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Archived: Dr Srinivas Dharmana Inadequate Also known as Dharmana's Family & General Practice

Reports


Inspection carried out on 30 July 2015

During an inspection to make sure that the improvements required had been made

Letter from the Chief Inspector of General Practice

We carried out an announced follow-up inspection of Dr Srinivas Dharmana, also known as Dharmana’s Family and General Practice, on 30 July 2015. This inspection was a follow-up to our inspection of 1 October 2014 when the practice was rated as ‘Inadequate’, placed into Special Measures and required to make significant improvements.

Whilst we found there were some minor improvements in the responsiveness of the practice to patients’ needs, overall we found the practice had not made sufficient improvement in three of the five key domains. The practice is rated as Inadequate for providing safe, effective and well-led care, treatment and services. The practice is rated as Requires Improvement for providing responsive and caring services. The practice has failed to meet any of the regulatory requirements prescribed after the last inspection in October 2014 and no improvement in meeting the fundamental standards has been made.

Following this latest inspection, the provider has submitted an application to cancel their registration with CQC and the practice will close in December 2015. CQC has agreed to cancel the registration. The practice will remain in Special Measures.

In the meantime, NHS England and Liverpool Clinical Commissioning Group continue to support the practice and are taking steps to arrange the transfer of patients to alternative GP services in the local area.

Our key findings were as follows:

  • The practice did not have an effective system in place for dealing with incoming patient related correspondence. We found a significant amount of correspondence that had not been read coded or annotated by the GPs working at the practice. No effective plan to address this backlog had been executed by the provider.
  • The practice nurse had received some training on the management of patients with long term conditions. However, the nurse had not been booked onto essential update training on the delivery of immunisations and vaccinations, leaving the practice unprepared to manage responsibility for all childhood immunisations and vaccinations, which will be passed back to practices from Liverpool Community Health in September 2015.
  • Insufficient records were held in relation to clinical staff and key background checks required had not been completed. Systems set up to promote quality checks on record keeping in relation to patient records were not upheld or effectively applied.
  • Management and leadership were inadequate; improvements required in relation to infection control had not been made. Key records in relation to buildings maintenance could not be produced. Key parts to the improvement plan submitted to CQC following the inspection of 1 October 2014 had still not been achieved.

Importantly, the provider must:

  • Provide care and treatment that meets the needs of patients. Patients seen by accident and emergency departments had not received appropriate intervention and support from their practice GP or nurse. The practice failed to respond in a timely manner to advice from hospital staff on patients’ conditions and medication.
  • Have suitably qualified, competent, skilled and experienced persons deployed to cover both the emergency and routine work of the service.
  • Hold, and have available, information in relation to each person employed for the purposes of delivery of regulated activities. Have records in place that are accessible to authorised people internally and externally, and as necessary to deliver care and treatment in a way that meets patient needs and keeps them safe.
  • Address infection prevention and control concerns to ensure that they comply with the ‘Code of Practice for health and social care on the prevention and control of infection and related guidance’.
  • Maintain records relating to the care and treatment of each person using the service that are fit for purpose.
  • Do all that is reasonably practical to mitigate risks. Conduct and evaluate significant event analysis to establish how clerical or clinical errors had occurred.

Insufficient improvements have been made such that there remains a rating of Inadequate overall for this practice. The domains of Well-led, Effective, and Safe remain rated as inadequate and the Responsive and Caring domains are rated as requires improvement. As a result of this overall rating of Inadequate, all population group ratings remain as Inadequate.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 1 October 2014

During a routine inspection

Letter from the Chief Inspector of General Practice

This is the report of findings from our inspection of Dr Dharmana’s Family and General Practice. Our inspection was a planned comprehensive inspection, which took place on 1 October 2014. Dr Dharmana delivers services under a General Medical Services contract.

The service provided by Dr Srinivas Dharmana is rated as inadequate.

All five domains for Safe, Effective, Caring, Responsive and Well Led were rated inadequate

Our key findings were as follows:

  • We received positive comments from patients we spoke with during the visit. They were complimentary about the reception staff.
  • Although Dr Dharmana had not been providing clinical care since November 2013 patients spoke highly of him.

  • There were no systems in place to monitor the quality and safety of the service provided to patients. Evidence of analysis of significant events was not available for 2014 and nor was there evidence of recent clinical audits.
  • The quality of service provided to patients by locum GPs was not monitored. Systems to ensure information was shared with locum GPs for example alerts for medicine and equipment were not in place.
  • Equipment to respond to medical emergencies was not accessible and when located was not adequately resourced to respond to a medical emergency. Checks to monitor medicines and medical equipment held at the practice were not undertaken.

  • Systems to monitor and respond appropriately to safeguarding concerns were not robust nor were staff pre-employment checks. .

  • Health and safety risk assessment were not up to date.

Importantly, the provider must:

  • The provider must take action to protect service users (patients) from the risks of inappropriate or unsafe care and treatment. There was no system in place to regularly assess and monitor the quality and safety of the service provided. The provider is failing to meet Regulation 10 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2010.
  • The provider must take action to identify, assess and manage risks or potential risks relating to the health, welfare and safety of patients and people working at the practice.  The provider is failing to meet Regulation 10 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2010.
  • The provider must ensure that incidents and significant events are recorded, analysed and action taken to minimise the risk of potential harm to patients. The provider is failing to meet Regulation 10 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2010.
  • The provider must ensure information alerting of potential issues with medicines and equipment is shared so that where necessary changes to the treatment or care provided to patients is undertaken swiftly. The provider is failing to meet Regulation 10 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2010.

  • The provider must ensure that patients’ views about the service they receive are obtained and action is taken as required to improve the service provided. The provider is failing to meet Regulation 10 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2010.
  • The provider must take action so that patients are protected against the risks of receiving care or treatment that is inappropriate or unsafe. Adequate measures to monitor the safety of care and treatment delivered were not in place. The provider is failing to meet Regulation 9(1) and (2) of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2010.
  • The provider must take action to ensure that suitable arrangements are in place so that all staff respond appropriately to any safeguarding concern and to report any safeguarding concerns to the appropriate body. The provider is failing to meet Regulation 11(1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.
  • The provider must take action to ensure sufficient information is provided to patients in relation to their care and treatment. Patients were not informed of choices available to them regarding accessing healthcare services that were no longer being provided at the GP practice since November 2013. The provider is failing to meet Regulation 17(2)(b) of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2010.

  • The provider must take action to protect patients’ health, welfare and safety by ensuring suitable arrangements are in place to share information with other health care professionals so that patients receive continuity of care when they move between services. The provider is failing to meet Regulation 24(1)(a)(b) Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.
  • The provider must take action to ensure its recruitment arrangements are in line with Schedule 3 of the Health and Social Care Act 2008, to ensure necessary employment checks are in place for all staff. The provider is failing to meet Regulation 21 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2010.

On the basis of this inspection and the concerns identified which have resulted in an inadequate rating for all domains I am placing the provider into special measures. This will be for a period of six months. We are currently piloting our approach to special measures, working closely with NHS England. The proposals we are piloting are that GP practices rated as inadequate for one or more of the five key questions or six population groups will be inspected no longer than six months after the initial rating is confirmed. We will inspect the practice again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice