All inspections: Dr Mahadeva Selvarajan

We carried out a review of the data available to us about Dr Mahadeva Selvarajan on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.

This could change at any time if we receive new information. We will continue to monitor data about this service.

If you have concerns about Dr Mahadeva Selvarajan, you can give feedback on this service.

We carried out an announced comprehensive inspection at Dr Mahadeva Selvarajan on 9 August 2021. The practice is rated Good overall.

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

Why we carried out this inspection

The practice was firstly rated Inadequate overall on 6 November 2018. They were inspected again on 6 July 2019 when the ratings improved to requires improvement overall. At that time they remained in special measures because the population group families and young children remained inadequate due to significantly lower than average child immunisation scores.

At an inspection on 8 January 2020 data outcomes remained lower than average for child immunisations and cervical screening. This affected the population groups families and young children and working age people (including those recently retired) which remained requires improvement. That resulted in an overall rating of requires improvement for the effective key question. In addition, patient satisfaction scores had decreased since the previous inspection resulting in the practice being rated requires improvement for caring. That impacted on the overall rating which remained requires improvement.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Dr Mahadeva Selvarajan on our website at www.cqc.org.uk

This inspection was a full comprehensive inspection including an on-site visit and was not limited to the concerns mentioned above. We found the practice had maintained all the improvement it had embedded at the last inspection and further improvements were seen again.

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included

Conducting staff interviews using video conferencing where possible.
Reviewing patient records to identify issues and clarify actions taken by the provider
Requesting evidence from the provider
A full day’s site visit

Our findings

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 Good overall and Good for all population groups except for Working Age People (including those recently retired and students) which remains requires improvement.

We found that:

The provider and the practice staff continued to engage with the Clinical Commissioning Group (CCG). We saw that the practice had taken every effort to improve data outcomes for immunisation and cervical screening. We saw continual improvement and we saw that the practice did not cease these efforts just because their inspection was over.
The inspection team saw evidence of a collective response from all members of the practice team who demonstrated hard work and collaborative desires to continue with the improvements.
GP and clinical cover were sufficient to manage long term conditions of patients safely and effectively. We saw that outcomes continued to improve in these population groups.
Improvements previously demonstrated around systems and processes had been maintained and were yet further embedded to keep patients safe.
Incident reporting, management of patient safety alerts, prescription protocols, emergency equipment, fridge monitoring and information sharing were all embedded within the practice.
Staff were clear about reporting incidents, near misses and concerns and all staff reported continued improvement around formal communication, access to information and learning.
The provider had produced audits and we saw evidence of a significant number of patient outcomes that had improved yet further since our last inspection. We saw that audits continued to be discussed at practice meetings.
Complaints were sufficiently dealt with and the practice maintained a constructive approach with regard to verbal comments received from patients which were being logged and reviewed. We saw evidence of many positive comments from patients which were also kept to share with staff.
Recruitment checks and personnel information were sufficiently maintained in accordance with requirements. Two new members of staff had started at the practice since the last inspection and we saw that all appropriate induction and mandatory training had been undertaken.
Appointment systems were improved so that all patients had access to care when they needed it.
There was improved practice leadership and evidence of a whole team approach.

We saw one area of outstanding practice:

The practice carried out their own phlebotomy and blood tests at the practice. As there was only one collection of samples per day to the pathology department this was problematic to the practice. To address this problem a centrifugal machine was purchased at the practice’s expense so that patients’ blood tests could be taken throughout the day and would not be affected by being stored overnight.

Whilst we found no breaches the provider should continue to:

Find ways to improve the uptake of immunisations and cervical screening.

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

We carried out an announced comprehensive inspection at Dr Mahadeva Selvarajan on 8 January 2020. The practice is rated Requires Improvement overall.

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Requires Improvement

Are services caring? – Requires Improvement

Are services responsive? – Good

Are services well-led? – Good

The practice was firstly rated Inadequate overall on 6 November 2018. They were inspected again on 6 July 2019 when the ratings improved to requires improvement overall. At that time they remained in special measures because the population group families and young children remained inadequate due to significantly lower than average child immunisation scores.

At this inspection the population groups families and young children and working age people (including those recently retired) remained requires improvement resulting in the effective domain remaining as requires improvement. The practice has put in measures to improve uptake of child immunisation and cervical screening within their transient population, but those measures are not yet showing impact. In addition, patient satisfaction scores had decreased since the last inspection resulting in the practice being rated requires improvement for caring.

The practice is therefore rated requires improvement overall.

At this inspection we found:

The provider and the practice staff continued to engaged with the Clinical Commissioning Group (CCG), and performance data showed continual improvement.
The inspection team saw evidence of a collective response from all members of the practice team who demonstrated hard work and collaborative desires to continue with the improvements.
GP and clinical cover were sufficient to manage long term conditions of patients safely and effectively.
Improvements previously demonstrated around systems and processes had been maintained and were embedded to keep patients safe.
Incident reporting, management of patient safety alerts, prescription protocols, emergency equipment, fridge monitoring and information sharing were all embedded within the practice.
Staff were clear about reporting incidents, near misses and concerns and all staff reported continued improvement around formal communication, access to information and learning.
The provider had produced audits and we saw evidence of a significant number of patient outcomes that had improved since our last inspection.
Complaints were sufficiently dealt with and the practice maintained a constructive approach with regard to verbal comments received from patients which were being logged and reviewed. We saw evidence of many positive comments from patients which were also kept to share with staff.
Recruitment checks and personnel information was sufficiently maintained in accordance with requirements.
Appointment systems were improved so that all patients had access to care when they needed it.
There was improved practice leadership and evidence of a whole team approach.

The areas where the provider should continue to make improvements are:

Find ways to educate patients about the importance of immunisations and cervical screening through their own languages or cultural beliefs to further improve uptake.
Introduce a formal travel risk assessment when travel vaccinations are administered.
Address the areas in the GP patient survey where scores are low.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

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

We carried out an announced comprehensive inspection at Mahadeva Selvarajan on 5 July 2019. This practice is rated Requires Improvement in the responsive domain and Good overall. (Previous rating November 2018 – Inadequate)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Requires Improvement

Are services caring? – Good

Are services responsive? – Requires Improvement

Are services well-led? - Good

The practice was previously given an overall rating of Inadequate on 6 November 2018 with the following domain ratings:

Safe – Inadequate

Effective – Inadequate

Caring – Requires Improvement

Responsive – Inadequate

Well-led – Inadequate

Warning Notices were issued in respect of Regulation 12 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 (safe care and treatment), Regulation 13 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 (safeguarding) and Regulation 17 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 (good governance).

We went back to follow up the issues identified in the Warning Notices on 5 April 2019. At that inspection we found that significant progress had been made and the practice had met the requirements of the Warning Notices although some further improvement was still required.

At this inspection we found:

The provider and the practice staff had engaged with the Clinical Commissioning Group (CCG), The Royal College of General Practitioners and the Primary Care Networks to facilitate improvement from an inadequate rating. The inspection team saw evidence of a collective response from all members of the practice team who demonstrated hard work and collaborative desires to achieve the improvements.
GP cover was now sufficient to manage long term conditions of patients safely and effectively.For example, the GP was now each day and was available on-site to support the advanced nurse practitioner and practice nurse during clinics if required.
Systems and processes had been implemented and embedded to keep patients safe. The previous risks found around incident reporting, clinical record keeping, patient safety alerts, prescription protocols, emergency equipment, fridge monitoring and information sharing had been removed.
Staff were clear about reporting incidents, near misses and concerns and all staff reported significant improvement around formal communication, access to information and learning.
The provider had produced audits and we saw evidence of a significant number of patient outcomes that had improved since our last inspection.
The practice had joined in the Bolton Quality Contract and was able to demonstrate twelve months of positive data. (This is a Clinical Commissioning Group (CCG) incentive to monitor whether practices are providing the best services for patients in their population).
Complaints were sufficiently dealt with and the practice took a more open and constructive approach with regard to verbal comments received from patients which were being logged and reviewed.
Recruitment checks and personnel information were sufficiently maintained in accordance with requirements.
Appointment systems were improved so that all patients had access to care when they needed it.
There was improved practice leadership and evidence of a whole team approach.

We rated the population group families, children and young people as inadequate in effective and requires improvement in responsive. This led to an overall rating of inadequate for that population group.

We rated the population Working age people (including those recently retired and students) as requires improvement in effective and requires improvement in responsive. This led to an overall rating of requires improvement for that population group.

