Archived: Dr Binoy Kumar Also known as St Pauls Surgery

Updated 12 October 2017

Dr Binoy Kumar (the provider), also known as St Pauls Surgery is situated at 36-38 East Street, Deepdale, Preston, PR1 1UU. The surgery is located close to Preston city centre and the premises are purpose built and offer appropriate access and facilities for disabled patients and visitors. There is time-limited, on-street parking available and easy access to public transport.

The practice is part of the NHS Greater Preston Clinical Commissioning Group (CCG) and services are provided under a general medical service (GMS) contract with NHS England.

Dr Kumar is a single handed male GP supported by one regular female locum GP. There are also a practice nurse, a practice manager and five reception and administration staff. The practice uses a locum GP when required to cover leave or sickness, for continuity of service and support for their patients.

The practice opens from Monday to Friday from 8.30am until 6.30pm. There are extended hours each Monday evening until 7pm. When the practice is closed patients are advised to contact NHS 111. Out of hours service is provided by GotoDoc, based at the local NHS hospital

Patients can book appointments in person, via the telephone or online. The practice provides telephone consultations, pre-bookable consultations, urgent consultations and home visits.

The practice provides services to 2008 registered patients. Data shows the practice population is made up of a lower proportion of patients aged 65 years and above compared to the national average The practice also has a slightly higher percentage of working age patients compared with the national average.

Information published by Public Health England rates the level of deprivation within the practice population group as two on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. Male life expectancy is 79 years compared to the local and national averages of 78 years and 79 years respectively. Female life expectancy in the practice area is 83 years compared to 82 years locally and 83 years nationally. There are 53% of patients with a long-standing health condition, the same as the national average. A total of 13% of patients are unemployed compared to the national average of 4%.

Updated 12 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Binoy Kumar, also known as St Paul’s Surgery, on 25 July 2017. This was to check that the practice had taken sufficient action to address a number of significant concerns we had identified during our previous inspections in June 2016 and August 2015. Following the inspection in August 2015, the practice was rated as inadequate for providing safe and well-led services, and as requires improvement for providing effective, responsive and caring services. Overall the practice was rated as inadequate. We issued a warning notice and two requirement notices under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and placed the practice in special measures as a result.

At our inspection in June 2016, we saw that the practice had taken action to meet the actions needed for the warning notice and requirement notices, however, we found that there were still areas that required improvement. We rated the practice as inadequate for providing effective services, requires improvement for providing caring, responsive and well-led services and good for providing safe services. Overall the practice was then rated as requires improvement and remained in special measures.

At this most recent inspection we saw that the practice had taken steps to address most of the concerns identified at our previous inspection, however, some significant concerns remained and we saw evidence that concerns regarding the safe recruitment of staff previously identified at our inspection in August 2015 had re-occurred. We also identified new concerns related to the clinical care of patients.

Overall the practice is now rated as inadequate.

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

• The practice had not followed the practice recruitment policy in the recruitment of three new staff. There had been insufficient checks made for the practice nurse on recruitment, key staff documents were missing from staff files and the use of the staff confidential health questionnaire had been discontinued.
• Processes for the safe monitoring of some patients taking high-risk medicines were lacking and patients were being prescribed these medicines without timely review.
• The practice had not engaged patients in the national screening programmes for breast and bowel cancer. Figures showed a lower uptake for breast screening at 49% compared with 65% locally and 73% nationally and bowel screening was also low; 36% compared with 58% both locally and nationally. These figures had dropped when compared to 2014/15 figures of 52% for breast screening and 40% for bowel screening.
• We saw evidence that knowledge of and reference to national guidelines and guidance for patients’ clinical care was lacking.
• There was evidence that patient treatment records had insufficient details to give assurance that an adequate assessment of the patient had been made and there was a lack of recording of the patient medical history and clinical signs. We saw that a referral to another service lacked detail.
• Although some audits had been carried out, none of the audits that we saw were completed audits, where improvements were implemented and monitored.

However:

• The practice had improved the number of patient medicines reviews undertaken in a timely fashion. Unverified data from the practice showed that 89% of reviews had been undertaken for any patient who was taking medication.
• The practice had streamlined appointments for patients with long-term conditions and we saw evidence that these were being undertaken in a timely way.
• The practice maintained care plans for vulnerable patients and these were updated following patient reviews.
• Cervical screening uptake had significantly improved. As the result of work by the practice nurse to increase uptake, we saw unverified data that figures had increased from 50% in 2015/16 to 72% at the time of our inspection (practice unverified data).
• The improved, open and transparent approach to safety and effective system for reporting and recording significant events had been maintained since our last inspection.
• There were regular staff meetings with standing agenda items although some minutes lacked detail, for example for identifying which significant events had been discussed.
• The practice had recruited a female locum GP to provide one surgery each week so that patients could access a female clinician. They had also increased administration staff.
• There was evidence of an improved staff appraisal process and training needs were more clearly identified.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

In addition the provider should:

• Enable sufficient records to be kept for discussion in meetings to allow learning to be shared.
• Review the timescale for new staff mandatory training, in particular safeguarding training.
• Improve the system for monitoring quality improvement in the practice, particularly in the area of clinical audit.

This service was placed in special measures in 2015 and remained in special measures following an inspection in June 2016. Insufficient improvements have been made such that there remains a rating of inadequate for providing safe, effective and well led services. Therefore we are taking 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 with the Care Quality Commission.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 12 October 2017

The practice is rated as inadequate for the care of people with long-term conditions. The issues identified as a concern affected all patients including this population group.

• As with our previous inspections, at this inspection the practice failed to demonstrate that there were strong, sustainable governance arrangements in place.
• We continued to have serious concerns that the leadership lacked the necessary capability and knowledge to lead the practice effectively. Action needed to mitigate continued identified risks was either not taken or not sustained. This was resulting in risk to overall safe care and treatment of all patients.

• Consultation notes on all of the patient records we viewed had insufficient details to give assurance that an adequate assessment of the patient had been made and there was a lack of recording of the patient’s medical history and clinical signs.
• Care and treatment of patients with long-term conditions did not always reflect current evidence-based practice.
• There was evidence of insufficient monitoring of some patients who were taking high-risk medicines for long-term conditions.

Updated 12 October 2017

The practice is rated as inadequate for the care of families, children and young people. The issues identified as a concern affected all patients including this population group.

• Care and treatment of children did not always reflect current evidence-based practice. We saw records of prescribing for two children that were not in line with the British National Formulary (BNF) for prescribing for children.
• Consultation notes on the patient records for three children that we sampled had insufficient details to give assurance that an adequate assessment of the patient had been made. Records of who attended with the child were not made and in one case, an urgent referral made to the hospital lacked detail.

• As with our previous inspections, at this inspection the practice failed to demonstrate that there were strong, sustainable governance arrangements in place.
• We continued to have serious concerns that the leadership lacked the necessary capability and knowledge to lead the practice effectively. Action needed to mitigate continued identified risks was either not taken or not sustained. This was resulting in risk to overall safe care and treatment of all patients.

Updated 12 October 2017

The practice is rated as inadequate for the care of older people. The issues identified as a concern affected all patients including this population group.

• As with our previous inspections, at this inspection the practice failed to demonstrate that there were strong, sustainable governance arrangements in place.
• We continued to have serious concerns that the leadership lacked the necessary capability and knowledge to lead the practice effectively. Action needed to mitigate continued identified risks was either not taken or not sustained. This was resulting in risk to overall safe care and treatment of all patients.
• Consultation notes on all of the patient records we viewed had insufficient details to give assurance that an adequate assessment of the patient had been made and there was a lack of recording of the patient’s medical history and clinical signs.

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice held multidisciplinary meetings on a monthly basis where patients with complex needs were discussed to ensure they were being cared for appropriately.
• Where older patients had complex needs, the practice shared summary care records with local care services including the out of hours service.

Updated 12 October 2017

The practice is rated as inadequate for the care of working age people (including those recently retired and students). The issues identified as a concern affected all patients including this population group.

• As with our previous inspections, at this inspection the practice failed to demonstrate that there were strong, sustainable governance arrangements in place.
• We continued to have serious concerns that the leadership lacked the necessary capability and knowledge to lead the practice effectively. Action needed to mitigate continued identified risks was either not taken or not sustained. This was resulting in risk to overall safe care and treatment of all patients.
• Consultation notes on all of the patient records we viewed had insufficient details to give assurance that an adequate assessment of the patient had been made and there was a lack of recording of the patient’s medical history and clinical signs.

Updated 12 October 2017

The practice is rated as inadequate for the care of people experiencing poor mental health (including people with dementia). The issues identified as a concern affected all patients including this population group.

• The practice system for monitoring repeat prescribing for patients receiving medicines for mental health needs was insufficient.
• As with our previous inspections, at this inspection the practice failed to demonstrate that there were strong, sustainable governance arrangements in place.
• We continued to have serious concerns that the leadership lacked the necessary capability and knowledge to lead the practice effectively. Action needed to mitigate continued identified risks was either not taken or not sustained. This was resulting in risk to overall safe care and treatment of all patients.
• Consultation notes on all of the patient records we viewed had insufficient details to give assurance that an adequate assessment of the patient had been made and there was a lack of recording of the patient’s medical history and clinical signs.

Updated 12 October 2017

The practice is rated as inadequate for the care of people whose circumstances may make them vulnerable. The issues identified as a concern affected all patients including this population group.

• As with our previous inspections, at this inspection the practice failed to demonstrate that there were strong, sustainable governance arrangements in place.

• We continued to have serious concerns that the leadership lacked the necessary capability and knowledge to lead the practice effectively. Action needed to mitigate continued identified risks was either not taken or not sustained. This was resulting in risk to overall safe care and treatment of all patients.
• Consultation notes on all of the patient records we viewed had insufficient details to give assurance that an adequate assessment of the patient had been made and there was a lack of recording of the patient’s medical history and clinical signs.
• The practice held a register of patients living in vulnerable circumstances including asylum seekers and those with a learning disability.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.