Archived: Dr Nisha Pathak

Updated 6 May 2020

Updated 6 May 2020

We carried out an unannounced focussed inspection at Dr Nisha Pathak on 16 March 2020 as part of our inspection programme.

This inspection was in response to concerns raised about the lack of processes to ensure the safety and care of patients at the practice. We also followed up on previous conditions that were issued to the provider following breaches of the Health and Social Care Act 2008 identified at a previous inspection on 8 January 2020. You can read the report from our last comprehensive inspection on 8 January 2020; by selecting the ‘all reports’ link for Dr Nisha Pathak 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 have rated this practice as inadequate overall.

We rated the practice as inadequate for providing safe services because:

• The practice did not have clear systems and processes to keep patients safe. On reviewing the safeguarding registers, we found them to be incomplete and inaccurate. There was ineffective clinical oversight in place to monitor and ensure registers were up to date.
• We found no evidence to demonstrate that clinical supervision was in place. This included the review of clinical practice to ensure patient’s care and treatment was being managed appropriately.
• We found some consultation records were illegible, incomprehensible and inaccurate information had been recorded.
• On reviewing the clinical system we found high numbers of tasks that had not been actioned. These included referrals to other services and safeguarding information.
• The practice was unable to demonstrate effective management of risks in relation to medicine safety alerts from the Medicines and Healthcare products Regulatory Agency (MHRA).
• The practice was unable to demonstrate how they learnt or made improvements when things went wrong. There was no evidence available of incidents or significant events that had been recorded, reviewed or actioned.
• On reviewing a sample of medicine reviews we found concerns in the information recorded. There was no evidence to demonstrate there had been clinical oversight, monitoring or auditing of the processes in place.
• Recruitment processes did not demonstrate appropriate arrangements for ensuring only fit and proper persons were employed.
• We found that there was no record to confirm that clinical staff had the appropriate immunisation status for working in their clinical role and no risk assessments were in place in the absence of immunisation records.
• There was some evidence of actions being taken for individual patients to ensure appropriate reviews and monitoring were carried out prior to prescribing high-risk medicines.

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

• While the practice had made some improvements since our inspection on 8 January 2020 to the management of patients on high risk medicines, we found the concerns identified at the previous inspection had not been appropriately addressed. This included the management of safeguarding concerns, significant events and incidents and effective processes for the recruitment of staff.
• Leaders could not show that they had the capacity and skills to deliver high quality, sustainable care.
• The practice culture did not effectively support high quality sustainable care.
• The overall governance arrangements were ineffective.
• The practice did not have clear and effective processes for managing risks, issues and performance.
• The practice did not always act on appropriate and accurate information.
• We saw little evidence of systems and processes for learning, continuous improvement.

Despite some actions which had been taken to address issues identified at our January 2020 inspection, there was no evidence that actions had had a positive impact on the providers ability to provide a safe and well-led service. Although some actions were ongoing such as actions to improve the safeguarding registers and medicines management, we found that ineffective leadership hindered the ability to imbed new systems and processes.

As a result, the areas where the provider must make improvements are:

• 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.

(Please see the specific details on action required at the end of this report).

The service remains in special measures. The practice is due to be inspected again within six months of publication of the January 2020 comprehensive inspection report. When we re-inspect, we will also look at whether progress had been made to enable compliance with Regulation 12: safe care and treatment; and Regulation 17 good governance HSCA (RA) Regulations 2014.

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.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Updated 2 March 2020

Updated 2 March 2020

Updated 2 March 2020

Updated 2 March 2020

Updated 2 March 2020

Updated 2 March 2020