Dr Jagtar Chaggar - Care Quality Commission

Background to this inspection

Updated 9 November 2017

The practice is situated in Smethwick, West Midlands. The surgery operates out of a two-storey building and clinical services are delivered on both floors. The facilities are generally accessible for patients with a disability. There is no lift to the first floor, although there are arrangements in place for patients with mobility difficulties to be reviewed in the ground floor consulting rooms. There is limited on-site parking but patients are able to park on the streets around the practice.

The staffing team consists of one principal male GP and a male salaried GP. There are two part-time female regular locum GPs and a part-time nurse practitioner. The management team consist of a business manager, practice manager and an assistant practice manager.

The practice is planning to move into purpose-built premises and expected building work is due to commence soon.

There are approximately 8000 patients of various ages registered with the practice. The practice has a General Medical Services (GMS) contract. A GMS contract is a contract between NHS England and general practices for delivering general medical services.

The practice is open between 8am and 6.30pm Mondays to Fridays. Appointments are available from 8.30am to 12.30pm and from 3.30pm to 6pm Mondays, Tuesdays, Wednesdays and Fridays. On Thursdays appointments are available 9pm to 12.30am and 3.30pm to 6pm. When the practice is closed, patients are redirected to their out of hours provider, ‘Primecare’.

Overall inspection

Good

Updated 9 November 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Jagtar Chaggar on 8 December 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the September 2016 inspection can be found by selecting the ‘all reports’ link for Dr Kanjana Paramanathan on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 4 October 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 8 October 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

During our previous inspection the practice reviews and investigations of incidents or significant events were not thorough enough and lessons learned were not communicated widely to support improvement. At this inspection the practice had reviewed its significant event protocol, developed a more effective process and introduced a learning and analysis element to the significant event investigation template.

Patient Group Directions (PGD) were signed by a manager and were up to date at this inspection.

When we inspected the practice in December 2016 we saw procedures for prescribing medicines which required regular monitoring were not implemented consistently for all patients’ prescribed high risk medicines. At this inspection we saw that an effective system had been implemented.

There were appropriate emergency medicines available in the practice.

The practice had addressed areas of high exception reporting for long term disease management (QOF).

Audits we looked at referenced quality standards and care pathways. The findings identified improvements in several areas of the referral process. Audits were detailed and had identified areas for improvement which they were acting on.

Staff files looked at demonstrated that appraisals had taken place for all staff within the last 12 months.

Reviews of some care plans demonstrated reference to guidance and the GP we spoke with was able to demonstrate competency in accessing care plans on the system.

Examples of referral letters we looked at were appropriate in formation. Most GPs used a template on the system for referral letters which they then used to make the referral.

During our previous inspection we saw that there was no hearing loop in the practice. The practice had considered the installation of a hearing loop and had developed alternative arrangement s to support patients with a hearing impairment in the interim until they moved to new premises

The practice had reviewed its management structure and had developed a clear organisational chart detailing line management responsibilities and roles.

When we inspected the practice in December 2016 we saw locum GPs did not appear to have engagement in areas such as QOF performance and the management of long term conditions. They were not routinely involved in evidence based guidelines discussions and there was a risk they may therefore not be aware of valuable clinical information. At this inspection we saw evidence that sessional GPs had taken over responsibility in clinical areas such as for diabetes and mental health. Records of meetings we looked at demonstrated their attendance where guidance was discussed.

The areas of practice where the provider should make improvements are:

Consider effective ways to ensure patients are made aware of the benefits of health screening programmes.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice