The Care Quality Commission
  • Doctor
  • GP practice

C.B. Patel & Partners Also known as Hayes Medical Centre

Overall: Good read more about inspection ratings

Hayes Medical Centre, 157 Old Station Road, Hayes, Middlesex, UB3 4NA (020) 8573 2037

Provided and run by:
C.B.Patel & Partners

All Inspections

17 and 18 May 2023

During an inspection looking at part of the service

We carried out an announced focused inspection at C. B. Patel & Partners (Hayes Medical Centre) on 17 and 18 May 2023. Overall, the practice is rated as Good.

Set out the ratings for each key question:

Safe - Good.

Effective - not inspected, rating of Good carried forward from the previous inspection.

Caring - not inspected, rating of Good carried forward from the previous inspection.

Responsive - not inspected, rating of Good carried forward from the previous inspection.

Well-led - not inspected, rating of Good carried forward from the previous inspection.

Following our previous inspection on 3 and 4 May 2022, the practice was rated Good overall and for all key questions but Requires improvement for providing safe services.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for C. B. Patel & Partners (Hayes Medical Centre) on our website at www.cqc.org.uk.

Why we carried out this inspection

We carried out this inspection to follow up on a breach of Regulation 12 Safe Care and Treatment from a previous inspection.

At this inspection, we covered:

  • Are services safe?

How we carried out the inspection

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included:

  • Conducting staff interviews using video conferencing.
  • Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
  • 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 found that:

  • The practice had demonstrated improvements in areas identified during the previous inspection.
  • Our clinical records searches showed that the practice had an effective process for monitoring patients’ health in relation to the use of medicines including medicines that require ongoing monitoring.
  • The practice provided care in a way that kept patients safe and protected them from avoidable harm.
  • Recruitment checks including Disclosure and Barring Service (DBS) were carried out in accordance with regulations.
  • Appropriate standards of cleanliness and hygiene were met.
  • There was a system for recording and acting on significant events.
  • There was a system for recording and acting on safety alerts.
  • All the GPs were able to access the information they needed to deliver safe care and treatment in a timely manner.

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

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Health Care

03 and 04 May 2022

During an inspection looking at part of the service

We carried out an announced focused inspection at C. B. Patel & Partners (Hayes Medical Centre) on 3 and 4 May 2022. Overall, the practice is rated as Good.

Set out the ratings for each key question:

Safe - Requires improvement.

Following our previous inspection on 10, 11 and 12 August 2021, the practice was rated Good overall. We rated the practice as requires improvement for providing safe services. The practice was rated good for the effective, caring, responsive and well-led key questions.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for C. B. Patel & Partners (Hayes Medical Centre) on our website at www.cqc.org.uk.

Why we carried out this inspection

This was a focused inspection to follow up on a breach of Regulation 19 Fit and proper persons employed. We followed up in response to concerns we received as part of our regulatory functions.

At this inspection we covered:

  • Are services safe?
  • ‘shoulds’ identified in the previous inspection.

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.
  • 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 Good overall.

We found that:

  • We found improvements had been made, however, we found additional concerns and the practice was required to make further improvements.
  • Recruitment checks including Disclosure and Barring Service (DBS) were carried out in accordance with regulations.
  • Not all the GPs had access to Coordinate My Care (CMC) and they were not able to access the information they needed to deliver safe care and treatment in a timely manner.
  • The practice had clear systems to keep people safe and safeguarded from abuse.
  • Appropriate standards of cleanliness and hygiene were met.
  • There was a system for recording and acting on significant events.
  • There was a system for recording and acting on safety alerts.
  • The practice had shared the childhood immunisation data 2021/22 received from North West London CHIS Hub. For example:
  • Childhood immunisation rates for under two year olds ranged from 86% to 92%, these were comparable to the national expected average of 90%.
  • Childhood immunisation rates for measles, mumps and rubella (two doses of MMR) given in 2021/22 to five year olds were 77%, compared to 66% in 2020/21. This was an 11% increase from the previous data.
  • The practice informed us there was a high refusal rate for immunisation for measles, mumps and rubella (MMR). The practice identified that some children were not living in the country or had childhood immunisation carried out in their native countries, but this information was not shared with the practice.
  • The practice had shared local primary care network comparable data and they had achieved 81% cervical cancer screening rates for patients aged 25-49 years.
  • The practice had shared recent Quality Outcomes Framework (QOF) results (2021/22) and informed us they had achieved 80% cervical cancer screening rates for patients aged 25-49 years and 83% screening rates for patients aged 50-64 years old.
  • The practice had offered 1520 smear appointments in the last 12 months.
  • We spoke with four Patient Participation Group (PPG) members and they confirmed that the practice was trying to arrange the PPG meeting for the last few months. They were positive about the care and treatment offered by the practice, which met their needs.
  • We saw evidence that the PPG meeting invites were sent and the meeting was planned for 29 January 2022 but no PPG member was available to attend the meeting. We saw the next PPG meeting was planned a few days after the inspection.
  • Our clinical records searches showed that the practice did not always have an effective process for monitoring patients’ health in relation to the use of medicines including high risk medicines. This issue was highlighted as a ‘should’ in the previous report.

We found that the practice had demonstrated improvements in areas identified as ‘should’ during the previous inspection:

  • The practice had taken steps to improve childhood immunisation uptake. The practice conducted a thorough analysis of the data and identified targeted areas to improve performance. The practice had maintained a register and a dedicated practice nurse was contacting the parents or guardians of children and encouraging childhood immunisation uptake.
  • The practice had taken steps to encourage the uptake of bowel cancer screening. Searches were run weekly and text messages and letters were sent to follow up do not attend appointments. The practice shared some unverified updated data for bowel cancer screening showing rates had increased from 51% in 2021 to 55% in 2022.

We found a breach of regulation. The provider must:

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

The areas where the provider should make improvements are:

  • Take steps to arrange the clinicians’ access to Coordinate My Care (CMC) to ensure they had the information they needed to deliver safe care and treatment.

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

12 August 2021

During a routine inspection

We carried out an announced comprehensive inspection at C. B. Patel & Partners (Hayes Medical Centre) on 10, 11 and 12 August 2021. Overall, the practice is rated as Good.

Set out the ratings for each key question

Safe – Requires improvement

Effective - Good

Caring - Good

Responsive - Good

Well-led - Good

Following our previous inspection on 2 October 2019, the practice was rated Requires Improvement overall and requires improvement overall for all population groups. We rated the practice as requires improvement for providing safe, effective and well-led services.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for C. B. Patel & Partners (Hayes Medical Centre) on our website at www.cqc.org.uk

Why we carried out this inspection

This was a comprehensive inspection to follow up on breaches of Regulation 17 Good governance.

At this inspection we covered all key questions:

  • Are services safe?
  • Are services effective?
  • Are services caring?
  • Are services responsive?
  • Are services well-led?

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.
  • 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 Good overall and good for all population groups.

We found that:

  • The practice had demonstrated improvements in governance arrangements compared to the previous inspection.
  • Recruitment checks including Disclosure and Barring Service (DBS) were not always carried out in accordance with regulations or records were not kept in staff files.
  • 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.
  • Some high risk medicines recommended monitoring requirements were not met and test results were not managed in a timely manner.

We found a breach of regulation. The provider must:

  • Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.

The areas where the provider should make improvements are:

  • Review and improve the systems in place to effectively monitor patients’ health in relation to the use of medicines including high risk medicines.
  • Continue to encourage and monitor cervical and bowel cancer screening and childhood immunisation uptake.
  • Review and consider the patient participation group (PPG) feedback regarding access to the service.

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

2 October 2019

During a routine inspection

We carried out an announced comprehensive inspection at C. B. Patel & Partners (Hayes Medical Centre) on 2 October 2019 as part of our inspection programme.

At this inspection, we followed up on breaches of regulations identified at a previous inspection on 29 January 2019. Previous reports on this practice can be found on our website at: https://www.cqc.org.uk/location/1-551034159.

At this inspection, we found that the practice had demonstrated improvements in most areas, however, they were required to make further improvements.

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 overall and good overall for all population groups, with the exception of people with long-term conditions and working age people (including those recently retired and students) which are rated as requires improvement.

We rated the practice as r equires improvement for providing safe, effective and well-led services because:

  • The practice had demonstrated improvements in governance arrangements, however, they were required to make further improvements.
  • The practice had failed to address some concerns highlighted during the previous inspection in a timely manner which included monitoring the prescribing competence of non-medical prescribers and the management of blank prescriptions.
  • The practice was unable to demonstrate that they had an appropriate system to monitor the registration of clinical staff on an ongoing basis.
  • Some staff had raised dissatisfaction regarding the staffing levels at the practice.
  • The practice was unable to provide documentary evidence of an asbestos survey.
  • The practice was unable to provide satisfactory assurance that the steps they had taken had improved the outcomes for patients with diabetes. The practice’s performance on quality indicators related to patients with diabetes was below the local and the national averages.
  • The practice’s uptake of the national screening programme for cervical and bowel cancer screening was below the national averages.
  • The practice routinely reviewed the effectiveness and appropriateness of the care it provided.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • The practice was aware of and complied with the requirements of the Duty of Candour.
  • There was a clear leadership structure and staff felt supported by the management.

We rated the practice as good for providing caring and responsive services because:

  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • Feedback from most patients reflected that they were able to access care and treatment in a timely way.
  • The practice was encouraging patients to register for online services and 52% of patients were registered to use online Patient Access.
  • The practice organised and delivered services to meet patients’ needs.
  • Information about services and how to complain was available.

We rated all population groups as good for providing responsive services. We rated all population groups as good for providing effective services, with the exception of people with long-term conditions and working age people (including those recently retired and students) which are rated as requires improvement, because of the poor outcomes for patients with diabetes, low cervical and bowel cancer screening rates.

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.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

  • Consider ways to improve the identification of carers to enable this group of patients to access the care and support they need.
  • Review patients’ feedback regarding telephone access to the service.
  • Update the details on the practice’s website.
  • Continue to encourage and monitor the childhood immunisation uptake.

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

29 January 2019

During a routine inspection

We carried out an announced comprehensive inspection at C. B. Patel & Partners (Hayes Medical Centre) on 29 January 2019 as part of our inspection programme.

At the last inspection in April 2015 we rated the practice as good overall. Previous reports on this practice can be found on our website at: https://www.cqc.org.uk/location/1-551034159.

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 overall.

We rated the practice as requires improvement for providing safe services because:

  • Risks to patients were assessed and well managed in some areas, with the exception of those relating to safety alerts, some safeguarding procedures, infection control procedures and the management of legionella.
  • The practice did not have appropriate systems in place for the safe management of medicines.
  • There was an ineffective system in place to monitor the use of blank prescription forms for use in printers and handwritten pads.
  • The practice had not carried out premises health and safety risk assessment and some fire safety procedures were not appropriately managed.
  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However, we noted there was a lack of communication and the practice had not widely shared lessons learned from significant events to improve safety in the practice.
  • Recruitment checks were not always carried out in accordance with regulations or records were not kept in staff files.

We rated the practice as requires improvement for providing effective services because:

  • The practice’s performance on quality indicators related to patients with diabetes was below the local and the national averages. The practice had taken steps to improve the outcomes for patients with diabetes, however, it was too early to assess the impact of these improvements.
  • The practice’s uptake of the national screening programme for cervical and bowel cancer screening and childhood immunisations rates were below the national averages.
  • There were no failsafe systems to follow up women who were referred as a result of abnormal results after cervical screening.
  • The practice routinely reviewed the effectiveness and appropriateness of the care it provided.
  • Staff had received the appropriate training and appraisal necessary to enable them to carry out their duties.

We rated the practice as requires improvement for providing responsive services because:

  • Feedback from patients reflected that they were not always able to access care and treatment in a timely way.
  • The practice was encouraging patients to register for online services and 49% of patients were registered to use online Patient Access.
  • Information about services and how to complain was available. However, some information was not up to date.
  • The practice organised and delivered services to meet patients’ needs.

