Archived: Dr Srinivasan Subash Chandran

Updated 18 February 2020

Dr Srinivasan Shubash Chandran’s surgery is located at Sheerness Health Centre, 250-262 High Street, Sheerness, Kent, ME12 1UP on the Isle of Sheppey. The practice is located in purpose built premises that also houses additional GP practices and other health services. In addition, there is a branch surgery at High Street, Queensborough, Kent, ME11 5AQ.

The local clinical commissioning group (CCG) is the NHS Swale CCG. Dr Srinivasan Subash Chandran is registered with the Care Quality Commission to provide the following regulated activities: Treatment of disease, disorder or injury, Diagnostic and screening procedures, Maternity and midwifery services and Surgical procedures

The practice has approximately 4,735 registered patients. The practice staff consists of one GP (male), and two additional long-term locum GPs (male and female). The practice had two locum nurses (female), one working one regular session a week and the other working on an ad hoc basis. There are two female healthcare assistants. A practice manager leads a small team of reception and administrative staff.

There are higher than average number of patients under the age of 18 when compared with national and local averages. There is a lower proportion of patients over the age of 65, when compared with the national average. Information published by Public Health England, rates the level of deprivation within the practice population group as one, on a scale of one to ten. Level 10 represents the lowest levels of deprivation and level one the highest. Life expectancy is lower than average for females (81 years compared with the national average of 83). Life expectancy for males is lower than average for males (77 years compared with the national average of 79 years).

General medical services are provided Monday to Friday between the hours of 8.30am to 6pm. Extended hours surgeries are offered Tuesday 6.30pm to 7.45pm. Out of hours services can be accessed via the NHS 111 service.

More information in relation to the practice can be found on their website:

www.chandrans.co.uk

Updated 18 February 2020

We carried out an announced comprehensive inspection at Dr Srinivasan Subash Chandran’s surgery on 10 December 2019 as part of our inspection programme.

We decided to undertake an inspection of this service following our annual review of the information available to us. This inspection looked at the following key questions:

• Safe
• Effective
• Caring
• Responsive
• Well-led

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 inadequate overall and for safe, effective and well-led services. We rated them as requires improvement for responsive and good for caring. We rated the practice as inadequate for all of the population groups.

We rated the practice as inadequate for providing safe services because:

• There was inadequate monitoring of patients on high risk medicines and insufficient action to ensure the safety of prescribing.
• There were poor repeat prescribing and medicine review practices.
• There were insufficient failsafe processes for minor surgery.
• There was no system for recording and acting on safety alerts.
• The practice had not undertaken a risk assessment for emergency medicines.
• Risk management processes in relation to health and safety and fire safety were insufficient.
• Medicines and prescription stationary were not stored securely.
• The system for learning and improving when things went wrong was not comprehensive.
• The practice could not demonstrate that recruitment checks and Disclosure and Barring Service (DBS) checks were undertaken when required.
• There was not a system to monitor the ongoing registration of clinical staff.
• Staff vaccinations were not monitored in line with Public Health England guidance.

We rated the practice as inadequate for providing effective services because:

The rating for effective moved from good to inadequate. This was due to a lack of evidence-based practice; insufficient patient assessments and a lack of clinical review; insufficient evidence of staff training updates; poor patient outcomes in some areas and high exception reporting; poor childhood vaccination performance; below target cervical screening; and, limited quality improvement activities.

• There was a lack of evidence-based practice.
• Patient assessment processes were insufficient and there was a lack of clinical review.
• There was insufficient evidence of staff training updates, including for specific clinical competencies.
• There were poor patient outcomes and high exception reporting in some areas.
• Childhood vaccination rates were below minimum targets.
• Cervical screening was below target.
• There were limited quality improvement activities.

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

• Leaders could not show that they had the capacity and skills to delivery high quality, sustainable care.
• The overall governance arrangements were ineffective.
• The practice did not have clear and effective processes for managing risks, issues and performance.
• The practice did not always act on appropriate and accurate information.
• We saw limited evidence of systems and processes for learning, continuous improvement and innovation.

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

• The system for identifying, receiving, recording, handling and responding to complaints was insufficient.

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

• Staff treated patients with care and compassion.

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.
• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.
• Ensure that fit and proper persons are employed.

The provider should:

• Improve staff vaccination records in line with Public Health England (PHE) guidance.

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

Updated 18 February 2020

Updated 18 February 2020

Updated 18 February 2020

Updated 18 February 2020

Updated 18 February 2020

Updated 18 February 2020