These ratings were because:

Although we noted many improvements there were still areas below average in the quality outcome framework (QOF).
Immunisation data was much lower than average and had not improved.
Cancer screening data was lower than average.
Satisfaction scores for making appointments remained lower than average at the current time.
The practice website had only just become available after a period of twelve months, meaning patients could not book appointments or order prescriptions online through that method. However we were told these facilities were available through the practice’s clinical system.
The practice had identified more than 2% of the population as carers at the practice.

The areas where the provider should make improvements are:

Continue to improve quality outcomes for patients.
Continue to increase the number of carers recorded on the practice system.
Continue to improve patient experiences around access.
Highlight to patients and encourage the use of on-line services.
Facilitate a productive patient participation group.

We saw improvement to patient safety, and clinical care had significantly improved. There was an improved, structured process and governance system in place to keep patients safe. We were told the aim would be to maintain these standards and continue to improve in areas of Quality Outcome Framework and patient access and experiences and the inspection team felt confident that this would continue.

I am keeping this service in special measures. The service will be kept under review and 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, or 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.

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

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

On 6 November 2018 we carried out a full comprehensive inspection of Dr Mahadeva Selvarajan. The practice was given an overall rating of inadequate and placed into special measures.

The domain ratings were:

Safe – Inadequate

Effective – Inadequate

Caring – Requires improvement

Responsive – Inadequate

Well-led – Inadequate.

Warning notices were issued in respect of Regulation 12 (safe care and Treatment), Regulation 16 (complaints) and Regulation 17 (good governance).

This inspection, on 5 April 2019, was to check the requirements of the warning notices had been met. We found that significant progress had been made to meet the requirements of the warning notices, although some further improvement was still required.

In particular:

The practice submitted an appropriate action plan. The lead GP had completed necessary training and was available at the practice five days per week.
Systems and processes had been suitably implemented to improve patient safety, including incident management, improved clinical record keeping, heightened assessment of risks, and better information sharing.
We saw improved communication and action on medical alerts, prescription protocols, emergency equipment and fridge monitoring.
We found improvement in the way in which NICE guidelines and local prescribing protocols were followed.
A process for incident management and discussion had been implemented with an easy to follow audit trail.
The process to manage complaints was more effective. We saw an improved system to record all patient feedback and an easy to follow audit trail so that information could be monitored.
There was an improved system to manage and monitor staff such as recording training, vaccinations, insurance and performance.
Emergency medicines and equipment was being satisfactorily monitored.
Infection control was being managed appropriately and the actions highlighted in the previous inspection report had been attended to.
The practice had implemented a shared drive which was easy to access and use by all members of staff. Was saw information on patient safety alerts, safeguarding, minutes from meetings with actions taken, access and guidance to incident reporting and improved policies and procedures.
We saw improved processes and procedures in place to monitor recruitment. However, the practice should include all documentation required under Section 36 of Regulation 19 (fit and proper persons).
We saw that not all fridges were being monitored in a consistent way to include the minimum and maximum temperatures on a daily basis.
The infection control lead had not undertaken specific training for the lead role.
We saw that the practice website is still showing as unavailable.

We found that the warning notices were met. The rating of inadequate awarded to the practice following our full comprehensive inspection on 6 November 2018. The practice will be re-inspected and their rating revised if appropriate in the future.

Details of our findings are set out in the evidence table.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

This practice is rated as Inadequate overall. (Previous rating January 2015 – Good)

The key questions at this inspection are rated as:

Are services safe? – Inadequate

Are services effective? – Inadequate

Are services caring? – Requires Improvement

Are services responsive? – Inadequate

Are services well-led? - Inadequate

We carried out an announced comprehensive inspection at Dr Mahadeva Selverajan (also known as Deane Clinic One Stop Health Centre) on 6 November 2018. The inspection was part of our regulatory functions to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014. Overall the practice is rated as inadequate.

At this inspection we found:

There was insufficient GP cover to manage long term conditions of patients safely and effectively. For example no GP on-site two days per week, leaving the advanced nurse practitioner unsupervised during clinics.
Patients were at risk of harm because systems and processes were not sufficiently implemented to keep them safe. We found concerns around incident reporting, clinical record keeping, patient safety alerts, prescription protocols, emergency equipment, fridge monitoring and information sharing.
Staff were not clear about reporting incidents, near misses and concerns and there was no evidence of formal communication and learning between staff.
Patient outcomes were hard to identify as little or no reference was made to audits or quality improvement. There was no evidence of quality monitoring other than the Quality Outcomes Framework (QOF) which is a voluntary annual reward and incentive programme for GP surgeries.
All practices in Bolton are signed up to the Bolton Quality Contract which is a Clinical Commissioning Group (CCG) incentive to monitor whether practices are providing the best services for patients in their population. It has been in place for four years. The practice joined this initiative in August this year.
Not all patients were positive about their interactions with staff and some commented through various avenues that they were not treated with compassion and dignity. Those comments were perceived by the practice as disingenuous and were not responded to.
Complaints were not sufficiently dealt with.
Recruitment checks and personnel information were not sufficiently maintained in accordance with requirements.
Appointment systems were not working well enough so that all patients received timely care when they needed it.
There was insufficient practice leadership and no evidence of a whole team approach.

The areas where the provider must make improvements are as follows :

Ensure care and treatment is provided in a safe way to patients
Ensure there is an effective system for identifying, receiving, recording, handling and responding to complaints by patients and other persons in relation to the carrying on of the regulated activity.
Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
Ensure specified information is available regarding each person employed and any such action as is necessary and proportionate is taken when any member of staff is no longer fit to carry out their duties

The areas where the provider should make improvement are:

Improve access and processes for making appointments.
Engage with the patient population

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

Please refer to the detailed report and the evidence tables for further information.

Letter from the Chief Inspector of General Practice

This is the report of findings from our inspection of Deane Clinic One Stop Health Centre. The practice was registered with the Care Quality Commission to provide primary care services.

We undertook a planned, comprehensive inspection on 3 December 2014 and spoke with patients, staff and the practice management team.

The practice is rated as good overall. We found an innovative, caring, effective, responsive and well-led practice that provided a service which met the needs of the diverse population it served. Our key findings were as follows:

Safety was paramount in the practice and all staff were encouraged to maintain high standards. The practice staff were transparent and inclusive and used learning from incidents, complaints and patient feedback to improve the service they provided.
There was an air of willingness by all staff to do the best for their patients which included looking at the patient holistically rather than just focusing on the problem they were attending the practice for.

We saw areas of outstanding practice. For example :

The practice had reached out to the local community by approaching mosques, churches and schools and had attended them to promote better health. If any underlying health issues were identified the patients (if they belonged to the practice) were offered an appointment at the practice and patients from other practices were advised to attend their own GP. Patients were also signposted to other services within the community such as weight management classes or counselling services.

We saw excellent examples of close working partnerships with other health and social care professionals which included care planning. Care Plans were in place for two per cent of the practice patients as part of a locally enhanced service and with a view to avoiding unplanned admissions to hospital. Care plans were very personalised and holistic and the practice nurse took great pride in their responsibility for ensuring the plans were maintained, reviewed and updated whenever changes occurred or at least three-to-six monthly.

There were several other services available to patients of the practice. The lead GP was trained and had equipment on-site to undertake tests and carry out treatment in audiology and dermatology. The practice also employed an ophthalmologist and the GP was trained and had equipment to carry out ultrasound and diagnose bone, muscle and joint disease. These services enabled early diagnosis and reduced inappropriate referrals to secondary services.

This practice showed outstanding examples of improving access for patients. A recent access audit had been undertaken by Bolton CCG and had identified that Deane Clinic scored highest (93.75%) for the total number of contacts per 1,000 patients when compared to their peer group and also within the CCG. They also scored highest (31.12%) for urgent appointments and the use of telephone consultations (27.17%). They have identified that their flexible access facility has reduced use of the out of hours (OOH) facilities. Patients spoken with told us they were happy with the access and were able to get an appointment when they needed one.

We saw areas where the practice should improve. For example :

Chaperone training for front line staff was ineffective because it did not cover all the requirements such as where to stand during intimate examinations and how to record their attendance on the patient record.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice

Dr Mahadeva Selvarajan Also known as Deane Clinic One Stop Health Centre

All Inspections

6 July 2023

During a monthly review of our data

9 August 2021

During a routine inspection

During a routine inspection

15/07/2019

During a routine inspection

5/4/2019

During an inspection looking at part of the service

6/11/2018

During a routine inspection

03/12/2014

During a routine inspection

Letter from the Chief Inspector of General Practice