Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection of Dr T Ganesh and Dr S Shanmugaratnam (also known as Parkview Surgery) on 11 May 2016. A breach of legal requirements was found in relation to regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
We undertook an announced focussed inspection on 21 June 2017 to check that the practice now met the legal requirements. During this inspection we found that some areas had been addressed, but we found some further areas of concern which required further investigation. Therefore, the decision was made to extend the focussed inspection to a full comprehensive inspection, and we returned to the practice for an announced visit on 5 July 2017 in order to consider the areas which had not been covered during the focussed inspection and to look in further detail into the areas of concern we had noted. This report covers our findings from the inspections on 21 June 2017 and 5 July 2017. You can read the report from the initial comprehensive inspection by selecting the ‘all reports’ link for Dr T Ganesh and Dr S Shanmugaratnam on our website at www.cqc.org.uk.
Overall the practice was rated as good following the initial comprehensive inspection on 11 May 2016. They were rated as requires improvement for providing safe services. Following the re- inspection we rated the practice as good for providing safe, caring and responsive services, and requires improvement for being effective and well led resulting in an overall rating of requires improvement.
Our key findings were as follows:
- There was an open and transparent approach to safety and a system in place for reporting and recording significant events; however, there could sometimes be a delay in incidents being formally recorded.
- The practice had systems to minimise risks to patient safety; however, those relating to the recording of patient information and the management of uncollected prescriptions needed improvement.
- Patient information was not always recorded and stored in a way that ensured that effective care could be provided, and staff had not received training in information governance.
- Data relating to the practice’s management of patients with long-term conditions was mixed, and in some areas the practice had excepted a high proportion of eligible patients. The practice also had a below average uptake amongst its patients for cancer screening and childhood immunisation programmes.
- Results from the national GP patient survey were mixed, with the practice scoring below average in some areas relating to the service provided by doctors and nurses.
- Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
- The practice had good facilities and was well equipped to treat patients and meet their needs.
- There was a documented leadership structure and staff felt supported by management; however, in some areas, such as infection prevention and control, there was a lack of clarity about who was responsible. The practice met occasionally as a team, but these meetings were not held consistently and minutes were not always taken.
- The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.
There were areas of practice where the provider needs to make improvements.
Importantly, the provider must:
- Ensure that staff are aware of their responsibilities in relation to information governance, and that a complete and contemporaneous record is kept in respect of each service user in an accessible way.
- Review, and put in place measures to improve, areas where patient outcomes are below average, in particular in relation to the proportion of patients excepted from the Quality and Outcomes Framework and the uptake of cancer screening and childhood immunisation programmes.
- Ensure that minutes of internal meetings are taken consistently.
In addition the provider should:
- Review the significant events process to ensure prompt recording.
- Review the process for checking uncollected prescriptions so it is consistently implemented across both sites.
- Consider whether it is appropriate to provide patients with a copy of their care plan.
- Review and address areas where patients have rated the service below average as part of the NHS GP Patient Survey.
- Ensure that patients are aware that translation services are available.
- Review the allocation of tasks and responsibilities within the practice to ensure that all staff are clear about their roles.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice