Background to this inspection
Updated
26 March 2020
The Sangam Surgery is situated within the NHS Newham Clinical Commissioning Group (CCG). The practice provides services under a Personal Medical Services (PMS) contract from three locations to a merged list of approximately 11,162 patients. The main location is Sangam Surgery, 31a Snowshill Road, Manor Park, London E12 6BE. The two branches are located at Sangam Surgery @ Gladstone Avenue, 57 Gladstone Avenue, Manor Park, London E12 6NR; and Sangam Surgery @ Katherine Road, 511 Katherine Road, London E7 8DR.
The practice provides a full range of enhanced services including minor surgery (joint injections only) and child and travel vaccines. It is registered with the Care Quality Commission to carry on the regulated activities of maternity and midwifery services, family planning services, treatment of disease, disorder or injury, surgical procedures, and diagnostic and screening procedures.
The staff team at the practice includes three GP partners, (two female working 28 hours and 10 hours per week), two salaried GPs (one male working a total of 7 sessions per week and one female working a total of 8 sessions per week), three female Practice Nurses (working 36 hours, 21 hours and 16 hours per week respectively), two Health Care Assistants (one male working 28 hours and one female working 10 hours per week), two Practice Managers (collectively working 62 hours to across the three sites), and a team of reception and administrative staff all working full time or part time hours.
Core opening hours across the three sites are from 8am to 6.30pm every weekday. The Sangam Surgery (31a Snowshill Road) site is open from 7.00am on Mondays and closes at 7.30pm on Fridays. The practice provides an extended hours service from the Sangam Surgery site on Tuesdays and Wednesdays from 6.30pm to 8.30pm; and from the Gladstone Avenue site from 6.30pm until 8.30pm on Mondays.
GP appointments are available from 7.30am to 6.30pm on Mondays, 8.30am to 6.30pm Tuesdays to Thursdays and 8.30am to 7.00pm on Fridays. Appointments include face to face consultations, telephone consultations, online pre-bookable appointments and home visits. Urgent appointments are available for patients who need them. The practice provides extended hours GP and Health Care Assistants appointments from the Sangam Surgery main site on Thursday 6.30pm to 9.30pm; and an off-site extended hours service for GP, Nurse and Health Care Assistants appointments from a nearby GP surgery, in collaboration with the local PCN (Primary Care Network). Patients telephoning when the practice is closed are advised to call NHS 111 service, who will assess the patient and signpost to the correct service.
The Information published by Public Health England rates the level of deprivation within the practice population group as three on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. The practice area has a higher percentage than national average of people whose working status is unemployed (10% compared to 4% nationally), and a lower percentage of people over 65 years of age (9% compared to 17% nationally). Information held locally at the practice showed most patients are of South Asian origin, speaking languages such as Tamil, Hindi, Urdu, Malayalam, Bengali and Punjabi.
Updated
26 March 2020
We carried out an announced comprehensive inspection at Sangam Surgery 7 February 2020 as part of our inspection programme, to check whether the practice had addressed concerns identified at the prior inspection on 26 February 2019 when it was rated as requires improvement because:
- There were gaps in systems, practices and processes to keep people safe and safeguarded from abuse such as fire, infection control, patients test results, safety alerts and significant events identification and management, and emergency medicines and equipment.
- The way the practice was led and managed promoted the delivery of effective clinical and person-centre care but there was a lack of management oversight to maintain quality and safety.
At this inspection, we found that the provider had not satisfactorily addressed all of these areas, and some new concerns were identified.
We based our judgement of the quality of care at this service is 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 Requires improvement overall.
We rated the practice as Requires improvement for providing safe services because:
- The practice inspection history, including this inspection showed ineffective arrangements to consistently ensure safe care and treatment.
- Significant events were not always sufficiently followed up.
- There were gaps in systems, practices and processes to keep people safe and safeguarded from abuse including recruitment, and management of health and safety risks such as infection control.
- Elements of prescriptions management were ineffective such as prescriptions usage monitoring and patient’s prescriptions collections.
We rated the practice as Requires improvement for providing effective services because:
- Patients received effective clinical care and treatment, but some staff had not received appropriate induction, appraisal or training including chaperoning, fire, and cervical screening.
We rated the practice as Good for providing caring services because:
- Staff dealt with patients with kindness and respect and involved them in decisions about their care.
We rated the practice as Good for providing responsive services because:
- The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
We rated the practice as Inadequate for providing well-led services because:
- The practice track record showed inconsistent compliance with regulations and appropriate standards across a five year period, and several concerns were repeated.
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.
- Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.
- Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.
- Ensure specified information is available regarding each person employed.
- Ensure, where appropriate, persons employed are registered with the relevant professional body.
(Please see the specific details on action required at the end of this report).
The areas where the provider should make improvements are:
- Review and improve signage, such as for oxygen gas to ensure it is displayed in the correct location.
- Review and improve interim arrangements to ensure appropriate standards of premises maintenance and decoration.
- Implement arrangements to evaluate the new process for test results inbox monitoring to ensure it is embedded and sustainable.
- Review arrangements to ensure and embed indicative improvements to cancer screening uptake and childhood immunisations rates.
Details of our findings and the evidence supporting our ratings are set out in the evidence tables.
Dr Rosie Benneyworth BM BS BMedSci MRCGP