We rated the practice as requires improvement for providing well-led services because:

  • There was a lack of good governance.
  • Clinical lead responsibilities were not always shared with other clinicians.
  • The practice had not appointed a dedicated clinical lead to oversee the management of test results and there was no monitoring system in place to ensure that patient correspondence across the practice was managed in a timely manner.
  • There was no formal monitoring system for following up patients experiencing poor mental health and patients with dementia who failed to collect their prescriptions in a timely manner; or to identify and monitor who was collecting the repeat prescriptions of controlled drugs from reception.
  • There was no formal supervision arrangement in place to monitor the clinical performance and decision making of a nurse prescriber employed by the practice.
  • Most policies and protocols did not include name of the lead member of staff including adult and child safeguarding policies. Most of the policies did not include the name of the author and they were not dated so it was not clear when they were written or when they had been reviewed.
  • The practice was aware of and complied with the requirements of the Duty of Candour.
  • Staff we spoke with on the day of inspection informed us they felt supported by the management.

These areas affected all population groups so we rated all population groups as requires improvement.

We rated the practice as good for providing caring services because:

  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.

The areas where the provider must make improvements are:

  • Ensure that care and treatment is provided in a safe way.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

  • Review formal sepsis awareness training needs for non-clinical staff to enable them to identify patients with severe infections.
  • Consider ways to improve the identification of carers to enable this group of patients to access the care and support they need.
  • Consider displaying information about a translation service in the reception area informing patients this service is available. Review the availability of information posters and leaflets in multiple languages.
  • Review the complaint policy and procedures and consider a response to complaints includes information of the complainant’s right to escalate the complaint to the Ombudsman if dissatisfied with the response.
  • Consider reviewing the practice’s website to see if it meets patients needs and expectations.
  • Consider how the accessible toilet is accessed in the event of an emergency.

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

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

29 April 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out a comprehensive inspection of CB Patel and Partners on 29th April 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, caring, responsive and well-led services. It was also good for providing services for the care provided to older people, people with long term conditions, families, children and young people, working age people (including those recently retired and students), people living in vulnerable circumstances and people experiencing poor mental health (including people with dementia).

Our key findings were as follows:

  • Arrangements were in place to ensure patients were kept safe. For example, staff understood and fulfilled their responsibilities to raise concerns, and report incidents and near misses
  • Patients’ needs were suitably assessed and care and treatment was delivered in line with current legislation and best practice guidance.
  • We saw from our observations and heard from patients that they were treated with dignity and respect and all practice staff were compassionate.
  • The practice understood the needs of their patients and was responsive to them. There was evidence of continuity of care and people were able to get urgent appointments on the same day.
  • There was a culture of learning and staff felt supported and could give feedback and discuss any concerns or issues with colleagues and management

However, there were also areas of practice where the provider should make improvements:

  • The practice should ensure that all staff that act as chaperones receive chaperone training.
  • The practice should ensure that references for all staff are sought before staff start work at the practice.
  • The practice manager should ensure they have the appropriate training to carry out their duties as fire marshal.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

15 April 2014

During an inspection looking at part of the service

Our Inspection of 11 February 2014 found that whilst safeguarding procedures were in place at the practice, staff had not received adequate training to recognise the signs of possible abuse in both children and adults. Some staff we spoke with were not aware of the whistleblowing procedures to follow if needed.

Following the inspection the provider sent an action plan that set out target dates for the completion of safeguarding training for all staff employed at the practice.

During our inspection of 15 April 2014 we saw evidence which demonstrated that each member of staff had completed safeguarding training applicable to their role. Staff we spoke with described a good understanding of safeguarding procedures, including how to escalate any concerns. Staff also demonstrated that they were aware and understood the whistleblowing procedures to follow if they needed to raise any concerns.

11 February 2014

During a routine inspection

During our inspection we spoke with four people using the service, the manager, three doctors, a nurse and six other staff. We viewed two medical records and seven staff files. People we spoke with had mixed opinions about the service. One person said, "all four doctors are very good." Another person said, "they don't always explain things in sufficient detail." All the people we spoke with said staff were usually polite and well mannered. People said it was not always easy to get an appointment over the telephone and they had to come in to the practice to get one although the situation had improved recently.

Safeguarding procedures were in place. However, staff had not received adequate training to recognise the signs of possible abuse in both children and adults and most staff were not aware of the whistleblowing procedures of the service.

Staff had received adequate support and training to ensure they were able to meet the needs of people using the service.

Systems were in place to monitor the standards of care and treatment provided including annual satisfaction surveys and clinical audits. Where shortfalls were identified, improvements to the service had been made although further improvements were necessary.