30 July 2015
During an inspection looking at part of the service
Letter from the Chief Inspector of General Practice
We carried out an announced follow-up inspection of Dr Srinivas Dharmana, also known as Dharmana’s Family and General Practice, on 30 July 2015. This inspection was a follow-up to our inspection of 1 October 2014 when the practice was rated as ‘Inadequate’, placed into Special Measures and required to make significant improvements.
Whilst we found there were some minor improvements in the responsiveness of the practice to patients’ needs, overall we found the practice had not made sufficient improvement in three of the five key domains. The practice is rated as Inadequate for providing safe, effective and well-led care, treatment and services. The practice is rated as Requires Improvement for providing responsive and caring services. The practice has failed to meet any of the regulatory requirements prescribed after the last inspection in October 2014 and no improvement in meeting the fundamental standards has been made.
Following this latest inspection, the provider has submitted an application to cancel their registration with CQC and the practice will close in December 2015. CQC has agreed to cancel the registration. The practice will remain in Special Measures.
In the meantime, NHS England and Liverpool Clinical Commissioning Group continue to support the practice and are taking steps to arrange the transfer of patients to alternative GP services in the local area.
Our key findings were as follows:
- The practice did not have an effective system in place for dealing with incoming patient related correspondence. We found a significant amount of correspondence that had not been read coded or annotated by the GPs working at the practice. No effective plan to address this backlog had been executed by the provider.
- The practice nurse had received some training on the management of patients with long term conditions. However, the nurse had not been booked onto essential update training on the delivery of immunisations and vaccinations, leaving the practice unprepared to manage responsibility for all childhood immunisations and vaccinations, which will be passed back to practices from Liverpool Community Health in September 2015.
- Insufficient records were held in relation to clinical staff and key background checks required had not been completed. Systems set up to promote quality checks on record keeping in relation to patient records were not upheld or effectively applied.
- Management and leadership were inadequate; improvements required in relation to infection control had not been made. Key records in relation to buildings maintenance could not be produced. Key parts to the improvement plan submitted to CQC following the inspection of 1 October 2014 had still not been achieved.
Importantly, the provider must:
- Provide care and treatment that meets the needs of patients. Patients seen by accident and emergency departments had not received appropriate intervention and support from their practice GP or nurse. The practice failed to respond in a timely manner to advice from hospital staff on patients’ conditions and medication.
- Have suitably qualified, competent, skilled and experienced persons deployed to cover both the emergency and routine work of the service.
- Hold, and have available, information in relation to each person employed for the purposes of delivery of regulated activities. Have records in place that are accessible to authorised people internally and externally, and as necessary to deliver care and treatment in a way that meets patient needs and keeps them safe.
- Address infection prevention and control concerns to ensure that they comply with the ‘Code of Practice for health and social care on the prevention and control of infection and related guidance’.
- Maintain records relating to the care and treatment of each person using the service that are fit for purpose.
- Do all that is reasonably practical to mitigate risks. Conduct and evaluate significant event analysis to establish how clerical or clinical errors had occurred.
Insufficient improvements have been made such that there remains a rating of Inadequate overall for this practice. The domains of Well-led, Effective, and Safe remain rated as inadequate and the Responsive and Caring domains are rated as requires improvement. As a result of this overall rating of Inadequate, all population group ratings remain as Inadequate.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice