6 May 2015
During a routine inspection
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Dr Suntharalingam on 6 May 2015. Overall the practice is rated as inadequate.
Specifically, we found the practice to require improvement for providing caring services. It was inadequate for providing safe, effective, responsive and well led service and therefore inadequate for providing services to the older people, people with long-term conditions, families, children and young people, working age people (including those recently retired and students), people living in vulnerable circumstances, and people experiencing poor mental health (including people with dementia).
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 appropriate recruitment checks on staff had not been undertaken prior to their employment and infection prevention control risks had not been identified and there were no records maintained to demonstrate cleaning had been conducted.
- Staff had not received training and development and there were no systems to assess staff competence to conduct their clinical roles and responsibilities.
- There were insufficient systems and processes in place to ensure medicines were in date and suitable for use.
- The lead GP and staff were not clear about reporting incidents, near misses and concerns. Where significant incidents had occurred such as the theft of the GP’s medical bag containing medicines from an insecure vehicle. It had not been reported to the police or lessons learnt to mitigate the potential of the incident happening again. There were no records of investigations being conducted or learning and communication with staff.
- There was insufficient assurance to demonstrate people received effective care and treatment. For example, there was an absence of systems in place to ensure patients’ clinical needs were reviewed in a timely and appropriately manner such as in response to changes in medication and reviewing patients with one or more long term condition. We found patients had new medications added to their prescriptions without prior discussion with them.
- Patients were positive about their interactions with staff and said they were treated with compassion and dignity.
- Urgent appointments were usually available on the day they were requested. However patients said that they sometimes had to wait a long time for non-urgent appointments and that the nurse’s appointments were often booked or cancelled at short notice.
- The practice had a clear leadership structure, but insufficient awareness and an absence of formal governance arrangements to ensure the safe and effective delivery of care. For example, staff told us no records of meetings were maintained or available to us when we asked the practice manager. The GP failed to take responsibility for ensuring the safe and appropriate appointment and supervision of clinical staff.
The areas where the provider must make improvements are:
- Ensure systems and processes are in place to ensure a clean and safe environment for patients.
- Ensure recruitment arrangements include all necessary employment checks for all staff.
- Put systems in place to ensure all clinicians are kept up to date with national guidance and guidelines.
- Ensure suitable arrangements are in place to ensure equipment is safe and suitable for use
- Ensure there are formal governance arrangements in place including systems for assessing and monitoring risks and the quality of the service provision e.g. medicines are in date and suitable for use.
- Ensure staff have appropriate policies and guidance to carry out their roles in a safe and effective manner which are reflective of the requirements of the practice.
- Ensure there is leadership capacity to deliver all improvements
The areas where the provider should make improvement are:
- Staff should be risk assessed to ascertain if a criminal records check through the Disclosure and Barring Service are required.
- Legionella risk assessments should be undertaken
- The practice should maintain accurate records for meetings.
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.
I have also served a notice on the provider placing conditions on their registration, which they must comply with. The conditions are that the practice must close their patient register, therefore, new patients are not permitted to register with the practice for a period of six months.