Dr Sivaranjini Shyamsundar Also known as Lincoln House Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Sivaranjini Shyamsundar’s practice (also known as Lincoln House Surgery) on 8 September 2017. Overall the practice was rated as good but required improvement for providing safe services. The practice was issued a requirement notice for being in breach of regulations for safety. The full comprehensive report on the on 8 September 2017 inspection can be found by selecting the ‘all reports’ link for Dr Sivaranjini Shyamsundar on our website at www.cqc.org.uk.

This inspection was an announced follow up inspection carried out on 15 December 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulation that we identified in our previous inspection on 8 September 2017. This report includes our findings in relation to those requirements.

Overall the practice is now rated as good for providing services and the requirement notice has been met.

The practice had made significant improvements and addressed the issues identified in the previous inspection. The practice engaged all staff in driving forward improvements.

Improvements included:

• An improved system to review and act on any patient safety and drug alerts.
• A new system to make sure there was an authorisation process for practice nurses to administer vaccinations.
• An improved monitoring system for uncollected prescriptions.
• A system to review any abnormal screening checks for patients.
• A system to record actions taken from any incidents.
• Oxygen was available for medical emergencies.
• An improved system for monitoring fridge temperatures for the storage of vaccinations.

All staff had been made aware of the new systems in place.

In addition:-

• The practice had updated patient information literature regarding who patients can complain to as an alternative to the practice i.e. NHS England.
• The practice had improved the system to monitor verbal complaints.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Sivaranjini Shyamsundar’s practice (also known as Lincoln House Surgery) on 8 September 2017. Overall the practice is rated as good but requires improvement for providing safe services.

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

• There was an open and transparent approach to safety. There were systems to monitor safety and quality. However, we found gaps in documentation and therefore there was not always a clear audit trail for how the practice managed:-significant events and complaints, accidents, drug alerts, uncollected prescriptions, vaccination authorisations, fridge temperatures for storage of vaccinations; and cervical screening. The provider advised us after the inspection that these shortfalls had been addressed. We will re-inspect the service at a later date to check the sustainability of the systems implemented and adherence to protocols.
• The practice had some equipment and medication available to respond to medical emergencies but no oxygen. This was ordered on the day of our inspection.

• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Patient survey information and Care Quality Commission (CQC) comment cards reviewed indicated that patients were very satisfied with the service they received. Patients commented that they were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Verbal complaints were addressed but there was no system to monitor these complaints.
• There was a clear leadership structure and staff felt supported by management and worked very well together as a team.

The provider must:

• Ensure care and treatment is provided in a safe way to patients

The areas where the provider should make improvement are:

• Include the correct details in patient information literature regarding who patients can complain to as an alternative to the practice i.e. NHS England.
• Record and treat verbal complaints in the same way as written complaints. 

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice