All inspections: Plashet Harmony Practice

We carried out a review of the data available to us about Plashet Harmony Practice on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.

This could change at any time if we receive new information. We will continue to monitor data about this service.

If you have concerns about Plashet Harmony Practice, you can give feedback on this service.

We carried out an announced inspection at Dr Sathyajith’s Practice on 30 November and 02 December 2022. Overall, the practice is rated as good.

We previously carried out announced inspections at Dr Sathyajith’s Practice on 09 March 2022 and 28 April 2021. In 2022, the practice was rated as requires improvement overall, and requires improvement for the key key questions for safe, effective and well-led. At our inspection in 2021, the practice was rated as requires improvement overall, was rated as inadequate in the key question for well-led; requires improvement in the key questions for safe and effective and good for the key questions for caring and responsive.

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

Why we carried out this inspection

This inspection was a comprehensive inspection to follow-up on breaches of regulation from our inspection on 09 March 2022 and to review ratings for the key questions:

How we carried out the inspection

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.
Information from the provider, patients, the public and other organisations.

We found the provider had made sufficient improvements and have rated the practice as good in providing safe services regarding:

Clear systems and processes to keep patients safe.
The provider had reliable systems and processes to keep patients safeguarded from abuse.
A safe system in place to monitor and manage recruitment, including disclosure and barring checks (DBS).
Appropriate systems in place to safely manage high-risk medicines and medicines that require additional monitoring.
A safe effective system in place to manage patient safety alerts.
Reliable systems to manage the practice premises safely.
A patient recall system to follow-up all patients as required, including for cervical screening and medicines management.

We found the provider had made sufficient improvements and have rated the practice as good in providing effective services regarding:

The practice system for new staff induction. We found all staff files had been updated with completed induction records.

The management and completion of regular training for all staff. We found all staff had completed regular training at the appropriate levels.

Quality improvement activity had significantly improved and we saw the provider had 11 examples of clinical audits they had completed.

Staff had received training regarding the practice’s referral systems and raised significant events for previous concerns regarding this system.

Quality improvement across several childhood immunisations achievement indicators.

Cervical screening achievement rate remained below the national screening target rate although the previous deterioration in the achievement rate had stabilised.

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

There was evidence that staff treated patients with kindness, care and compassion.
There was evidence the provider had taken action to improve patient experience at the practice in response to feedback from the patient participation group.
There was evidence to show how the practice carried out patient surveys and patient feedback exercises.

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

Waiting times, delays and cancellations were minimal and managed appropriately.
Patients reported that the appointment system was easy to use.
Referrals and transfers to other services were undertaken in a timely way. For example, staff proactively followed up that patients had been seen by the secondary care team.
Patient satisfaction response scores in the national GP Patient Survey were in line with local and national averages.

We found the provider had made sufficient improvements and have rated the practice as good in providing well-led services regarding:

Leaders could demonstrate that they had the capacity and skills to deliver high quality, sustainable care.
The practice culture effectively supported high quality sustainable care.
The overall governance arrangements were effective.
The practice had clear and effective processes for managing risks, issues and performance.
The practice acted on appropriate and accurate information.
We saw evidence of systems and processes for learning, continuous improvement and innovation.

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

Continue to drive improvement regarding childhood immunisation achievement rates.
Continue to drive improvement regarding cervical screening achievement rates.

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

We carried out an announced inspection at Dr Sathyajith's Practice on 9 March 2022. Overall, the practice is rated as requires improvement.

Ratings for each key question:

Safe – Requires improvement

Effective - Requires improvement

Well-led – Requires improvement

Following our previous inspection on 28 April 2021, the practice was rated requires improvement overall and good for the key questions caring, and responsive. The practice was rated inadequate for well-led and issued a notice of proposal to cancel the provider’s registration for breaches of Regulation 12 Safe care and treatment, Regulation 17 Good governance, Regulation 18 Staffing and Regulation 19 Fit and proper persons employed.

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

Why we carried out this inspection

This inspection was a focused inspection to follow up on breaches of Regulation 12 Safe care and treatment, Regulation 17 Good governance, Regulation 18 Staffing and Regulation 19 Fit and proper persons employed. At the previous inspection we found:

The delivery of high-quality care was not assured by the leadership or governance.
Leaders could not demonstrate that they had the capacity and skills to deliver high quality sustainable care.
Many of the issues identified at this inspection had been raised as issues at the previous CQC inspection in November 2019.
There were weaknesses in the overall governance arrangements, for example in relation to oversight of recruitment checks and training.

We also followed up on areas we identified the practice should improve at the last inspection. Specifically:

Ensure non disposable privacy curtains are cleaned in accordance with the service's Infection Prevention and Control guidelines.
Ensure actions identified from risk assessments are completed and documented as being completed.
Ensure learning from significant events are completed.
Continue to take action to improve uptake of childhood immunisations and cervical screening.

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
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

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 Requires Improvement overall

We found that:

The practice had addressed most of the concerns raised during the last inspection.
The practice had introduced systems and processes to ensure effective overall governance regarding policies and procedures, recruitment and induction and staff training.
Staff dealt with patients with kindness and respect and involved them in decisions about their care.
The practice 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.
The way the practice was led and managed promoted the delivery of person-centred care.
Patients received care and treatment that met their needs, however gaps were identified in patient monitoring regarding patients with long term conditions and those taking high risk medicines.
Gaps were identified in safeguarding systems.

We found a breach of regulations. The provider must:

Ensure care and treatment is provided in a safe way to patients.
Implement robust systems and processes for the safe handling of requests for repeat medicines and ensure the required monitoring is carried out prior to prescribing.
Ensure that systems and processes are in place to keep people safe and safeguarded from abuse.

We also found the provider should:

Consider a clear vision and credible strategy to provide high quality, sustainable care and monitor progress against delivery of the strategy.
Continue to take action to improve uptake of childhood immunisations and cervical screening.

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

We are taking this service out of special measures. This recognises the improvements that have been made to the quality of care provided by this service.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced inspection at Dr Sathyajith's Practice on 28 April 2021 Overall, the service is rated as Requires Improvement.

Ratings for each key question:

Safe - Requires improvement

Effective - Requires improvement

Caring - Good

Responsive - Good

Well-led - Inadequate

Following our previous inspection on 7 November 2019 when the service was registered as East Ham Memorial Hospital the service was rated Inadequate overall and good for the key questions caring, and responsive. The service was rated inadequate for safe and well-led and requires improvement for effective and issued warning notices for Regulation 12 Safe care and treatment, Regulation 17 Good governance, Regulation 18 Staffing and Regulation 19 Fit and proper persons employed. Following our previous inspection, the East Ham Memorial Hospital partnership deregistered with CQC. One of the partners, Dr Sathyajith, became the provider of the service.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for East Ham Memorial Hospital on our website at www.cqc.org.uk

Why we carried out this inspection

This inspection was a comprehensive inspection to follow up on breaches of Regulation 12 Safe care and treatment and Regulation 17 Good governance, Regulation 18 Staffing and Regulation 19 Fit and proper persons employed. At the previous inspection we found:

There was no proper and safe management of medicines. In particular: Patient Group Directions.
Staff not able to use emergency equipment.
Recording of consent and chaperones inconsistent.
Health and safety risk assessment not practice-specific.
Fire risk assessment overdue.
Practice policies overdue for review or missing information.
Ineffective governance arrangements.
Lack of awareness and oversight of potential risks.
Failure to address concerns identified at the previous CQC inspection
Lack of monitoring and oversight of staff training, staff appraisals and induction checks and processes.
Gaps in recruitment checks, including DBS checks, references, checks of professional registration and staff immunity status.

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
Completing clinical searches on the service'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

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 service as Requires improvement and Requires improvement for all population groups.

We found that:

The delivery of high-quality care was not assured by the leadership or governance.
Leaders could not demonstrate that they had the capacity and skills to deliver high quality sustainable care.
Many of the issues identified at this inspection had been raised as issues at the previous CQC inspection in November 2019.
There were weaknesses in the overall governance arrangements, for example in relation to oversight of recruitment checks and training.
The service 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 four breaches of regulation. 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
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.

Please see the specific details on action required at the end of this report.

The areas where the provider should make improvements are:

Ensure non disposable privacy curtains are cleaned in accordance with the service's Infection Prevention and Control guidelines.
Ensure actions identified from risk assessments are completed and documented as being completed.
Ensure learning from significant events are completed.
Continue to take action to improve uptake of childhood immunisations and cervical screening.

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

The previous service, of which the current provider was a senior member, was placed in special measures in December 2019. Insufficient improvements have been made, such that there remains a rating of inadequate for well led. Therefore we are taking action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Plashet Harmony Practice

All Inspections

6 July 2023

During a monthly review of our data

30 November and 02 December 2022

During a routine inspection

09 March 2022

During an inspection looking at part of the service

28 April 2021

During a routine inspection