Dr V Paramanathan's Practice

We carried out an announced follow up inspection at Dr Paramanathan’s Practice on 14 November 2019 as part of our inspection programme.

The practice was first inspected in September 2016. We rated the practice good for providing a safe, effective, responsive and well led service and requires improvement for providing a caring service. We rated the practice good overall. At the inspection we asked the practice to look at ways to improve their low national patient survey scores for patient satisfaction.

We carried out a second inspection in March 2019. At this inspection we rated the practice good for providing a caring and responsive service and requires improvement for providing a safe, effective and well led service. The practice was rated requires improvement overall. We found that the practice had successfully addressed our previous concerns but found that many of the governance systems in regard to patient safety had not been maintained due to an extensive practice refurbishment programme. This included a failure to maintain infection control, health and safety and fire safety assessments, calibration of equipment and emergency medicines and equipment checks. We also found that the practice had not produced any plans to address poor uptake for the childhood immunisation and cervical screening programmes. There was no clinical supervision of nursing staff resulting in many of the nurses Patient Group Directions being either absent or out of date. The practice had undertaken clinical audits but none as yet were two cycle that demonstrated change in patient care. We issued a requirement notice for Regulation 17 HSCA (RA) Regulations 2014 Good Governance for the absence of PGDs and the failure to provide supervision to nursing staff.

This inspection focused on the following key questions:

• Safe
• Effective
• Well-led

Because of the assurance received from our review of information we carried forward the ratings for the following key questions:

• Caring
• Responsive

At this inspection 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.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

Whilst we found no breaches of regulations, the provider should:

• Continue to look at ways to improve the uptake of the cervical screening and childhood immunisation programmes.
• Consider carrying out clinical audits for antibacterial prescribing items prescribed per specific therapeutic group age-sex related prescribing unit and the number of prescription items for co-amoxiclav, cephalosporins and quinolones.

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 V Paramanathan’s Practice on 14 March 2019.

We previously inspected the practice in September 2016. We rated the practice good for providing a safe, effective, responsive and well led service and requires improvement for providing a caring service. We rated the practice good overall. At the inspection we asked the practice to look at ways to improve their low national patient survey scores for patient satisfaction.

At this inspection 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 Requires improvement overall.

We rated the practice as Requires improvement for providing safe services because:

• The practice had not undertaken a recent health and safety risk assessment.
• There was a lack of awareness in regard to the need for Patient Group Directions (PGDs) and some (MMR and influenza) had expired in February 2018.
• Defibrillator pads were out of date (expired 2015).
• Calibration of equipment was out of date (last checked in 2016)
• There was no system for checking emergency medicines held on the premises were in date and fit for use.

We rated the practice as Requires Improvement for providing an effective service because:

• The practice had not completed any 2 cycle clinical audits and did not have any other systems to measure and improve outcomes for patients.
• Published child immunisation figures were below the minimum World Health Organisation target of 90%.
• Cancer screening targets were below the national average.

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

• There was a lack of clinical supervision of nursing staff resulting in some governance responsibilities such as checking of emergency equipment and emergency medicines not being completed. In addition, PGDs were not complete and up to date.
• Processes for managing risks, issues and performance had lapsed during the refurbishment of the practice. For example, health and safety risk assessments had not been carried out since 2016.

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

• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs.
• Patients could access care and treatment in a timely way.

The areas where the provider must make improvements are:

• Ensure 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.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Consider placing cleaning check lists in a place where they are accessible to staff.
• Consider making significant event forms clearer for review.
• Carry out the planned fire drills.

• Put plans in place to improve outcomes for patients in the cancer screening programme.
• Consider improving systems to identify and support carers.

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