Archived: Dr Umesh Chandra Kathuria Also known as City Health Centre

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Umesh Kathuria on 22 November 2016. Overall the practice is rated as inadequate.

Our key findings across all the areas we inspected were as follows:

• Staff understood their responsibilities to raise concerns, and to report incidents and near misses. However, the majority of reviews were not thorough enough and there was minimal evidence of learning and communication with staff. No significant events were recorded in 2015.
• Risks to patients were generally assessed and managed, with the exception of those relating to recruitment checks. For example, one member of clinical staff did not have medical indemnity insurance.
• Data showed that patient outcomes were variable compared to the national average.
• Inconsistent coding meant that there was a risk of sharing incorrect information with other services.
• Under prevalence of chronic lung disease signified a potential lack of diagnosis and treatment.
• Although two audits had been carried out, we saw no evidence that audits were driving improvements to patient outcomes.
• A female locum GP worked at the practice for one morning a week.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Patients said that they were treated with kindness, dignity and respect.
• Patients said that it was easy to make an appointment with a named GP and that they appreciated the continuity of care. Urgent appointments were available the same day.
• Information about services was available but the complaints leaflet was not available in hard copy in reception. Although three quarters of the patients were from ethnic minority backgrounds, the practice leaflet was only available in English.
• The practice had a number of policies and procedures to govern activity.
• The practice had a leadership structure, but there were limited effective formal governance arrangements. 

The areas where the provider must make improvements are:

• Review the coding of medical records to ensure that an accurate and contemporaneous record is maintained for all patients.
• Record safety incidents in a timely manner and ensure that learning is shared amongst all practice staff.
• Ensure that recruitment arrangements include all necessary employment checks for all staff, including medical indemnity cover.
• Ensure that the Hepatitis B status is recorded for clinical staff.
• Ensure that there is a system to identify carers and provide them with appropriate treatment and support.
• Carry out a systematic quality improvement programme, including patient identification and diagnosis, clinical audits and re-audits to ensure that improvements to patient outcomes have been achieved and maintained.
• Implement formal governance arrangements including systems for assessing and monitoring risks and the quality of the service provision.

In addition the provider should:

• Maximise the functionality of the computer system in order that the practice can run clinical searches, provide assurance around patient recall systems, consistently code patient groups and produce accurate performance data.
• Implement a system to track prescription pads through the practice.
• Adopt guidelines for checking uncollected prescriptions before destruction. Routinely review all patients who have been discharged from hospital.
• Take action to improve patient experience in relation to waiting times.
• Undertake a formal risk assessment before accepting a previously issued DBS check for a new employee.
• Continue to encourage patients to engage with the national bowel cancer screening programme.
• Ensure that key staff have offsite access to the disaster handling and business continuity plan.
• Provide practice information in appropriate languages.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice