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Mrs Suhasini Nirgude Good Also known as Abbey Medical Centre

Reports


Inspection carried out on 26 June 2019

During a routine inspection

We carried out an announced comprehensive inspection at Mrs Suhasini Nirgude, more commonly known as Abbey Medical Centre in Reading, Berkshire on 26 June 2019 as part of our inspection programme.

At the last inspection in September 2018, we rated the practice as requires improvement for providing safe and well-led services because:

  • The practice’s systems, processes and practices did not always keep people safe and safeguarded from abuse.
  • Patients were at risk of harm due to medicines management procedures not always being implemented effectively by the practice. This included procedures for medicines that required refrigeration.

The full comprehensive report on the September 2018 inspection can be found by selecting the ‘all reports’ link for Mrs Suhasini Nirgude on our website at www.cqc.org.uk.

At this inspection (June 2019), we found improvements had been made, we have rated this practice as good overall and good for all population groups.

We found that:

  • The practice provided care in a way that kept patients safe and protected them from avoidable harm.

  • Patients received effective care and treatment that met their needs. This was evidenced through specific areas of improvement, clinical audits and health promotion.

  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.

  • The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.

  • The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

Whilst we found no breaches of regulations, the provider should:

  • Review the cancer care pathway, specifically the ‘Two Week Wait’ referral process.

  • Continue to identify and engage with carers to ensure their health needs are met.

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

Dr Rosie Bennyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Inspection carried out on 19/09/2018

During a routine inspection

This practice is rated as requires improvement overall. (Previous rating November 2017 – Requires Improvement)

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Requires Improvement

We carried out an announced comprehensive inspection at Mrs Suhasin Nirgude on 19 September 2018 to follow up on breaches of regulations.

At this inspection we found:

  • The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
  • The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
  • The systems to keep patients safe did not always evidence appropriate action in relation to medicines and safety alerts.
  • Staff did not always involve and treat patients with compassion, kindness, dignity and respect.
  • Patients felt they were not always involved in decisions regarding their care and treatment.
  • Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
  • There were ineffective governance structures in process for areas such as monitoring of vaccine storage and clinical staff training needs.

The areas where the provider must make improvements as they are in breach of regulations are:

  • Ensure care and treatment is provided in a safe way to patients.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

  • Continue to monitor and work on improving uptake of childhood immunisations and cervical screening.
  • Continue to identify and engage with carers to ensure their health needs are met.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Inspection carried out on 28 November 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

This practice is rated as Requires Improvement overall.

At our previous inspection in January 2016 the practice had an overall rating as good with requires improvement in safe. We carried out a desktop follow up inspection in May 2016 to ensure improvements had been made and to review if the service was meeting regulations. We found the practice had made improvements and as a result we updated the rating to good in safe.

Following the November 2017 inspection, the key questions are rated as:

  • Are services safe? – Requires improvement

  • Are services effective? – Good

  • Are services caring? – Good

  • Are services responsive? – Good

  • Are services well-led? – Inadequate

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

  • Older People – Requires improvement

  • People with long-term conditions – Requires improvement

  • Families, children and young people – Requires improvement

  • Working age people (including those recently retired and students – Requires improvement

  • People whose circumstances may make them vulnerable – Requires improvement

  • People experiencing poor mental health (including people with dementia) - Requires improvement

We carried out an announced comprehensive inspection at Mrs Suhasini Nirgude (Abbey Medical Centre) in Reading, Berkshire on 28th November 2017. We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether Abbey Medical Centre was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

At this inspection we found:

  • The practice had clear systems to manage risk so that safety incidents were less likely to happen. However these did not always operate effectively. For example in relation to infection control, security of blank prescriptions and recruitment checks.
  • When incidents did happen, the practice learned from them and improved their processes.
  • The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.
  • Staff involved and treated patients with compassion, kindness, dignity and respect. The practice was above average for its satisfaction scores on consultations with GPs and nurses in a number of areas.
  • Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
  • Most staff had received training appropriate to their roles and the population the practice served. However, we identified update training that had not been completed and the practice did not have a system for monitoring training needs.
  • We received positive feedback from external stakeholders and patients who access GP services from the practice.
  • The clinical and managerial leadership was not always supported by good governance. For example in relation to recruitment processes and checks, oversight of staff training, disabled access and practice policies.

The areas where the provider

must

make improvements are:

  • Ensure care and treatment is provided in a safe way to patients.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider

should

make improvements are:

  • Ensure systems and processes are in place to monitor and respond to safety alerts when the registered manager is not in the practice.
  • Continue to review arrangements for the identification of carers to assure themselves that they are identifying carers effectively and are able to offer them the appropriate support.
  • Ensure failsafe systems are in place to make sure results are received and reviewed for all samples sent for the cervical screening programme.
  • Ensure systems and processes are in place to facilitate access to all services and practice facilities by patients with mobility problems.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 23 May 2016. We have not revisited Mrs Suhasini Nirgude as part of this review because the practice was able to demonstrate that they were meeting the standards without the need for a visit.

During an inspection to make sure that the improvements required had been made

Letter from the Chief Inspector of General Practice

On 21 January 2016 we carried out a comprehensive inspection of Mrs Suhasini Nirgude, also known as Abbey Medical Centre, and found concerns relating to the practice not assessing the risk of staff administering immunisations without appropriate approval or the risk of staff undertaking chaperone duties without DBS checks. The phlebotomist had administered flu immunisations using a patient group direction and three members of staff had carried out chaperone duties without having undertaken a 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).

We carried out a desktop review of Mrs Suhasini Nirgude on 23 May 2016 to ensure these changes had been implemented and that the service was meeting regulations. Our previous inspection in January 2016 had found a breach of the regulation relating to good governance in assessing risk to patients. The rating for the provision of safe services has been updated to reflect our findings.

We found the practice had made significant improvements since our last inspection on 21 January 2016 and they were now meeting the regulation, relating to identifying and assessing risk and taking action to reduce risk.

Specifically the practice had:

  • Ensured the phlebotomist only administered flu immunisations with specific authority from a prescriber for each patient immunised.

  • Completed a DBS check for staff undertaking chaperone duties.

We also noted that the practice team had reviewed consultation processes. The last national patient survey showed an improvement in patient rating for GPs caring and the practice was within 6% of the local average for this question. The practice achieved 77% compared to the CCG average of 83%. The system to book interpreters had been discussed at a practice meeting and the process to make the booking had been added to the practice IT system with a link for all staff to follow.

We have changed the rating for the safe domain for this practice to reflect these improvements. The practice is now rated good for the provision of safe, effective, caring, responsive and well led services. The overall rating of good remains unchanged.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 21 January 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Mrs Suhasini Nirgude (also known as Abbey Medical Centre) on 21 January 2016. This was the second comprehensive inspection of the practice. In January 2015 when we last visited, the practice was rated as requires improvement. Specifically the practice was rated as requiring improvement for the delivery of safe, effective and well led services.

We undertook this second inspection to see whether the practice had completed the actions included in the action plan they sent us and because the practice wished for the ratings to be updated. Overall the practice is now rated as good. Specifically it is rated as good for the delivery of effective, caring, responsive and well led services. However, it remained rated as requires improvement for delivering safe services.

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

  • The practice had made improvements to ensure an open and transparent approach to safety. Effective systems were in place for reporting and recording significant events.
  • Most risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had 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 easy to understand.
  • Patients said they could make an appointment with a named GP. However, one of the salaried GPs was on extended leave and their duties were being covered by locum GPs at the time of inspection. Urgent appointments were available the same day.
  • The practice had appropriate facilities and was well equipped to treat patients and meet their needs.
  • There was a leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
  • The provider was aware of and complied with the requirements of the Duty of Candour.
  • Not all staff who undertook chaperone duties had received a Disclosure and Barring service check. The practice could not be assured that these staff did not have a criminal record or any restrictions placed upon them working with children or vulnerable adults.

The areas where the provider must make improvement are:

  • To ensure all staff who undertake chaperone duties complete a Disclosure and Barring Service (DBS) check.

  • Ensuring appropriate authorisation is in place for the phlebotomist to administer flu immunisations.

The areas where the provider should make improvement are

  • Consider the mixed responses from patients who took part in the national survey in regard to the caring nature of GPs and the nurse. Reflecting upon how this might be improved.

  • Ensuring all staff are aware of the process to book interpreters.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 14 January 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

Mrs Suhasini Nirgude manages the primary healthcare services delivered from Abbey Medical Centre in Reading, Berkshire. The medical centre is located in a listed building, built during the Victorian era. The building was refurbished to provide a GP surgery in 1985. Approximately 2,250 patients are registered at the practice. We carried out an announced comprehensive inspection of the practice on 14 January 2015. This was the first inspection of the practice since registration with the CQC.

Overall we have rated the practice as requiring improvement. There was evidence of delivery of services from a caring team of GPs and staff. Patients did not find it difficult to obtain appointments. However, some processes and procedures relating to recruitment of staff, infection control and quality monitoring must be improved.

Our key findings were as follows:

  • The significant majority of the comments on comment cards and patients we spoke with during inspection referred to the GPs and staff being caring.
  • Staff were well motivated and were supported by appraisal and a proactive registered manager.
  • The practice appointment system was flexible and we saw that appointments were available on the day of inspection and on the next day. Patients were generally pleased with access to appointments.
  • New patients were offered health checks when they registered. This enabled GPs to identify future treatment needs and ensure that health screening checks were completed. For example, scheduling annual health checks for new patients with a diagnosis of diabetes.

There were areas of practice where the provider needs to make improvements.

Importantly, the provider must:

  • Undertake and record all employment checks required by legislation.
  • Maintain accurate records relating to health and safety and risk assessments that are up to date and fit for purpose and retain management records that are easily accessible.
  • Ensure treatments carried out are accurately recorded in patient records. For example, those relating to the treatment of patients diagnosed with heart failure and depression.
  • Enhance and improve quality monitoring of processes and procedures in use at the practice. Policies and procedures employed to support delivery of care and treatment must be kept under review and audited.
  • Introduce cleaning schedules and monitoring of cleaning standards.Ensure cleaning equipment is appropriately segregated for use in clinical and non-clinical areas and that it is properly prepared for use the next day. Provide training for the lead for infection control, carry out a legionella risk assessment and act upon the findings.

  • Expand the programme of clinical audits and introduce an audit programme to identify, plan and monitor improvements to clinical care.

In addition the provider should:

  • Commission testing of portable electrical appliances and follow Health and Safety Executive (HSE) guidance relating to frequency of future similar tests.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice