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How I pulled my practice out of special measures

Dr Tamasi Basu describes how she transformed her practice’s performance in just eight months through hard work and dedication, earning her a shortlist place at the prestigious General Practice Awards.

Dr Tamasi Basu faced an uphill struggle to raise the performance of her practice when the CQC rated it ‘Inadequate’ and her partner was on long-term sick leave. With the practice facing closure and patient safety falling short, Dr Basu went above and beyond to turn things around. This is how she did it.

Profile: Dr Tamasi Basu

dr tamasi basu 3 x 2

 

What’s your role? GP Partner at Balfour Medical Centre in Grays, Essex

How long have you been a GP? 11 years

How would you describe your practice? It is an urban practice with around 5,100 patients, a mixture of young and elderly; we care for a few nursing homes.

What gets you up in the morning?

As a full-time mum and full-time GP, this is more than enough to get me going – I love my profession and my family.

What problems was the practice facing?

In 2016, Balfour Medical Centre was rated ‘Inadequate’ by the CQC and placed under special measures. There were manifold problems: inappropriate prescribing – of antibiotics and DMARDs in particular – and no controlled drugs policy was in place. Our medicine management team had also highlighted that we were overspending on prescribing.

Patient safety needed to be improved, as safeguarding of both adults and children fell short. The surgery was in the lower half of national statistics for two-week wait cancer referrals, and emergency cancer diagnosis was higher than national average.

We had high rates of DNAs for chronic disease clinics. With the practice facing closure and my senior partner on long-term sick leave, pressures were mounting, patients were extremely worried and staff morale was at an all-time low.

What did you do?

As the newly appointed prescribing lead for the practice, I worked in collaboration with the CCG and local medicine management team, updating clinical prescribing guidance and sharing it with the practice’s GPs. I developed a protocol for the prescription of DMARD, antibiotics and warfarin to ensure appropriate prescribing, and established a controlled drugs policy in collaboration with the local medicine management team.

I conducted 14 clinical audits on prescribing and MHRA drug alerts, patient safety alerts and cost-effective prescribing. In addition, we raised a significant event in delayed DVT diagnosis, which led to the development of a strategy for GPs to chase referrals. This was shared with the CCG and new phone lines for the DVT clinic were made available on the hospital website for all practices.

As safeguarding lead, I set up a protocol for in-house safeguarding multidisciplinary team meetings with health visitors and school nurses for children registered with the practice, including looked-after children and those under child protection. I did an audit on Looked After Children which was shared with CCG safeguarding team and discussed in the local safeguarding forum.

Working with the patient participation group, I put steps in place to minimise DNAs, with a ‘DNA action plan’.

I also discussed plans to increase two-week wait referrals for cancer with the public health cancer team to boost timely diagnosis. I have also planned an in-house audit on cancer referrals.

What were the challenges?

It was a very difficult time and involved my working 60-plus hours a week to make all the necessary improvements. With my partner on long-term sick leave, I took responsibility for overall supervision of clinical and non-clinical staff and services, took on the mantle of prescribing lead, and extended my role further as the incumbent safeguarding lead. With so much to achieve, I had to cancel some of my time off and holidays during this year.

What improvements did you see?

Most importantly, our 2017 CQC inspection yielded an overall rating of ‘Good’ – an exceptional improvement in just eight months from the previous year’s result. The CQC were particularly impressed with the audit for Looked After Children, and took a copy of the audit as an example of good work.

After implementing guidance for antibiotics prescription, we exceeded our target of a 5% reduction in prescriptions – achieving a 9% reduction.

So far we have recorded an increase in two-week wait cancer referrals and we are now waiting for final data from the public health team for the year 2016/17.

We were able to give all practice staff a pay rise reflecting their hard work and dedication, and feel the whole process improved staff morale and enthusiasm.

What colleagues say

Practice staff:

‘I have known Dr Basu for several years… She has taken over the practice in the last year and has overcome pressures and problems, whilst continuing her caring for patients. She has the respect of patients and staff.’

‘Motivating and lovely doctor to work with, popular with the patients and goes out of her way to help patients.’

CQC Inspector: ‘Most doctors would leave in such a situation but you have taken on the challenge and made everything right for the practice and the patients. You have worked extremely hard in just eight months to improve the surgery so much from where we saw it in 2016.’

 

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Readers' comments (12)

  • How is it possible to be a full-time mum and a full-time GP simultaneously? I don't believe it is.

    Such martyrdom to a losing cause might be admirable in the eyes of some (like CQC inspectors); the real effects of this dedication could well be bitterness and dysfunction in the good lady doctors' children some years down the line.

    And to end on a less glum note-the weather is really lovely today.

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  • Well done.

    But in a 2 partner practice, when the other is off sick, you are lead for everything!! You weren't appointed it!

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  • Morale flagging

    CQC Inspector: ‘Most doctors would leave in such a situation...
    (Sounds like that's what they would have preferred... esp a bme led practice )
    Cynical????

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  • Morale flagging

    It would be good if CQC could actually provide support, resources and funding where this is required
    Rather than just tick box critique and rubber stamping.. and billing the practice..

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  • cqc will not provide that and unfortunately not part of their agenda.
    If it had been set up correctly and for the right reasons they would be providing help and support to get everyone up to scracth

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  • Faced with similar
    I just left .
    Ive never looked back, best decision I’ve ever made.


    It’s really difficult to do but with a vicious and unfair regulator and no support why take it on yourself?

    Leave. Let the practice collapse. Don’t hold back against the system at a cost to yourself .

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  • Thank you for taking the time to read the article. I came to know from my GP friends that this was published.
    It was a real hard time for me and the team and we are glad that we have sailed across fine.
    CCG representative helped us so much in developing guidelines, policies and protocols. The so called ‘unsafe’ prescription of DMARDs and Warfarin as per CQC was a problem in all the practices locally and CCG is now closely working with hospital to develop an appropriate shared care protocol.
    I took guidance from Nigel’s surgery website while developing the protocols.
    Medicine Management Team and CCG representative suggested I took over the prescribing and few other responsibilities to improve the situation while the senior partner was still on. This partner later unfortunately became long term sick and eventually retired straight from the sick leave.
    With increasing CQC issues and huge managerial and administrative responsibilities most doctors are now leaving partnership and doing locum work for better earning and peace of mind. NHSE need to provide more support to practices.

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  • Dr Basu is a ray of sunshine and hope in all the negative vibes and cynicism that is hallmark of today’s NHS.
    Why can’t we think , for a change, that the next generation may choose to follow her glorious lead and do something positive and applaud all her good work in its true spirit!

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  • Thank you Dr Sinha. I feel it’s always easy to leave the battlefield than stay on and fight, as you are then also fighting with your own self ... should I or shouldn’t I.
    The love and support I had from patients were very satisfying.

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  • Good work. I wonder how you managed your work life balance?

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