The Care Quality Commission
  • Doctor
  • GP practice

Dr Narendra Patel

Overall: Good read more about inspection ratings

The Surgery, Main Road, Betley, Wrinehill, Crewe, Cheshire, CW3 9BL (01270) 820527

Provided and run by:
Dr Narendra Patel

All Inspections

6 July 2023

During a monthly review of our data

We carried out a review of the data available to us about Dr Narendra Patel on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.

This could change at any time if we receive new information. We will continue to monitor data about this service.

If you have concerns about Dr Narendra Patel, you can give feedback on this service.

12 May 2022

During an inspection looking at part of the service

We carried out an announced inspection at Dr Narendra Patel on 12 May 2022. Overall, the practice is rated as Good.

Set out the ratings for each key question

Safe - Good

Effective -Good

Well-led - Good

Following our previous inspection on 10 December 2019, the practice was rated Good overall and rated Requires Improvement for providing a Well led service.

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

Why we carried out this inspection

This inspection was focused to follow-up on:

  • The areas inspected included the domains entitled; Safe, Effective and Well Led.
  • The regulatory breach identified on our last inspection on 10 December 2019; Regulation 17 HSCA (RA) Regulations 2014 Good governance.
  • The ‘shoulds’ identified in the previous inspection.

How we carried out the inspection/review

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
  • 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
  • Staff feedback questionnaires.

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 Good overall.

We found that:

  • The practice provided care in a way that kept patients safe and protected them from avoidable harm.
  • Patients received effective care and treatment that met their needs.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. Patients could access care and treatment in a timely way.
  • The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

Whilst we found no breaches of regulations, the provider should:

  • Consider ways of encouraging attendance at a Patient Participation Group.
  • Document the practice strategy in order that the practice may monitor progress against delivery of the strategy.

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

10 December 2019

During an inspection looking at part of the service

We previously carried out an announced comprehensive inspection of Dr Narendra Patel on 15 December 2017 and rated the practice requires improvement overall and for providing safe, effective and well-led services. We carried out an inspection on 16 October 2018 to monitor that the required improvements had been made. At the inspection in October 2018 we rated the practice as good overall and requires improvement for providing effective services because:

  • The care provided to patients near the end of their life was not delivered according to evidence-based guidelines or supported through a coordinated approach between services.
  • Unverified quality indicators for patients with diabetes or patients experiencing poor mental health remained below national averages.

We also made four best practice recommendations:

  • Update the recruitment policy so that it reflects legal requirements.
  • Consider systems to reconcile safeguarding registers with the health visiting team.
  • Complete a formal risk assessment to record the processes non-clinical staff followed to protect themselves and patients in the absence of immunisation for hepatitis B.
  • Consider ways of gathering feedback from the virtual patient participation group to shape and improve services.

The full comprehensive reports for the inspections in December 2017 and October 2018 can be found by selecting the ‘all reports’ link for Dr Narendra Patel on our website at .

We carried out an announced focused inspection at Dr Narendra Patel on 10 December 2019. We decided to undertake an inspection of this service following our annual review of the information available to us. Due to the assurance received from our review of information we carried forward the ratings of good for the following key questions, caring and responsive, from our last inspection in October 2018.This inspection looked at the following key questions: safe, effective and well-led.

We based our judgement of the quality of care at this service is 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 good overall and in safe and effective but requires improvement in well-led. We rated all the population groups as good.

We rated the practice as good in safe because:

  • The practice provided care in a way that kept patients safe and protected them from avoidable harm.
  • Guidance for access to patient online services, health and safety risk assessments and evidence of hardwire electrical testing were not in place. The day after our inspection the practice forwarded to us the appropriate documents.
  • Appropriate standards of cleanliness and hygiene were met.
  • Recruitment checks were carried out in accordance with legal requirements.
  • A formal risk assessment to record the processes non-clinical staff followed to protect themselves and patients in the absence of immunisation for hepatitis B had been completed.

We rated the practice as good in effective because:

  • Patients received effective care and treatment that met their needs.
  • The care provided to patients near the end of their life was delivered according to evidence-based guidelines and supported through a coordinated approach between services.
  • Quality indicators for patients with diabetes or patients experiencing poor mental health were comparable to the national averages.

We rated the practice as requires improvement in well-led because:

  • Systems for storing emergency, controlled drugs were not secure and a risk assessment to mitigate any risks had not been completed.
  • Systems were not in place to support or monitor the competency of dispensary staff who worked unsupervised. We found ongoing recording errors in the controlled drugs log book.
  • Opportunities to reduce the high exception reporting for patients with asthma, COPD and atrial fibrillation had been missed.
  • A clear practice vision and strategy was not in place.
  • Ways of engaging with patients to seek out their views on the way in which care and treatment was delivered had not been explored as recommended at our previous inspection.

The areas where the provider must make improvements are:

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

The areas where the provider should make improvements are:

  • Make staff aware of and, embed into practice the new policy for access to patient online services.
  • Make staff aware of and, embed into practice the new health and safety risk assessments.

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

16 October 2018

During a routine inspection

This practice is rated as Good overall. (The previous rating on 15 December 2017 was requires improvement).

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We previously carried out an announced comprehensive inspection at Dr Narendra Patel on 15 December 2017. The overall rating for the practice was requires improvement with requires improvement in safe, effective and well led and good in caring and responsive. Breaches of legal requirements were found and requirement notices were served in relation to safe care and treatment, good governance and staffing. The full comprehensive report on the December 2017 inspection can be found by selecting the ‘all reports’ link for Dr Narendra Patel on our website at www.cqc.org.uk.

We carried out an announced comprehensive follow up inspection at Dr Narendra Patel on 16 October 2018 to follow up on breaches of regulations we found at our previous inspection.

At this inspection we found:

  • The practice had introduced systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
  • The practice had appropriate systems to safeguard children and vulnerable adults from the risk of abuse. However, there were no processes in place for the practice to reconcile their safeguarding registers with the health visiting team.
  • There had been improvements in the recruitment process however, the recruitment policy did not fully reflect legal guidance.
  • The practice routinely reviewed the effectiveness and appropriateness of the care it provided. However, the care provided to patients near the end of their life was not delivered according to evidence-based guidelines or supported through a coordinated approach between services.
  • The practice worked with Age UK to provide ‘The 80 Plus Service’. The service provided social support and liaison with other services.
  • Unverified data showed that care and treatment provided for patients with asthma and high blood pressure was in line with the national average however, some care indicators for patients with diabetes or patients experiencing poor mental health remained below national averages.
  • Staff involved and treated patients with compassion, kindness, dignity and respect.
  • Patients found the appointment system very easy to use and reported that they were able to access care when they needed it.
  • There had been an improvement in governance procedures. Appropriate actions had been completed in response to risk assessments, policies were correctly dated and systems to act of safety alerts had been put in place.
  • The practice had a virtual patient participation group however it was not active. We saw no evidence of feedback gathered from the group.

The areas where the provider must make improvements are:

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

The areas where the provider should make improvements are:

  • Update the recruitment policy so that it reflects legal requirements.
  • Consider systems to reconcile safeguarding registers with the health visiting team.
  • Complete a formal risk assessment to record the processes non-clinical staff followed to protect themselves and patients in the absence of immunisation for hepatitis B.
  • Consider ways of gathering feedback from the virtual patient participation group to shape and improve services.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

15 December 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

This practice is rated as requires improvement overall. (We previously inspected this practice on 14 January 2015 and rated it as Good overall.)

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Requires improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires improvement

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Requires improvement

People with long-term conditions – Requires improvement

Families, children and young people – Requires improvement

Working age people (including those recently retired and students – Requires improvement

People whose circumstances may make them vulnerable – Requires improvement

People experiencing poor mental health (including people with dementia) - Requires improvement

We carried out an announced comprehensive inspection at Dr Narendra Patel on 15 December 2017 as part of our inspection programme.

At this inspection we found:

  • The practice had systems to keep patients safe and safeguarded from the risk of abuse however, policies did not reflect the most up to date guidance and not all staff had received appropriate safeguarding training.

  • The practice had audited antimicrobial prescribing. There was evidence of actions taken to support good antimicrobial stewardship. The practice was the fourth lowest prescriber of antibiotics within the Clinical Commissioning Group.

  • Protocols for the care of patients with diabetes or asthma had not been updated to reflect current National Institute for Health and Care Excellence (NICE) guidelines.

  • Patients with long term conditions were offered an annual review of their health. However data showed that care and treatment provided for patients with conditions, such as asthma, high blood pressure or diabetes, and patients experiencing poor mental health were below local and national averages.

  • The practice had a system in place to monitor training completed by staff. Some staff had not received mandatory training as identified by the practice.

  • Some clinical staff had not received training specific to their role to support them in providing appropriate treatment for people who lacked mental capacity.

  • Staff involved and treated patients with compassion, kindness, dignity and respect.

  • The practice had only identified two patients as carers (0.1% of the practice list). They planned to work with the Age UK co-ordinator to increase their identification of carers.

  • Patients were highly complementary regarding the care and treatment they received from the practice. The national patient survey rated the practice as the leading practice in the region for patient satisfaction and it ranked 52nd out of 7,000 practices nationwide.

  • Patients found the appointment system easy to use and reported that they were able to access care when they needed it.

  • The practice’s complaints leaflet was out of date and was not readily available for patients to refer to. A complaint had not been dealt with in line with their own complaints policy.

  • Staff stated they felt respected, supported and valued and there was an open culture within the practice, however systems for reporting and learning from significant and complaints were not always followed.

  • There were clear responsibilities and roles of accountability. However, structures, processes and systems to support good governance and management were not clearly set out or effective.

The areas where the provider must make improvements are:

  • Ensure care and treatment is provided in a safe way to patients.

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

  • Ensure persons employed in the provision of the regulated activity receive the appropriate training necessary to enable them to carry out their duties.

For details, please refer to the requirement notices at the end of the report.

The areas where the provider should make improvements are:

  • Implement systems to proactively improve the identification of carers registered with the practice.

  • Update their practice complaints leaflet and ensure it is readily available for patients to refer to. Ensure that all complaints are dealt with in line with their own complaints policy.

  • Review access arrangements for disabled patients through the front door.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

14 January 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr. Narendra Patel practice on 14 January 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing a safe, well-led, effective, responsive and caring service. It was also rated as good for providing services for all population groups.

Our key findings were as follows;

  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them.
  • The appointment system was sensitive to the needs of the population groups and offered extended hours every Monday from 6.30pm to 7.30pm.
  • All staff understood their responsibilities in raising concerns and reporting incidents and near misses.
  • The practice linked with the Clinical Commissioning Group and other local providers to enhance services and share best practice.
  • Complaints were sensitively handled and patients are kept informed of the outcome of their comments and complaints
  • The practice had a clear vision which had quality and safety as its top priority.

However, there were areas of practice where the provider needs to make improvements.

Importantly the provider should:

  • Complete an appropriate Legionella risk assessment.
  • Ensure there is a completed fire risk assessment which is acted upon.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice