The Care Quality Commission
  • Doctor
  • GP practice

Archived: Dr Hedathale Anantharaman Also known as Venkat Medical Centre

Overall: Inadequate read more about inspection ratings

263 Tile Cross Road, Tile Cross, Birmingham, West Midlands, B33 0NA (0121) 779 7333

Provided and run by:
Dr Hedathale Anantharaman

All Inspections

5 October 2015 and 15 October 2015

During a routine inspection

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

3 February 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Hedathale Anantharaman’s practice on 3 February 2015. Overall the practice is rated as inadequate.

Specifically, we found the practice inadequate for providing safe and effective services, being responsive and well led. It was also inadequate for providing services for the six population groups we reviewed. Improvements were also required for providing caring services.

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 there was insufficient staffing for the smooth running of the service and to fully meet the needs of patients. The risks of unforeseen circumstances which might impact on the running of the service had not been identified or appropriately managed.
  • Staff were not clear about reporting incidents, near misses and concerns and there was little evidence of learning from these.
  • There was insufficient assurance to demonstrate people received effective care and treatment. Multidisciplinary working took place but care and treatment for those with long term conditions was largely opportunistic. Audits were not used effectively to drive service improvement.
  • Patient feedback indicated that patients were satisfied with the service received and that staff treated them with respect and dignity. However arrangements seen did not fully support this.
  • Patients were satisfied that they could get appointments on the same day. However they were not able to book in advance or on line if they wanted to which made it difficult for those with working or other commitments.
  • The practice had no clear leadership structure, insufficient leadership capacity and limited formal governance arrangements.

The areas where the provider must make improvements are:

  • Implement effective systems for the management of risks to patients and others against inappropriate or unsafe care. This should include arrangements for managing safety alerts, unforeseen events, equipment, premises, fire safety, staffing and recruitment.
  • Implement robust governance arrangements to ensure appropriate systems are in place for assessing and monitoring the quality of services provided.
  • Regard should be made to information available and patient views in delivering services and driving improvements.
  • Review staffing levels to ensure there are sufficient staff for the smooth running of the practice and the provision of safe services.
  • Ensure that staff have appropriate support and the necessary training to enable them to deliver the care and work they perform.
  • Ensure services are planned and delivered to meet the needs of and support the welfare and safety of service users.

The areas where the provider should make improvement are:

  • Ensure audits complete their full audit cycle in order to demonstrate improvements made to practice.
  • Review systems and arrangements for ensuring patients’ privacy and dignity and implement changes needed to ensure it is not compromised.
  • Review systems for identifying and supporting patients who need emotional and other support in relation to their health and wellbeing and caring responsibilities.
  • Implement systems to ensure patients who may have difficulty accessing the service (such as language and other barriers) are able to do so.
  • Review and implement systems to ensure the patient voice is heard when developing and delivering services.
  • Ensure consistency in the information relating to the complaints processes to ensure they are managed in line with patient expectations.
  • Review how the practice nurse provision is deployed to ensure there is choice to patients requiring access to immunisation and cytology screening services.

On the basis of the ratings given to this practice at this inspection, I am placing the provider into special measures. This will be for a period of six months. We will inspect the practice again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

6 March 2014

During a routine inspection

On the day of our inspection we spoke with five patients, one doctor and three members of staff.

All patients we spoke with were satisfied with the appointment system and had all been given an appointment on the same day. They all said they found it easy to obtain appointments and could always get through to the practice by telephone without difficulty. One patient said: 'This is one of the things I particularly like about this practice.'

We saw that patients' views and experiences were taken into account in the way the service was provided and that they were treated with dignity and respect. When patients received care or treatment they were asked for their consent and their wishes were listened to. One patient said: 'The doctor is very caring and always carefully listens.'

The practice is located in a single storey building. It is fully accessible for patients with disabilities. There was ample parking outside of the practice which is shared with other local businesses.

We found the practice to be clean and well organised. Processes were in place to minimise the risk of infection. There were also processes in place for monitoring the quality of service provision. There was an established system for regularly obtaining opinions from patients about the standard of the service they received.