The Care Quality Commission
  • Doctor
  • GP practice

Archived: Dr Aman Raja Also known as Parklane Medical & Surgical Services

Overall: Requires improvement read more about inspection ratings

625 Green Lanes, London, N8 0RE (020) 8340 6898

Provided and run by:
Dr Aman Raja

All Inspections

2 June 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Aman Raja (also known as Park Lane Medical & Surgical Services) on 2 June 2016. Overall the practice is rated as requires improvement.

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

  • Some risks to patients were assessed and managed. However, those relating to infection control and emergency oxygen were not.
  • Reasonable adjustments had not been made to remove barriers to people accessing the service. For example, the reception desk did not have a lowered section to accommodate wheel chair users. This area of concern had been highlighted at our last inspection.
  • We did not see evidence that the practice was obtaining the views of people who used the service.

  • Governance arrangements did not always operate effectively. For example, infection prevention and control risks were not well managed.

  • We saw evidence that the GP assessed patients’ needs and delivered care in line with current evidence based guidance.
  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
  • Patients said they were treated with compassion, dignity and respect.
  • 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 areas where the provider must make improvements are:

  • Introduce a system for checking emergency oxygen.

  • Ensure that there are appropriately signed patient group directions (PGDs) on file to enable the practice’s locum nurse to legally administer medicines.

  • Ensure that staff receive annual basic life support training.

  • Review processes to ensure reasonable adjustments are made for disabled people under the Equality Act 2010.

In addition the provider should:

  • Review its systems for identifying and providing support to carers.

  • Ensure there are processes for identifying where improvements in clinical care can be made and monitored.

  • Review policies and procedures to ensure they are fit for purpose.

This service was placed in special measures in January 2016. Insufficient improvements have been made such that there remains a rating of inadequate for providing safe services. Shortly after our inspection, the provider notified the CQC that they were retiring and applied to cancel their registration.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

8 October 2015

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Aman Raja on 8 October 2015. Overall the practice is rated as inadequate.

We inspected this location in February 2014 using our old methodology and identified concerns regarding vaccines management and infection prevention and control. We inspected again in January 2015 and noted that although these issues had been addressed, new concerns had emerged regarding medical emergency medicines, pre-employment checks and fire safety. Overall, we rated the practice as requires improvement as there were areas where improvements needed to be made. We also rated the practice as requires improvement for providing safe, effective, caring, responsive and well led services and for the quality of care provided for each of the six population groups.

The inspection which took place on 8 October 2015 was therefore planned as a focussed follow up inspection to check whether the provider was now 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. However, because the provider had not addressed the concerns identified in January 2015 and because other concerns came to light in this inspection, we widened the scope of the focused inspection to a comprehensive inspection.

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

  • Patients were at risk of harm because systems and processes were not in place to keep them safe. For example, we noted a continued limited range of medical emergency medicines and found that some of these medicines potentially put some patient groups at risk. We also identified concerns with infection prevention and control (IPC) at the practice.
  • The practice had a leadership structure but formal governance arrangements were limited or absent.
  • There was insufficient assurance to demonstrate people received effective care and treatment. We looked at five patient medical records which highlighted that clinical management did not take account of current evidence based guidance. The records were brief and contained minimal detail.
  • There was little evidence of learning from events or action taken to improve safety. We were told that significant events were discussed at team meetings but these were not recorded. Some staff we spoke with did not recognise what might constitute concerns, incidents or near misses.
  • There were inadequate plans in place to manage risks associated with anticipated future events. We were told that the GP would shortly be taking a leave of absence for more than 28 days but there were no arrangements in place to ensure adequate clinical staffing cover.
  • Patient feedback was positive about interactions with staff and about how staff treated them with compassion and dignity.

The areas where the provider must make improvements are:

  • Review systems in place for monitoring and improving patient outcomes including cervical screening uptake.
  • Ensure that risk assessments take place regarding Control of Substances Hazardous to Health (COSHH).
  • Ensure an automated external defibrillator (AED) is available on the premises or undertake a risk assessment if a decision is made not to have an AED on the premises.
  • Ensure there are formal governance arrangements in place for use of GP locums at the practice.
  • Undertake a risk assessment of the practice’s decision to carry a limited range of emergency medicines; and introduce a system of checking expiry dates of emergency medicines.
  • Take action to address identified IPC concerns (such as an absence of annual audits, lack of cleaning schedules for clinical equipment and lack of a building cleaning schedule).
  • Undertake a programme of clinical audit so as to drive improvements in patient outcomes.

The areas where the provider should make improvement are:

  • Reconvene Patient Participation Group (PPG) meetings, so as to identify and act on patients’ views about the service.
  • Develop an action plan in light of low patient satisfaction on involvement in decisions about their care and treatment.
  • Introduce a system of regular fire drills.
  • Provide training for staff undertaking chaperone duties.

I am placing this practice in special measures. Practices 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 practice 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 vary the provider’s registration to remove this location or cancel the provider’s registration.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

15 January 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Aman Raja (also known as Parklane Medical & Surgical Services) on 15 January 2015. Overall the practice is rated as requires improvement.

Specifically, we found the practice to require improvement for providing safe, effective, responsive, well led and caring services. It also required improvement for providing services for older people, people with long term conditions, families, children and young people, working age people (including those recently retired and students), people living in vulnerable circumstances and people experiencing poor mental health (including people with dementia).

Our key findings were as follows:

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
  • Risks to patients were assessed and managed, with the exception of those relating to fire safety and medical emergencies.
  • Data showed patient outcomes were at or above the average for the locality.
  • We saw no evidence that audits were driving improvement in performance to improve patient outcomes.
  • 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.
  • Urgent appointments were usually available on the day they were requested.
  • The practice did not have a website but arrangements were in place for booking appointments.
  • The practice had a number of policies and procedures to govern activity and we noted that these had been reviewed within the last twelve months.

The areas where the provider must make improvements are:

  • Undertake a fire safety risk assessment to ensure that adequate fire safety arrangements are in place.
  • Ensure medical oxygen and other medicines for management of medical emergencies are available or undertake a risk assessment if a decision is made not to have a full range of emergency medicines available on the premises.
  • Carry out criminal record checks on non-clinical staff who act as chaperones.

In addition the provider should:

  • Ensure an automated external defibrillator (AED) is available on the premises or undertake a risk assessment if a decision is made not to have an AED on the premises.
  • Introduce more frequent and minuted Patient Participation Group meetings (with annual action plans).
  • Consider holding governance meetings more regularly and ensure meetings are minuted.
  • Introduce a programme of clinical audit to drive improvement in performance and improve patient outcomes.
  • Develop an action plan in light of national patient survey result which reported that only 63% of respondents said the last GP they saw or spoke to was good at involving them in decisions about their care (compared with the Haringey practice average of 77%).
  • Develop an action plan to improve disabled access. We noted that the reception desk did not have a lowered section to accommodate wheel chair users. Also, the location of the practice’s disabled toilet hindered access.
  • Introduce a cleaning schedule for specific areas such as minor surgery and patient waiting area.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

11 February 2014

During an inspection in response to concerns

People spoke positively about the extent to which they were involved in decisions about their care and the dignity and respect they received. Comments included, "he's very caring' and 'he's got that very good, typical doctor-like approach and is very sensitive in his approach'. People said their care and support was explained to them and staff took account of their diverse needs.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

There were shortfalls in the management of infection control and as a result, people were not always cared for in a clean, hygienic environment. There were shortfalls in medicines management because arrangements for the safe storage, recording and disposal were not always followed.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

The service shared a location address with another doctor who was separately registered. The provider shared their administrative, reception and other systems, policies and procedures with another practice and was in the process of discussing the possibility of merging with the other doctor's practice.