Archived: Dr N Niranjan's Practice

Dr Niranjan’s Practice has been inspected six times and has been in breach of the Health and Social Care Act Regulation 2014 at five of the inspections, since registration on 4 March 2013.

Our initial inspection was carried out on 2 January 2014 where we found the practice was meeting four of the five areas inspected of the required standards of care and treatment. The practice did not meet the standard for requirements relating to workers, at a further inspection in May 2014 this area had met the standards.

At an inspection on 11 and 18 May 2015, the practice was rated as requires improvement overall. We found the practice needed to improve in the safe, effective, and well led key questions. The practice was found in breach of Regulations 12 and 17 of the Health and Social Care Act Regulations 2014.

At an inspection on 16 January 2017, the practice was rated requires improvement overall. We found the practice needed to improve in safe, effective, caring, and well-led care. The practice was found in breach of Regulations 12 and 17 of the Health and Social Care Act Regulations 2014.

At an inspection on the 11 October 2017, the practice was rated good overall but required improvements in safe care and treatment. The practice was found in breach of Regulation 12 of the Health and Social Care Act Regulations 2014.

At an inspection on the 2 May 2018, the practice was rated good overall and there were no breaches of regulation found.

We carried out this inspection October 2020 in response to concerns raised directly with CQC. This related to safety systems and processes and governance of the practice. In response to these concerns, we initially carried out a remote clinical records review on 7 September 2020, followed by an announced comprehensive inspection on 26 October 2020. This report covers our findings in relation to both the review and inspection.

We found the quality of services provided at the practice had deteriorated. 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 adequate systems and processes to keep patients safe.
• Recruitment checks were not carried out in line with guidance.
• The systems to monitor and manage risk to patient safety were inadequate.
• Staff did not have the information they needed to deliver safe care and treatment.
• Emergency procedures in the practice were inadequate and placed staff and patients at risk of harm.
• The practice did not have appropriate systems in place for the safe management of medicines.
• The practice did not learn and make 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.
• The practice was unable to show that staff had the skills, knowledge and experience to carry out their roles.
• The practice was unable to show that it always obtained consent to care and treatment.
• Some performance data was significantly below local and national averages.

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

• There were mixed reviews from patients regarding how they were treated and patients were not always involved in decisions about their care.
• Patients could not access care and treatment in a timely way.
• The practice did not take action to improve patient feedback.

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

• The service did not meet patients needs.
• Patients could not access care in a timely way.

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.
• There was no clear vision or a credible strategy to provide high quality care.
• The practice culture did not effectively support high quality sustainable care.
• The overall governance arrangements were inadequate.
• The practice did not have clear and effective processes for managing risks, issues and performance.
• The practice did not 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.

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).

On 27 October 2020, Dr Niranjan’s Practice was issued with urgent notice to suspend their registration as a service provider in respect of regulated activities. This notice was served under Section 31 of the the Health and Social Care Act 2008. This notice of urgent suspension of their registration was given because we believe that a person will or may be exposed to the risk of harm if we do not take this action. As of 27 October 2020, Dr Niranjan’s Practice handed back their contract to the commissoners and are therefore no longer responsible for providing services to the registered patients.

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