The Care Quality Commission
  • Doctor
  • GP practice

Archived: Dr Nisha Pathak

Overall: Inadequate read more about inspection ratings

Primary Care Centre, 6 High Street, West Bromwich, West Midlands, B70 6JX (0121) 612 2500

Provided and run by:
Dr Nisha Pathak

All Inspections

16 March 2020

During a routine inspection

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

8 January 2020

During a routine inspection

We carried out a comprehensive unannounced inspection of Dr Nisha Pathak’s practice on 8 January 2020. We identified that the service at Dr Nisha Pathak’s practice was being delivered under a partnership arrangement with Dr Devanna Manivasagam. However, Dr Pathak was registered with the Care Quality Commission as an individual provider. Dr Pathak had not informed us of these changes and was in breach of conditions of their registration. We carried out this inspection because concerns had been identified at another practice in which Dr Manivasagam was the provider. These concerns highlighted a lack of effective leadership and clinical oversight. A decision was therefore made to inspect all of Dr Devanna Manivasagam’s services on 8 January 2020 including Dr Nisha Pathak’s practice.

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.
  • The practice did not have effective systems for safeguarding patients from abuse or harm.
  • Recruitment processes did not demonstrate appropriate arrangements for ensuring only fit and proper persons were employed.
  • The practice did not have effective systems in place for managing infection control and risks relating to the service.
  • The practice did not have effective systems for the safe management of medicines, included regular monitoring arrangements for patients on high risk medicines.
  • The practice was unable to demonstrate that it learnt and made improvements when things went wrong.

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

  • There was limited monitoring of the outcomes of care and treatment in particular we found issues relating to the management of patients with diabetes and on high risk medicines.
  • The practice was unable to show that staff had the skills, knowledge and experience to carry out their roles, were up to date with training and received appropriate supervision.
  • We saw limited evidence of support for patients to lead healthier lifestyles and working closely with other organisations to deliver care and treatment or of service improvement activity.
  • The practice was not proactive in undertaking service improvement activity.

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

  • Results from the latest national GP patient survey were in line with local and national averages for questions about access. However, the practice could not clearly demonstrate that they understood their local population needs and were developing services in response to those needs.
  • The practice did not have effective systems for managing complaints and learning from them.

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

  • Leaders could not show that they had the capacity and skills to deliver high quality, sustainable care.
  • We found significant issues with the practice registration.
  • The practice did not have a clear vision, supported by a credible strategy to deliver high quality sustainable care.
  • The practice culture did not effectively support high quality sustainable care.
  • The overall governance arrangements were ineffective in helping to support patients and safeguard them from harm.
  • 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 and innovation.

These areas affected all population groups so we rated all population groups, as inadequate.

We rated the practice as Good for providing caring services because:

  • Results from the latest national GP patient survey were in line with local and national averages for questions about consultations. However, the practice was not proactive in obtaining patient feedback to support service improvement.
  • During the inspection we saw staff treating patients with kindness and respect. However, Patients were not always aware of support available to them.

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).

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.

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

22 November 2017

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 Nisha Pathak on 9 May 2017. The overall rating for the practice was good. However, for providing safe care, the practice was rated as requires improvement. The full comprehensive report on the May 2017 inspection can be found by selecting the ‘all reports’ link for Dr Nisha Pathak on our website at www.cqc.org.uk.

This inspection was a focused inspection, carried out on 22 November 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 9 May 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

  • The practice had made arrangements to ensure pathology results were being actioned in a timely manner.
  • The practice had recently started to communicate latest clinical guidance to all GPs through email communication in the absence of clinical meetings.
  • We saw evidence of health screening promotion with patients being encouraged to attend appointments for cancer screening.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

9 May 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Dr Nisha Pathak on 22 March 2016. The overall rating for the practice was requires improvement. The full comprehensive report for the March 2016 inspection can be found by selecting the ‘all reports’ link for Dr Nisha Pathak on our website at www.cqc.org.uk.

This was an announced comprehensive follow up inspection carried out on 9 May 2017 to confirm that the practice had carried out their plan to meet the required improvements in relation to the breaches in regulations that we identified in our previous inspection on 22 March 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

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

  • When we inspected the practice in March 2016 we saw there was an open and transparent approach to safety and a system in place for reporting and recording significant events. However, the learning from significant events was not consistent. At this inspection, records we looked at demonstrated that action had been taken to improve.
  • Staff we spoke with demonstrated a personal awareness of guidance such as NICE. However in the absence of clinical meetings the provider did not demonstrate how they ensured all clinical staff were up to date with latest guidance
  • Most risks to patients were generally assessed and well managed; however, some risks were not effectively managed. For example, the practice received test results in electronic as well as in paper format. We saw evidence that some blood tests and X-ray results had not been actioned timely. The provider GP had a preference for processing incoming blood tests and X-ray results in paper format and staff told us that this often caused the delays.
  • During our previous inspection in March 2016 patients said they found it difficult to make an appointment with a named GP which affected continuity of care. At this inspection, we were told that the provider GP who previously only carried out administrative duties now offered consultations three days a week. There had also been two regular locum GPs since December 2016.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. The July 2016 national GP patient survey results aligned with these views.
  • When we inspected the practice in March 2016 we saw administration staffing levels were not adequate to meet patient needs. At this inspection we were told that one additional receptionist and two apprentice reception staff had been recruited. Staff we spoke with confirmed this and told us that greater stability in regards to staffing had been achieved.
  • Information about services and how to complain was available. During our previous inspection we identified that information on how to escalate complaints that were not satisfactorily resolved was not provided in the complaints response. At this inspection we saw this information had been included in the response letter.
  • When we inspected the practice in March 2016 staff members told us that they were not involved in discussions regarding developments proposed for the practice. At this inspection staff told us there was greater communication about the future direction and developments of the practice.

We saw one area of outstanding practice:

The practice had a proactive approach to registering patients for online services. Many patients were unsure of how to register or use the online service. The practice responded by having a computer available in the reception waiting area so that it could be used to guide patients on using the system. We saw evidence that 694 patients (26% of the list size) had been registered for online services. We were told that many patients were regularly using the service.

The areas where the provider must make improvement are:

  • Introduce effective systems or processes to mitigate the risks relating to the timely management and actioning of hospital communications.

The areas where the provider should make improvement are:

  • Consider in the absence of clinical meetings how the provider could demonstrate how all clinical staff were kept up to date with latest guidance.
  • Continue to consider promotion of the bowel cancer screening programme to achieve improvement.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

23 March 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Nisha Pathak practice on 23 March 2016. Overall the practice is rated as requires improvement.

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

  • Patients said they found it difficult to make an appointment with a named GP which affected continuity of care, the practice was endeavouring to improve access and continuity of care and we saw evidence that they were recruiting an additional GP. Urgent appointments were available the same day.
  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. However the learning from significant events was not consistent.
  • 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 improvements were made as a result of complaints and concerns. However the complaint response letter did not contain information signposting patients to other agencies if they were unhappy with the response received from the practice.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice manager had a comprehensive understanding of the performance of the practice, However staff were not involved in discussions about the performance of the practice.
  • The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvement are:

  • The provider must ensure that appropriate medicines are available in case of emergencies when undertaking procedures and that prescriptions are managed and stored securely.

  • The provider must ensure that patient information is recorded appropriately to enable access to up to date accurate information to support care and treatment.

The areas where the provider should make improvement are:

  • The provider should consider communicating the practice vision and strategy with staff.

  • The provider should ensure the business continuity plan includes emergency contact numbers for staff.

  • The provider should improve access to a named GP to enable continuity of care.

  • The provider should consider the administration staffing levels to ensure there are enough staff to provide the necessary services to patients.

  • The provider should ensure learning from all significant events is documented to prevent further occurrence and improvements are made.

  • The provider should consider contacting families that have suffered a bereavement to provide support and advice.

  • The provider should consider providing information on how to escalate complaints that are not satisfactorily resolved.

  • The provider should ensure all staff have regular appraisals of their performance, and development needs identified

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice