Background to this inspection
Updated
10 January 2020
Dr V Paramanatha’s Practice, also known as the Otterfield Medical Centre is located in West Drayton in the London Borough of Hillingdon. The practice provides a general practice service to around 7200 patients.
The practice is registered as a partnership with the Care Quality Commission (CQC) to orivide the regulated activities of: treatment of disease, disorder or injury; diagnostic and screening procedures; family planning services; surgical procedures and maternity and midwifery services. The practice has a Primary Medical Services (PMS) contract with NHS England and provides a full range of essential, additional and enhanced services including maternity services, child and adult immunisations, family planning and sexual health services.
The practice has a diverse population with a number of patients registered at the practice as being single parents, the homeless and also substance misusers. The ractice also provides care to the residents of a local nursing home. The majority of patients at the nursing home have s diagnosis of dementia. Forty-five percent of patients are under the age of 18 and 21% are over 65. Forty-six percent have a long standing health condition.
The practice has one female GP partner and three male GP partners and employs a female salaried GP, working a total of thirty sessions amongst them. The practice has a full time practice manager. The remainder of the practice team consists of two part time nurses, a part time healthcare assistant, part time pharmacist and administrative staff.
The practice currently opens five days a week from 8.00am to 6.30pm on Monday to Fridays. The practice offers extended hours on Tuesdays for pre-booked appointments between 6.30pm and 8.30pm. Consultation times are 8.30am until 12.30pm and 3.00pm until 6.00pm. when the practice is closed, the telephone answering service directs patients to contact the out of hours provider.
Updated
10 January 2020
We carried out an announced follow up inspection at Dr Paramanathan’s Practice on 14 November 2019 as part of our inspection programme.
The practice was first inspected in September 2016. We rated the practice good for providing a safe, effective, responsive and well led service and requires improvement for providing a caring service. We rated the practice good overall. At the inspection we asked the practice to look at ways to improve their low national patient survey scores for patient satisfaction.
We carried out a second inspection in March 2019. At this inspection we rated the practice good for providing a caring and responsive service and requires improvement for providing a safe, effective and well led service. The practice was rated requires improvement overall. We found that the practice had successfully addressed our previous concerns but found that many of the governance systems in regard to patient safety had not been maintained due to an extensive practice refurbishment programme. This included a failure to maintain infection control, health and safety and fire safety assessments, calibration of equipment and emergency medicines and equipment checks. We also found that the practice had not produced any plans to address poor uptake for the childhood immunisation and cervical screening programmes. There was no clinical supervision of nursing staff resulting in many of the nurses Patient Group Directions being either absent or out of date. The practice had undertaken clinical audits but none as yet were two cycle that demonstrated change in patient care. We issued a requirement notice for Regulation 17 HSCA (RA) Regulations 2014 Good Governance for the absence of PGDs and the failure to provide supervision to nursing staff.
This inspection focused on the following key questions:
Because of the assurance received from our review of information we carried forward the ratings for the following key questions:
At this inspection 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 good for all population groups.
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.
- The way the practice was led and managed promoted the delivery of high-quality, person-centre care.
Whilst we found no breaches of regulations, the provider should:
- Continue to look at ways to improve the uptake of the cervical screening and childhood immunisation programmes.
- Consider carrying out clinical audits for antibacterial prescribing items prescribed per specific therapeutic group age-sex related prescribing unit and the number of prescription items for co-amoxiclav, cephalosporins and quinolones.
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