The Care Quality Commission
  • Doctor
  • GP practice

Archived: Dr Swaminathan Ravi

Overall: Inadequate read more about inspection ratings

2a Cope Street, Barnsley, South Yorkshire, S70 4HY (01226) 246829

Provided and run by:
Dr Swaminathan Ravi

Important: The provider of this service changed. See new profile

All Inspections

1 July 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 1 July 2016 at Dr Swaminathan Ravi at Cope Street Surgery. The practice was placed in special measures due to non-compliance with the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 following our previous inspection in November 2015.

During this inspection, we found the practice had made some improvements since our last inspection and most of the issues raised had been rectified. However fresh concerns and breaches of regulations were noted.

The provider is in breach of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 12 Safe Care and Treatment, Regulation 17 Good Governance and Regulation 18 Staffing.

We found the practice to be inadequate in areas relating to safe, effective and well led. The practice was rated as requires improvement for areas related to being responsive and was rated as good at caring for patients.

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

  • During this inspection we found the practice had reviewed some of their systems to ensure risks to patients were addressed and managed. For example a fire risk assessment had been completed along with Control of Substances Hazardous to Health (COSHH) and Legionella risk assessments. However we found shortfalls in other areas. For example, the safeguarding policy had been updated but did not contain details of local social services and clinical commissioning team safeguarding contacts.
  • Staff were not clear about reporting incidents, near misses and concerns and there was no evidence of learning and communication with staff.
  • Patient outcomes were hard to identify as little or no reference was made to audits or quality improvement and there was no evidence that the practice was comparing its performance to others; either locally or nationally.
  • Patients were positive about their interactions with staff and said they were treated with compassion and dignity.
  • The practice had no clear leadership structure, insufficient leadership capacity and limited formal governance arrangements.

The areas where the provider must make improvements are:

  • Introduce robust processes for reporting, recording, acting on and monitoring significant events, incidents and near misses.
  • To review the findings of the infection prevention and control audit to reflect a true picture of the practice and act in accord with the findings.
  • Ensure the guidance from NHS Protect security of prescription forms is implemented and systems established.
  • Ensure paper and electronic records are held securely meeting the requirements of the Data Protection Act 1998.
  • Ensure that all staff performing chaperone duties have received a disclosure and barring service (DBS) check. DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable.
  • Ensure processes are in place for the safe management of returned or unwanted medicines.
  • Ensure patient outcomes are reviewed and recommendations made to contribute to a programme of continuous quality improvement.
  • To review the staff appraisal process so that all staff have regular appraisals and performance reviews.

The areas where the provider should make improvement are:

  • Ensure a GP lone worker risk assessment is completed. The GP was the sole provider for clinical care and took the lead for everything. There was no risk assessment undertaken for the GP being a lone clinical worker nor clear instructions to follow if they were unable to work .

This service was placed in special measures on 30 November 2015. Insufficient improvements have been made such that there remains a rating of inadequate for safe, effective and well led. 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 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 six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

30 November 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Swaminathan Ravi’s practice (known as Cope Street Surgery) on 30 November 2015. Overall the practice is rated as inadequate. However, we recognise there have been considerable efforts made maintaining patient satisfaction in recent months.

• Staff were clear about reporting incidents, near misses and concerns; however there was no evidence of learning from them and communicating this with staff.

• Arrangements to safeguard adults and children from abuse were not adequate in relation to staff training, clarity of lead roles and identification of patients considered to be at risk. Arrangements to provide chaperones for patients were in place but staff had not received training.

• Risks to patients and others were high as systems to assess, monitor and mitigate risks, such as regular fire drills or testing of alarm points were not carried out.

• There were procedures for the management of medicines in the practice. However, there were some shortfalls in the processes to ensure the safe storage of vaccines and procurement of emergency drugs.

• There were no formal induction processes for new or locum staff.

• Staff had not received role specific training to improve and extend services for patients. They had not received recent training in safeguarding adults and children and infection prevention and control.

• Non-clinical staff received regular supervision and support but there was no process for practice nurses to receive clinical supervision.

• Data showed patient outcomes were low for the locality and there was no evidence audits used to improve patient outcomes.

• Patients were positive about their interactions with staff and said they were treated with compassion and dignity.

• The practice had listened to patients and had made improvements to the appointment system. Patients said they were satisfied with the appointment system and told us urgent appointments were usually available on the day they were requested.

• Information about how to complain was available and easy to understand. However, there was no documented evidence that learning from complaints was shared with staff and other stakeholders.

• The practice had no clear leadership structure.

• The practice did not have a written set of aims and objectives.

There was no maintenance programme for the building seen.

• The practice acted on feedback from patients and had focused on improving the patient experience of the services provided. However, there were limited systems in place to monitor the quality of services provided.

• Records were not always adequately maintained to ensure effective management of the practice. For example patient care records, training and recruitment records and records of risk assessments undertaken.

The provider must make improvements in the following areas:

  • Ensure systems and processes are in place to assess, monitor and mitigate risks to patients and others health and safety. For example, regular checks of fire alarm points and fire drills, legionella and COSHH.

  • Ensure the cold chain processes are followed for safe storage of vaccines.

  • Ensure the emergency drugs are procured correctly and available for use.

  • Ensure induction processes are in place for new and locum staff.

  • Ensure staff receive training relevant to their role such as, management of long term conditions, ear syringing, safeguarding vulnerable adults and children and infection prevention and control.

  • Ensure staff recieve information governance training.

  • Ensure systems are in place to assess monitor and improve the quality and safety of the services provided.

The areas where the provider should make improvement are:

  • All staff who chaperone should undertake the specific training to do so.

  • Those patients considered to be at risk should be identified through the use of risk registers and system alerts.

  • Review the process to check practice nurse registration with the Nursing Midwifery Council (NMC) is current.

  • Review the provision of a maintenance programme for the building.

  • Review the length of GP emergency appointments.

I am placing this practice in special measures. Practices 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 practice 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 vary the provider’s registration to remove this location or cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice