The Care Quality Commission
  • Doctor
  • GP practice

The Elms Medical Practice Also known as Dr Anbakan Krishnamurthy

Overall: Good read more about inspection ratings

16 Derby Street, Ormskirk, Lancashire, L39 2BY (01695) 588710

Provided and run by:
The Elms Medical Practice

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

All Inspections

22 May 2023 and 30 May 2023

During an inspection looking at part of the service

We carried out an announced focused inspection at The Elms Medical Practice on 22 and 30 May 2023. Overall, the practice is rated as good.

Safe - good

Effective – good

Caring - good

Responsive - good

Well-led – requires improvement

Following our previous inspection on 12 and 14 September 2022, the practice was rated requires improvement overall. It was rated inadequate for the key question well led and requires improvement for the safe and effective key questions, with caring and responsive rated as good. At this inspection we found improvement in most areas, however the practice was rated requires improvement in the well led key question.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for The Elms Medical Practice on our website at www.cqc.org.uk

Why we carried out this inspection

We carried out this inspection to follow up a breach of Regulation 12(1) Safe care and treatment and Regulation 17(1) Good governance from the previous inspection.

How we carried out the inspection/review

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included;

  • Conducting staff interviews using video conferencing.
  • Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
  • Reviewing patient records to identify issues and clarify actions taken by the provider.
  • Requesting evidence from the provider.
  • A short site visit.

Our findings

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 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.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • Patients could access care and treatment in a timely way.
  • Quality assurance at the practice was ad-hoc and reactive. There were issues with governance processes and oversight of how well the practice was performing.

We found a breach of regulation. The provider must:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

We also found areas where the provider should take action:

  • Continue to repeat regular audits to provide ongoing assurance of the competency of those staff employed in advanced clinical roles.
  • Improve cervical screening uptake data.
  • Continue to take action to improve compliance with best practice guidance on the management of patients prescribed high risk medications subject to safety alerts.
  • Continue to take action to improve compliance with best practice guidance around the diagnosis and management of long-term conditions. Including the review of patients prescribed steroid medication for acute exacerbation of asthma.
  • Improve the quality of documentation relating to medicines reviews to include context and actions completed.
  • Continue to review and improve their infection prevention and control policy.
  • Secure the clinical waste bin.

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

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services

14 September 2022

During an inspection looking at part of the service

We carried out an announced focused inspection at The Elms Medical Practice on 12 & 14 September 2022. Overall, the practice is rated as requires improvement.

Safe - requires improvement

Effective - requires improvement

Caring - good

Responsive - good

Well-led - inadequate

Following our previous inspection on 18 May 2021, the practice was rated good overall and for all key questions with the exception of the safe key question, which was rated requires improvement.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for The Elms Medical Practice on our website at www.cqc.org.uk

Why we carried out this inspection

We carried out this inspection to follow up a breach of regulation 12(1) (safe care and treatment) from the previous inspection.

Due to concerns at the start of the inspection, the decision was made to increase the scope of the inspection to a fully comprehensive inspection.

How we carried out the inspection/review

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included;

  • Conducting staff interviews using video conferencing.
  • Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
  • Reviewing patient records to identify issues and clarify actions taken by the provider.
  • Requesting evidence from the provider.
  • A short site visit.

Our findings

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 found that:

  • The practice could not always demonstrate that they managed clinical or non-clinical risk appropriately or had the systems in place to support them to do this. We found that patients were not always monitored appropriately and that safety alerts were not always acted upon. We also found that environmental risk was not always considered or addressed.
  • We found that the practice was not confident of coding within their clinical system and had informal plans to address this. We found that their management of patients with long-term conditions was not always in line with good practice or guidance.
  • Patient satisfaction in relation to how patients felt treated and access to care and treatment was in line with local and national averages.
  • Governance arrangements at the practice were ineffective and not fully embedded and they had failed to act on previous concerns that had been raised at inspection. We found that leaders could not demonstrate that they communicated effectively or that they formed a cohesive team with a current and accurate knowledge of the challenges that faced them.

We found breaches of regulations. The provider must:

  • 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.

We also found areas where the provider should take action:

  • Formalise and action your plans to address coding concerns to ensure that all records are accurate.
  • Improve cervical screening uptake data.

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

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services

18 May 2021

During an inspection looking at part of the service

We carried out an announced focused inspection at The Elms Medical Practice on 18 May 2021. Overall, the practice is rated as good.

The key question ratings are as follows:

Safe - Requires Improvement

Effective – Good

Caring – Carried forward from the last inspection in February 2019.

Responsive - Carried forward from the last inspection in February 2019.

Well-led – Good

Following our previous inspection on 12 February 2019 (published 14 March 2019), the practice was rated requires improvement overall and for the safe, effective and well-led key questions. All population groups were also rated requires improvement. The caring and responsive key questions were rated good. Since this inspection, the provider has changed (the previous single handed provider GP has taken on a GP partner). The new provider had inherited the previous ratings.

The full reports for previous inspections can be found by selecting the ‘read previous reports’ link for The Elms Surgery on our website at www.cqc.org.uk

Why we carried out this inspection

This inspection was a focused inspection to follow up on:

  • Ratings carried forward from the previous inspection for the safe, effective and well-led key questions.
  • To follow up breaches of regulations for Regulation 12 (safe care and treatment); Regulation 17 (good governance) and Regulation 19 (fit and proper persons employed).
  • Progress with ‘shoulds’ identified in previous inspection.

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

  • Conducting staff interviews using video conferencing and telephone calls
  • Completing clinical searches on the practice’s patient records system and discussing findings with the provider
  • Reviewing patient records to identify issues and clarify actions taken by the provider
  • Requesting evidence from the provider
  • A short site visit
  • Further communications for clarification.

Our findings

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 good overall and for providing an effective and well-led services. All population groups were also rated good. The safe key question is rated requires improvement.

We found that:

  • The practice demonstrated improvements in relation to the safe key question. Specifically, in relation to recruitment records, revised procedures for managing the analysis of skin samples following minor surgery, ensuring emergency medicines and medical equipment were checked and fit for use, recording and managing significant events and the authorisation and management of PGD/PSDs. However, during this inspection we identified further concerns in relation to the management of risk. For example, in relation to vulnerable adult registers and safeguarding alerts, the management of safety alerts and the monitoring of people prescribed high-risk drugs.
  • The practice showed us that improvements had been made in relation to the effective key question. Specifically, in relation to staff training and development and the recording of patient consent. Gaps remained in relation to the development of care plans for some patients and staff appraisals and supervision.
  • Improvements had also been made by the practice in relation to the well-led key question. Since our last inspection, there had been a change in the registration of the practice from a single-handed provider to a partnership. A new practice manager had also recently been employed at the practice. Staff provided positive feedback about the culture in the practice and confirmed leaders were approachable and supportive. Business development and Covid-19 recovery plans had been developed.
  • The practice had adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. Patients could access care and treatment in a timely way.

We found a breach of regulations. The provider must:

  • Ensure that care and treatment is provided a safe way to patients.

The provider should also:

  • Implement the planned business recovery action plan to address any clinical backlog including for example cervical cancer screening and patient annual health check reviews.
  • Ensure vulnerable patient registers are updated and alerts placed on patient records.
  • Expand the programme of quality improvement activity and clinical audit.
  • Arrange for the external IPC audit to be updated.
  • Ensure annual appraisals are provided to staff.
  • Maintain effective supervision and oversight of nurse prescribers
  • Continue to expand the offer and development of personalised care plans for patients.
  • Update the practice safety alerts records with the results of any actions taken.

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