The Care Quality Commission
  • Doctor
  • GP practice

Archived: Dr Saravanapalasuriyar Shrikrishnapalasuriyar Also known as Mornington Surgery

Overall: Inadequate read more about inspection ratings

Mornington Surgery, 433 New Cross Road, New Cross, London, SE14 6TD (020) 8692 8299

Provided and run by:
Dr Saravanapalasuriyar Shrikrishnapalasuriyar

All Inspections

26 August 2020 to 25 September 2020

During a routine inspection

This practice is rated as inadequate (Previous rating July 2019 – good)

The key questions are rated as:

Are services safe? – inadequate

Are services effective? – inadequate

Are services caring? – good

Are services responsive? – requires improvement

Are services well-led? - inadequate

In August 2020, we received information of concern about the standards of care and treatment for people who used the service. In response, we carried out an unannounced inspection on 26 August 2020. Following this we decided to carry out a comprehensive inspection which took place on 23 and 25 September 2020. On 23 September we reviewed remotely specific documentation including policies and audits and undertook a site-visit on the 25 September. (In light of the current Covid-19, CQC has looked at ways to fulfil our regulatory obligations, respond to risk and reduce the burden placed on practices by minimising the time inspection teams spend on site. To seek assurances around potential risks to patients, we are currently piloting a process of remote working as far as practicable. This provider consented to take part in this pilot, and some of the evidence in the report was gathered without entering the practice premises).

Following a comprehensive inspection on 23 and 25 September 2020, we rated the practice inadequate overall and specifically in the safe, effective and well-led key questions. The responsive key question was rated requires improvement, and caring was rated as good; all the population groups were rated inadequate due to our overall concerns which impacted these groups.

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

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 rated the practice inadequate for providing safe services because:

  • The practice did not have appropriate systems in place for the safe management of medicines.
  • There was limited evidence of structured medication reviews for patients.
  • Medicines and Healthcare products Regulatory Agency (MHRA) alerts were not actioned appropriately.

We rated the practice inadequate for providing effective services because:

  • There was limited monitoring of the outcomes of care and treatment.
  • The provider undertook limited quality improvement activity other than that directed from the clinical commissioning group.
  • These areas affected all population groups, so we rated all population groups inadequate.

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

  • There was limited evidence of quality improvement activity which had taken place.
  • The practice did not have safe systems regarding the management of patients on high-risk medicines.
  • The practice did not have a process in place to structure medication reviews.
  • Staff meeting minutes were a headline of discussions, they were not a comprehensive account of meeting discussions and decisions.
  • We saw limited evidence of systems and processes for learning, continuous improvement and innovation
  • The practice did not demonstrate an effective system to manage patient safety alerts.

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

  • There was insufficient nursing capacity to meet patients’ needs.
  • The overall ratings for the population groups are inadequate due to concerns in providing effective services.

We rated the practice good for providing caring services because:

  • Data from the GP Patient survey showed that the practice was in-line with local and national data.
  • The practice had identified 2% of their patients as carers.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.

There were areas where the practice must make improvements:

  • 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.

The areas where the practice should make improvements:

  • Develop a strategy to improve national cancer screening programme achievement rates.
  • Review feedback from the National GP Patient Survey and develop an action plan to address areas the practice is two standard deviations below the average performance.

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.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Please refer to the detailed report and the evidence

tables for further information.

12/07/2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Saravanapalasuriyar Shrikrishnapalasuriyar (Mornington Surgery) on 12 July 2016. Overall the practice is rated as good.

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 in place for reporting and recording significant events.
  • 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 were made to the quality of care as a result of complaints and concerns.
  • 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 and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
  • The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

  • Implement a system to ensure that staff who do not attend practice meetings have access to the minutes.
  • Ensure the infection control lead has adequate training, time and resources to carry out the role identified.
  • Assess the need to have a nominated fire marshal.
  • Develop an ongoing audit programme that demonstrates continuous improvement to patient outcomes.
  • Review how carers are identified and recorded on the clinical system to ensure information, advice and support is made available to them.
  • Advertise translation services in the patient waiting areas.
  • Ensure clinical staff have undertaken Mental Capacity Act training.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

09 July 2014

During a routine inspection

Dr Saravanapalasuriyar Shrikrishnaplalsuriyar, also known as Mornington Surgery is located in New Cross, South East London. The practice serves a diverse multi-ethnic population with high deprivation and a high proportion of elderly patients. The practice delivers primary medical services to approximately 4,426 people. It is operated by a GP partner, one salaried GP and two locum GPs (one male and one female), a part-time Practice Nurse, a Practice Manager, an Office Manager and a team of reception and administration staff. The practice supports medical students (Years 1-to five) from a leading London medical school.

Public Health England (2014) Health Profile for Lewisham shows the health of people in Lewisham is varied compared with the England average. Deprivation is higher than average and about 30.5% (17,500) children live in poverty. Life expectancy for both men and women is lower than the England average. Life expectancy is 6.6 years lower for men and 6.6 years lower for women in the most deprived areas of Lewisham. In 2012, 23.6% of adults are classified as obese.

Before our inspection, we asked other organisations, including NHS England, Lewisham Clinical Commissioning Group and Healthwatch Lewisham to share what they knew about the service with us. We also spoke to a number of organisations who worked jointly with the practice. We spoke to a district nurse, a community nurse, a member of staff at a hostel for patients experiencing poor mental health and a local pharmacist. During the inspection, we spoke with 17 patients who used the practice (including two members of the patient participation group) and we received and reviewed 41 patient comments cards. We carried out an announced visit to the practice which lasted one day.

Patients said they were usually able to access both face to face and telephone appointments relatively easily. Although patients had to wait up to a week or longer if they wanted to see a specific GP, they said they understood why this was the case. A small number said they sometimes had to wait in reception for long periods to see the GP. The practice offered an extended hours service and patients we spoke with valued this arrangement. We saw that staff responded to urgent appointment requests wherever possible. Out of hours, patients could access care through the local SELDOC GP out of hour’s emergency service.

The practice was increasingly developing a better understanding of the needs of its patient population. Patient health outcomes (including those for older people, people with long term conditions, mothers, babies, children and young people, the working age populations and those recently retired, people in vulnerable circumstances and people experiencing poor mental health), were being improved.

However, the practice was in breach of a regulation related to the care and welfare of patients.

Other areas for improvement included:

•           Learning from incidents and reflective practice

•           Routinely responding to adverse feedback from patients via the practice website

We found care pathways in place for patients with long term conditions such as diabetes or high blood pressure. Patient care management included referral to healthcare professionals in both primary and secondary care in a timely way. Patients received safe care and were protected from abuse because staff had a good level of awareness about safeguarding and the practice had systems in place for safeguarding of vulnerable adults and children.

We looked at services for:

•           Older people

•           People with long-term conditions

•           Mothers, babies, children and young people

•           The working-age population and those recently retired

•           People in vulnerable circumstances who may have poor access to primary care

•           People experiencing poor mental health

We found these population groups received care that was safe, effective, responsive and caring. Improvements were required to ensure the service was well-led and that all population groups could access the service when they needed to.

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.