. Further enforcement action was proposed, but following the provision of evidence and written representations from the practice it was agreed that a further comprehensive inspection would take place to assess whether the practice had made sufficient improvement before proceeding with the enforcement action.

We carried out an announced comprehensive inspection at Dr Ankur Chopra on 1 February 2017. Overall the practice is rated as requires improvement.

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

  • Improvements had been made in several areas including, training, security and infection control.
  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. There were systems in place for the handling of significant events and complaints. However in some instances, reviews and mitigating actions were not always fully analysed or carried out.
  • Most risks to patients were assessed and well managed, with the exception of those relating to some general health and safety issues and medicines management.

  • Data showed patient outcomes were generally high compared to the national average.

  • Audits had been carried out and we saw evidence that audits were driving improvements to patient outcomes.

  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • Information about services and how to complain was available and easy to understand.
  • Complaints processes were not always followed through in a timely manner.
  • The management team had been re-structured with the addition of a business manager.

  • The revised management team had made several policy and procedural improvements since the last inspection however it was still too early to ascertain whether the changes had become embedded and sustained.

  • Despite being in special measures since February 2016 and the imposition of enforcement action there are still breaches of the regulations relating to the governance of the practice requiring further enforcement.

The areas where the provider must make improvements are:

  • To ensure that all significant events are investigated and analysed thoroughly enough to support improvement.

  • To ensure systems are in place and followed to ensure that all complaints are responded to and investigated fully and in a timely manner.

  • To ensure that systems are in place and adhered to to identify all risks to health and safety and mitigate against them.

  • To ensure systems are in place to effectively monitor the audit trail and expiry dates of dressings and medicines stored in stock cupboards.

In addition the provider should:

  • Format care plans in such a way that hard copies can always be produced.

  • Consider keeping a log of verbal complaints that were resolved informally.

  • To put systems in place to ensure the integrity of medicines stored in fridges not monitored by the provider.

  • Ensure that effective communication and processes are in place so that staff feel appreciated and that their contribution to the practice is valued.

This service was placed in special measures in February 2016 and remains in special measures. Insufficient improvements have been made such that there remains a rating of inadequate in the well-led domain. We have taken further enforcement action in line with our policies. 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 six months, and if there is not enough improvement we will move to close the service, or to vary the provider’s registration to remove this location, or cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

6 July 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

Dr Chopra’s practice was inspected in October 2015. It was rated inadequate in safe and well-led services. The practice was rated as requires improvement in effective and as good in caring and responsive. As a result the practice was placed into special measures and a warning notice was issued. In March 2016 we carried out a focussed inspection of the areas covered by the warning notice and found that they had not been met. As a result a condition was imposed on the practice to ensure there was sufficient, effective and co-ordinated management support for the practice to achieve compliance with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and to sustain that compliance.

The practice was inspected again on 6 July 2016. The practice is rated as inadequate for safe and well-led services and overall. They are rated as requires improvement for responsive services and good in effective and caring.

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. For example infection control, maintenance and security issues at the branch surgery had not been sufficiently addressed.
  • There was no clear process within the practice for the recording of notifiable incidents under the duty of candour.
  • There was limited evidence that complaints had been thoroughly investigated, appropriately responded to or that learning from complaints had been shared with staff.
  • Not all nursing staff were trained to the appropriate level of child safeguarding.
  • While improvements had been made in relation to appropriate recruitment checks on staff there were still gaps apparent in relation to recruitment records. One new member of staff had commenced in post without a Disclosure and Barring Service check although the practice had carried out an associated risk assessment. Another staff member in an interim position had no record of the terms or nature of this position on their file. Contracts of employment had not been signed by the employer and the practice did not hold staff immunity records on file.
  • The practice had ensured that staff received an annual appraisal; however induction records for new staff were not completed. Training records were inconsistent and there were gaps in the mandatory training completion for some staff.
  • The leadership structure and capacity of the practice was not clear and while there were governance arrangements in place these were limited in relation to the management of risk and appropriate mitigating actions.
  • There were ongoing maintenance issues identified at the branch surgery and these had not been adequately addressed. This included an issue with security of the surgery where access was available through a connecting door from the attached residence.
  • Staff were clear about reporting incidents, near misses and concerns however there was little evidence of robust investigation processes, learning and communication with staff. Complaints were not adequately addressed and associated records of investigations and actions were not kept.
  • Improvements had been made in relation to medicines management however there continued to be some issues relating to this. For example, in relation to the adoption of patient group directions, the availability of emergency medicines, the management of medicine incidents and the use of patients own dressings within the practice.
  • Patients were positive about their interactions with staff and said they were treated with compassion and dignity.
  • Patient outcomes were high when compared with local and national averages.
  • Patients consistently told us they were happy with the treatment and care they received from the practice.

The areas where the provider must make improvements are:

  • Introduce effective processes for analysing, recording, acting on, monitoring and learning from significant events, incidents, near misses and complaints.
  • Ensure effective processes are in place within the practice for the recording of notifiable incidents under the duty of candour.
  • Ensure all staff are trained to the appropriate level of child safeguarding.
  • Take action to address identified concerns with infection prevention and control practice.
  • Ensure recruitment records include contracts signed by both the staff member and employer and evidence of staff immunity checks.
  • Ensure that all staff have appropriate recruitment checks prior to commencing in post and that when staff roles change these changes are reflected in the documents and contracts held.
  • Ensure that structured induction processes are in place and recorded for new staff.
  • Ensure that all staff complete mandatory training in line with their roles in a regular and timely manner and that training logs are clear and up to date.
  • Carry out clinical audits including re-audits to ensure improvements have been achieved based on areas of risk and necessary improvements identified within the practice.
  • Ensure that formal governance arrangements are effective including systems for assessing and monitoring risks and the quality of the service provision.
  • Clarify the leadership structure and ensure there is leadership capacity to deliver all improvements.
  • Ensure that maintenance and security issues at Guestling (branch surgery) are addressed in a timely manner and with sufficient regard for the associated risks.
  • Ensure that ongoing medicine management issues are effectively addressed. This must include ensuring that the appropriate emergency medicines are available to reflect the risks associated with procedures being undertaken within the practice.

The provider should also:

  • Ensure that information for carers is accessible, including the use of links through the practice website.

This service was placed in special measures in February 2016. Insufficient improvements have been made such that there remains a rating of inadequate overall and for safe and well-led services. We are now taking further action in relation to this provider and will report on this when it is completed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

01 March 2016

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out a focused warning notice follow up inspection at Dr Chopra on 1 March 2016. Overall the practice is rated as inadequate.

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

  • While we saw that the provider had taken some action against the warning notice issued in respect of regulation 12, patients continued to be at risk of harm because the provider was failing to operate and implement effective and safe medicine management systems. This placed patients at risk of inappropriate care and treatment.

  • The practice met the warning notice in respect of the management of controlled drugs as controlled drugs were stored securely and access to them was restricted. Prescriptions for controlled drugs were signed before the medicines were dispensed. The practice recorded the name of the person who had collected the dispensed controlled drugs.

  • The practice met the warning notice in respect of the management of medicines that require refrigeration. All the medicine and vaccine refrigerators at both the main practice and the Guestling branch surgery had their minimum and maximum temperatures checked and recorded daily and only medicines were stored within these refrigerators.However the there was no written cold chain procedure and the cold chain had not been validated, although the practice had ordered a suitable container to ensure future validation of the cold chain.

  • There were two vaccines in the refrigerator at Guestling branch surgery and one at the main practice which had expired.

  • The practice had adopted the patient group directions (PGDs) identified in the warning notice and nursing staff had been authorised to work under them. However, PGDs published since February 2016 had not been adopted.

  • The warning notice in relation to the security and storage of blank prescriptions had not been met. At both the main and branch surgeries blank prescription forms for use in printers were not stored on-site in accordance with national guidance and there were inconsistencies in relation to tracking and monitoring of prescriptions.

  • The practice did not hold the expected list of emergency medicines and there was no risk assessment in place for this.

  • The provider had continued to fail to establish and operate effective and safe recruitment systems. Placing patients at risk of harm. They had failed to take action against the warning notice issued in respect of regulation 19.

  • The practice did not have a comprehensive recruitment policy in place. Records of staff recruited to the practice were incomplete. For example, DBS checks had still not been processed for staff identified as requiring a check.

  • There was no evidence of current registration with a professional regulator on record for one member of nursing staff and references had not been sought for a new member of staff.

The practice must ensure

  • That a comprehensive recruitment policy is in place.

  • Recruitment practices are robust and staff records contain the information required by regulation.

  • Medicine management systems are reviewed and they are robust and safe.

  • Medicines are securely stored, a cold chain procedure is in place and that a validated cold chain is used when transferring medicines requiring refrigeration to the branch surgery.

  • The security and tracking of blank hand written and computer prescription forms at all times.

  • That staff using Patient Group Directions have been approved by the practice to work under these documents and the Patient Group Directions are available to staff when being used.

On the basis of the findings at this inspection, I am imposing conditions on the registration of the provider. We will inspect the practice again in order to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

27 October 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an unannounced comprehensive inspection of Dr A Chopra on 27 October 2015 in response to concerns raised about the practice. Overall the practice is rated as requires inadequate.

Specifically, we found the practice to be inadequate in being well-led and for providing safe services. It required improvement for effective services and was good for providing a caring and responsive service.

Dr Ankur Chopra provides primary medical services to people living in Hastings. At the time of our inspection there were approximately 3810 patients registered at the practice. The practice is registered as an individual, Dr Chopra who was also being supported by a nurse practitioner, practices nurses, reception and administrative staff.

The inspection team spoke with staff and patients and reviewed policies and procedures. The practice understood the needs of the local population and engaged effectively with other services. Whilst the practice was committed to providing high quality patient care and patients told us they felt the practice was caring we found significant concerns that placed patients at risk.

Our key findings were as follows:

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded however there was a lack of systems to ensure this was appropriately reviewed and addressed.
  • Risks to patients were not always assessed and managed.
  • Infection control audits were not up to date and whilst cleaning schedules were in place some parts of the practice were not clean and tidy.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance.
  • Staff had received some training appropriate to their roles. However the systems for monitoring training were inconsistent in their implementation and lacked detail.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • The practice had the appropriate equipment, medicines and procedures to manage foreseeable patient emergencies.
  • The practice’s systems to keep patients safe were not robust this included safeguarding procedures and recruitment practices.
  • Whilst significant events were discussed informally at management level there was no evidence that the practice had systems to disseminate this information to the staff team.
  • Medicine management systems including their security and storage was not safe.

The areas where the provider must make improvements are;

The practice MUST ensure:

  • Systems are put in place to demonstrate that the practice learns from and disseminate information related to risk, complaints and incidents.
  • The quality and safety of services are monitored, including a programme of audits and take appropriate action without delay where progress is not achieved as expected.
  • They implement and record regular multidisciplinary meetings, practice and clinical meetings.
  • Staff are appropriately trained and receive an appraisal.
  • Recruitment practices are robust and staff records contain the information required by regulation.
  • Improvements are made to the recording and management of staff training records.
  • Medicine management systems are reviewed and they are robust and safe.
  • Medicines are securely stored, refrigerator temperatures are monitored to ensure the cold chain is maintained and that a validated cold chain is used when transferring medicines requiring refrigeration to the branch surgery
  • The security and tracking of blank hand written and computer prescription forms at all times
  • That staff using Patient Group Directions have been approved by the practice to work under these documents and the Patient Group Directions are available to staff when being used.

At the Guestling branch surgery:

  • Repeat prescriptions for medicines dispensed to patients and all Controlled Drug prescriptions are signed before they are dispensed.
  • That food is not stored with medicines
  • Staff have access to adequate emergency medicines

On the basis of the ratings given to this practice at this inspection, I am placing the provider into special measures. This will be for a period of six months. We will inspect the practice again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice