Archived: Dr Hedathale Anantharaman Also known as Venkat Medical Centre

Updated 7 January 2016

Dr Hedathale Anantharaman’s practice is part of the NHS Birmingham Cross City Clinical Commissioning Group (CCG). CCGs are groups of general practices that work together to plan and design local health services in England. They do this by 'commissioning' or buying health and care services.

Dr Hedathale Anantharaman’s (also known as Venkat Medical Centre) is registered with the Care Quality Commission to provide primary medical services. The practice has a general medical service (GMS) contract with NHS England. Under the GMS contract the practice is required to provide essential services to patients who are ill and includes chronic disease management and end of life care.

The practice is located in is a converted shop within a small shopping area in the Tile Cross Area of Birmingham. Based on data available from Public Health England the area served is one of the most deprived areas in the country. The practice has a registered list size of approximately 1,350 patients.

The practice is open 8.30am to 1.00pm and 4.00pm to 6.30pm on Mondays, Tuesdays and Fridays. On Wednesday it is open 8.30am to 1.00pm and 3pm to 6.30pm. On Thursday 8.30am to 1.00pm. Extended opening hours are available on Tuesday evenings between 6.30pm and 7.30pm. When the practice is closed during the day there are arrangements with another provider to provide cover. During the out of hours period (6.30pm and 8.00am) patients receive primary medical services through an out of hours provider (BADGER).

The practice is run by a single handed GP (male). Other practice staff consisted of a practice nurse (female), a health care assistant, three reception staff and a practice manager.

The practice was previously inspected by CQC in February 2015 and placed into special measures following an inadequate rating. Following this inspection the practice had sought support from the Royal College of General Practitioners to help deliver improvements. There was also interest from another practice to go into partnership with Dr Hedathale Anantharaman.

Updated 7 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Hedathale Anantharaman’s practice on 5 October 2015 and 15 October 2015. The practice had been in special measures and we returned to re-inspect to consider whether sufficient improvements had been made. We found the practice had not made sufficient improvement and the overall rating for this practice remains inadequate.

We found the provider to be in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The regulations breached were:

Regulation 12: Safe care and treatment

Regulation 17: Good governance

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

The practice had worked with the Royal College of General Practitioners to deliver improvements to the practice including staffing levels, reviewing policies and procedures and in relation to governance arrangements. While these were noted the improvements had not gone far enough to ensure patients were kept safe. Patient care and treatment was not meeting the needs of patients at the practice and was therefore placing them at risk.

• Patients were at risk of harm and poor outcomes because they did not always receive the care they needed. We had concerns about the management of some of the most vulnerable patients.
• Patients with long term conditions were not kept under regular review. No recall systems had been put in place to monitor their conditions.
• Contemporaneous notes were not maintained in many of the patient records reviewed and evidence was found of retrospective recording of patient information. The information held could therefore not be relied upon to make accurate decisions about care and treatment.
• Staffing levels had been improved but there still remained uncertainty about the stability of the new workforce.
• There had been some improvements in the governance arrangements, for example reviews of policies and procedures, management of significant events and provision of emergency equipment. However, risks were generally not well managed. No plans were in place to manage unforeseen events that might impact on the running of the service and risks in relation to the premises.
• Patients told us that they were treated with dignity and respect and that staff were helpful and caring. Patients were particularly positive about the reception staff. However, findings from the national patient survey rated consultations with the GP lower than the CCG and national averages.
• Most patients found it easy to access the service for an appointment. The appointment system was flexible and urgent appointments were usually available on the day they were requested.
• The practice did not have a clear understanding of its performance and could not demonstrate the impact on patient outcomes from changes made or where improvements were needed.

Following this inspection the provider tendered their resignation. Had this not been the case CQC would have taken further action.

The areas identified that must be improved had the provider continued to operate were:

• The provider must implement effective systems for the management and monitoring of risks relating to the premises, staffing and unforeseen events that might impact on the running of the service.
• The provider must ensure patients receive care and treatment that is appropriate to their needs and keeps them safe. This must have regard to current best practice guidance and where additional support is required appropriate referral and signposting to the most appropriate services.
• The provider must give regard to the patient voice when delivering and improving services.

As part of the action taken, CQC liaised with the CCG and NHS England. The CCG have put in place measures to provide support, care and treatment for the patients affected by this closure.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 7 January 2016

The provider was rated as inadequate for providing safe, effective, responsive and well-led services and requires improvement for providing a caring service. The concerns which led to these ratings apply to everyone using the practice, including this population group. The practice is therefore rated as inadequate for people with long term conditions. We found continued breaches in the provision of safe services and the governance of the practice.

The practice had failed to meet the needs of those with long term conditions. Although additional staff had been employed to deliver regular reviews of patients’ needs the practice was unable to demonstrate the impact of this. National published data showed that patients with long term conditions had poorer outcomes than other practices locally and nationally. This was particularly evident for patients with diabetes. Our review of patients records raised serious concerns with the quality of care patients with long term conditions received and the impact of this on their long term health. Patients did not receive appropriate recalls so that their condition could be monitored and any action required put in place.

Updated 7 January 2016

The provider was rated as inadequate for providing safe, effective, responsive and well-led services and requires improvement for providing a caring service. The concerns which led to these ratings apply to everyone using the practice, including this population group. The practice is therefore rated as inadequate for families, children and young people. We found continued breaches in the provision of safe services and the governance of the practice.

Although additional staff had been employed to support the delivery of childhood immunisations the practice was unable to demonstrate the impact of this. National published data showed uptake of childhood immunisations were significantly lower than other practices locally and nationally for those under two. The midwife ran an antenatal clinic at the practice and the health visitor ran a clinic once a month which coincided with the baby clinic. Appointments were available outside of school hours and the premises were accessible to push chairs. No baby changing facilities were available on site. However, from our review of patient records we were not confident that patients health needs were being appropriately met.

Updated 7 January 2016

The provider was rated as inadequate for providing safe, effective, responsive and well-led services and requires improvement for providing a caring service. The concerns which led to these ratings apply to everyone using the practice, including this population group. The practice is therefore rated as inadequate for older people. We found continued breaches in the provision of safe services and the governance of the practice.

The practice offered health checks and Flu vaccinations to patients over 65 years. National data showed the uptake of flu vaccinations was comparable to other practices nationally. The practice was also accessible to those with mobility requirements and home visits were available for patients who needed them due to their health. Multi-disciplinary meetings took place to discuss those with palliative care needs. However, from our review of patient records we were not confident that patients health needs were appropriately met.

Updated 7 January 2016

The provider was rated as inadequate for providing safe, effective, responsive and well-led services and requires improvement for providing a caring service. The concerns which led to these ratings apply to everyone using the practice, including this population group. The practice is therefore rated as inadequate for working age people. We found continued breaches in the provision of safe services and the governance of the practice.

The practice had employed additional clinical staff which had enabled it to undertake NHS Health Checks and improve the uptake of cervical screening for this population group. However, the practice had not been proactive in encouraging patients to attend and were unable to tell us what proportion of patients had taken up the offer of health checks and cervical cytology . National published data showed uptake of cervical cytology was significantly lower than other practices locally and nationally. Although the practice offered extended opening hours for appointments from Monday to Friday, patients could not book appointments or order repeat prescriptions online. From our review of patient records we were not confident that patients health needs were being appropriately met.

Updated 7 January 2016

The provider was rated as inadequate for providing safe, effective, responsive and well-led services and requires improvement for providing a caring service. The concerns which led to these ratings apply to everyone using the practice, including this population group. The practice is therefore rated as inadequate for people experiencing poor mental health. We found continued breaches in the provision of safe services and the governance of the practice.

There were registers in place for patients experiencing poor mental health. However, the practice was unable to provide evidence that this needs of this patient group had been adequately met. Care planning for patients in this population group had not been undertaken. Although there was evidence of patients receiving a health check within the last 12 months we did not have confidence in the quality of the reviews undertaken.

The practice did not participate in assessments for dementia in order to identify early onset and referral to specialist care.

Updated 7 January 2016

The provider was rated as inadequate for providing safe, effective, responsive and well-led services and requires improvement for providing a caring service. The concerns which led to these ratings apply to everyone using the practice, including this population group. The practice is therefore rated as inadequate for people whose circumstances may make them vulnerable. We found continued breaches in the provision of safe services and the governance of the practice.

There were registers for patients living in vulnerable circumstances such as patients with a learning disability. The practice told us that 50% of the patients with a learning disability had received a health review in the last 12 months. However, from our review of patient records we did not have confidence in the quality of the reviews undertaken to ensure the health needs of patients in this population group were being met. There were also no systems of recall in place to ensure the patients’ health needs were kept under review.

The practice regularly worked with multi-disciplinary teams in the management of vulnerable people. Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies to report those concerns.