The Care Quality Commission
  • Doctor
  • GP practice

Archived: Dr Srinivasan Subash Chandran

Overall: Inadequate read more about inspection ratings

Sheerness Health Centre, 250-262 High Street, Sheerness, Kent, ME12 1UP (01795) 585001

Provided and run by:
Dr Srinivasan Subash Chandran

All Inspections

10 December 2019

During a routine inspection

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

24 May 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Srinivasan Subash Chandran on 24 May 2016. Overall the practice is rated Good.

This inspection was a follow-up of our previous comprehensive inspection which took place in May 2015 when we rated the practice as inadequate overall. In particular the practice was rated as inadequate for providing safe and well-led services, requires improvement for effective and responsive services and good for proving caring services. The practice was placed in special measures for six months.

The inspection carried out on 24 May 2016 found that the practice had made significant progress in addressing breaches of the legal requirements that had been identified at the May 2015 inspection. The practice was able to demonstrate that they had met the legal requirements for all requirement notices issued.

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

  • There was an open and transparent approach to safety and an effective system for reporting and recording significant events.
  • Governance processes, procedures and systems had been implemented effectively, in order to help ensure that risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand. Improvements had been made to the quality of care as a direct result of complaints procedures being improved.

  • Clinical audits were in progress and there were plans to complete these and embark on second audit cycles, in order to improve patient care and outcomes.

  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure, the staff team felt supported by management and told us that the system for training and appraisals encouraged them to develop within their role.
  • The practice had improved how they sought feedback from staff and patients and a patient participation group had been established.
  • The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvements are:

  • Continue to revise the system that identifies patients who are also carers, to help ensure that all patients on the practice list who are carers are offered relevant support if required.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

12 May 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Srinivasan Subash Chandran on the 12 May 2015. During the inspection we gathered information from a variety of sources. For example, we spoke with patients, interviewed staff of all levels and checked that the right systems and processes were in place.

Overall the practice is rated as inadequate. Specifically, we found the practice inadequate for providing safe and well –led services. It also required improvement for providing effective and responsive services and was rated as good for providing a caring service.

Our key findings were as follows:

  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. We saw staff treated patients with kindness and respect, and maintained confidentiality.

  • Patients said that the practice team provided attentive care which met their needs. They said they appreciated the fact that the staff knew them well.

  • Patients told us urgent appointments were usually available the same day

  • Patients were at risk of harm because systems and processes were not in place in a way to keep them safe.

  • Although the practice had carried out some limited audits in respect of patient care we saw no evidence of completed clinical, medicine and safety alert related audit cycles to support improvement in performance and improve patient outcomes.

  • Whilst the practice received national guidance there was no evidence that the practice was using this to review their clinical practice, share learning or improve outcomes for patients.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

  • Ensure that safe care and treatment is provided to patients by having a formal system to underpin how significant events, incidents and concerns should be monitored, reported and recorded.

  • Ensure that information about safety is used to promote learning and improvement.

  • Ensure that national guidance and professional guidelines are used to promote best practice in the care and treatment provided.

  • Ensure there is a formal system to routinely check the medicines held within home visit bags.

  • Ensure that medicine audits are routinely conducted, in order to review patients who may be at risk of taking medicines that are highlighted in medicine safety alerts.

  • Ensure that there is a robust system for monitoring and responding to complaints so that lessons are learned to improve outcomes for patients or the service based on complaints received.

  • Ensure that governance processes and procedures are implemented to establish an on-going programme of clinical audits, as well as audits of safety alerts which must be used to monitor quality and systems to identify where action should be taken.

  • Ensure that national data collected from the Central Alerting System and incidents/events is monitored, assessed and/or used to improve patient safety within the practice. Additionally, formal arrangements for monitoring safety, using information from audits, risk assessments and routine checks must be established.

  • Ensure that Disclosure and Barring Service (DBS) checks or appropriate risk assessments are completed for all staff who act as chaperones.

In addition the provider should:

  • Update the process for checking and recording stock levels of emergency medicines.

  • Record and maintain minutes of all meetings held at the practice.

  • Review staff training to provide all staff with knowledge and an understanding of the Mental Capacity Act 2005.

  • Maintain minutes of meetings where GPs and the practice manager discuss adverse events on a weekly basis, which include details of actions taken by the practice to prevent future adverse events,

On the basis of this inspection and the ratings given to this practice the provider has been placed into special measures. This will be for a period of six months when we will inspect the provider again.

Special measures is designed to ensure a timely and coordinated response to practices found to be providing inadequate care.

Being placed into special measures represents a decision by CQC that a practice has to improve within six months to avoid having its registration cancelled.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice