The Care Quality Commission
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Archived: Dr Aarron Patel

Overall: Requires improvement read more about inspection ratings

Ashton Gardens,, Chadwell Heath,, Romford, Essex, RM6 6RT (020) 8918 0580

Provided and run by:
Dr Aarron Patel

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

All Inspections

Remote interviews 7 – 9 December 2021, Clinical interviews 13 December 2021, site visit 10 February 2022

During a routine inspection

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

25 September 2018

During a routine inspection

This practice is rated as good overall. (Previous rating 09 2017 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We carried out an announced comprehensive inspection at Dr Aaron Patel on 25 September 2018, to follow up on breaches of regulations. At our previous two inspections of the practice, we rated them requires improvement for providing responsive services. This was because at both inspections, we found that the national GP patient survey results showed that patients rated the practice below local and national averages on questions relating to telephone access, opening hours, waiting times and their experience of making appointments. Also at the 20 July 2017 inspection, the population group of people with long term conditions was rated as requires improvement because of high clinical exception reporting rates among people in this population group. The practice was also rated as requires improvement at their 27 April 2016 inspection because they did not have a website and had identified a relatively low proportion of patients with caring responsibilities.

At this inspection we found:

  • The practice had clear 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 routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
  • Staff involved and treated patients with compassion, kindness, dignity and respect.
  • Patients found the appointment system had improved in recent months. The provider had introduced some changes to improve access to appointments, including additional nurse appointments and telephone consultations. Patients we spoke with told us they were now able to access care when they needed it.
  • There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

  • Review their training arrangements to ensure reception staff received training in the sepsis for primary care services.
  • Review their policies and procedures to ensure they reflected current staff details. For example, their complaints leaflet to ensure it is updated with the correct current complaints manager’s details.
  • Review their arrangements to continue to improve uptake of childhood immunisations and cervical screening.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

20 July 2017

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Aarron Patel’s Surgery on 27 April 2016. The overall rating for the practice was good, however it was rated requires improvement for providing responsive services. The full comprehensive report on the April 2016 inspection can be found by selecting the ‘all reports’ link for Dr Aarron Patel on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 20 July 2017 to confirm that the practice had carried out their plan to improve the service as identified in our previous inspection on 27 April 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

At our previous inspection on 27 April 2016, we found the practice had a high exception reporting for those with long term conditions. Additionally, results from the national GP patient survey showed patient satisfaction with how they could access care and treatment was below the local CCG and national averages. In addition, the practice did not have an active patient participation group (PPG) and the practice had identified less than 1% of its practice list as carers. At this inspection we found some of these issues had been addressed, however we still had concerns about patient access as the latest national GP survey results did not show improvements. The practice provided us with an action plan detailing how they intended on improving services; however these measures had yet to demonstrate any improvement. The practice is still rated as requires improvement for providing responsive services.

Our key findings were as follows:

  • The practice still did not have a practice website, however they told us patients could book appointments and request repeat prescriptions online through NHS Choices.

  • Childhood immunisation data submitted to the local CCG for the quarter which ended in June 2017 showed the practice had achieved 100% in all areas.

  • At the last inspection, 29 patients were identified as carers. The practice reviewed how patients with caring responsibilities were identified and recorded, for example, standardising the code which should be used on the clinical system. Over 1% of the patient population (49) were now identified and flagged on the clinical system as carers.

  • The business continuity business plan was updated in April 2017 and contained all the necessary information. Hard copies were held off site by the practice manager and principal GP.

  • The practice now had a PPG which consisted of four members who the practice told us had scheduled their first meeting to take place in August 2017.

  • Patient’s feedback from the most recent national GP patient survey showed the practice was still below the local CCG and national averages for questions pertaining to how they could access care and treatment.

  • Data from the Quality and Outcomes Framework (QOF) 2015/16 showed the practice still had higher than average exception reporting rates for those with long term conditions.

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

Importantly, the provider must:

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

In addition the provider should:

  • Take steps to improve the practice’s performance in the management of long term conditions.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

27 April 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Aarron Patel on 27 April 2016. Overall the practice is 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 an effective system in place for reporting and recording significant events.
  • Exception reporting at the practice was much higher than the local and national averages.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients’ feedback on the ease of making an appointment with a named GP, satisfaction with practice opening hours and experience of booking appointments was below the national average.
  • 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 proactively sought feedback from staff and patients, which it acted on.
  • The provider was aware of and complied with the requirements of the duty of candour.
  • There was not an active Patient Participation Group.
  • The practice were unable to evidence that there was a system in place to review and improve patient feedback from national survey results.

The areas where the provider should make improvement are:

  • The provider should improve outcomes for patients with long term conditions including review clinical exceptions for all long term conditions to ensure they meet the clinical criteria for exception reporting.

  • Review patient feedback from national survey results and identify ways to improve telephone access and access to routine appointments.

  • Review and improve the uptake in vaccinations of patients under the age of five years old.

  • The provider should take action to ensure there is an active Patient Participation Group within the practice.

  • To review how patients with caring responsibilities are identified and recorded on the patient record system to ensure information, advice and support is made available to them.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

10 September 2013

During a routine inspection

We spoke to people visiting the surgery on the day of our inspection. People told us they were happy with the service provided by the medical staff at the practice. One person said 'I have no problem here'. Another said 'the doctors and nurses are really good'. People told us the GPs were approachable, listened, and they could ask questions if they needed to.

Some people we spoke to on the day of our inspection told us they had been able to make an appointment which suited them on that day. However, a number of people told us it was difficult firstly to get an appointment and secondly an appointment with a named GP, or nurse. People we spoke to had positive views about the reception staff at the practice. One person said 'reception staff are fine, there are no problems'. All those we spoke to said that their privacy and dignity were respected.

People's care was planned and delivered in a way that met their individual needs. We looked at four people's records regarding chronic disease planning, care and advice. There was evidence that plans were discussed with patients and appropriate referrals made.

We found that people were protected from the risk of abuse because the provider had procedures in place for safeguarding vulnerable adults and children. Medical staff we spoke to were aware of these procedures. The provider had effective systems in place to assess the risk and to prevent, detect and control the spread of infection. There was also an adequate system dealing with complaints made by people who used the service.