Dr K Anantha-Reddy's Practice Also known as Yeading Court Surgery

Updated 19 July 2023

Dr K Anantha-Reddy’s Practice, also known as Yeading Court Surgery, is located in Hillingdon at:

1-2 Yeading Court

Masefield Lane

Hayes

Middlesex

UB4 9AJ

The provider is registered with CQC to deliver the Regulated Activities: diagnostic and screening procedures; maternity and midwifery services; and treatment of disease, disorder or injury.

The practice is situated within the London Borough of Hillingdon and is part of the North West London Integrated Care System (ICS). The practice delivers General Medical Services (GMS) to a patient population of about 5,400. This is part of a contract held with NHS England.

Information published by Office for Health Improvement and Disparities shows that deprivation within the practice population group is in the fourth lowest decile (out of 10). The lower the decile, the more deprived the practice population is relative to others.

According to the latest data available, the ethnic make-up of the practice is 40% White, 35% Asian, 16% Black, 5% Mixed and 4% Other ethnic groups.

The practice is led by two GP partners who are supported by a nurse practitioner, a phlebotomist, a practice manager and a team of administrative and reception staff. The practice utilises the services of a Primary Care Network (PCN) clinical pharmacist, PCN pharmacy technician and PCN podiatrist.

The practice is open between 8am to 6.30pm Monday to Friday. The practice offers a range of appointment types including book on the day, telephone consultations and advance appointments.

Extended access is provided locally at a hub location where late evening and weekend appointments are available.

Updated 19 July 2023

We carried out an announced focused inspection at Dr K Anantha-Reddy’s Practice on 19 October 2022, with the remote clinical review on 17 October 2022. Overall, the practice is rated as requires improvement.

Safe – Inadequate

Effective – Requires improvement

Caring – Not inspected, rating of good carried forward from previous inspection

Responsive – Not inspected, rating of good carried forward from previous inspection

Well-led – Requires improvement

Following our previous inspection on 21 November 2019, the practice was rated good overall and for the safe, caring, responsive and well-led key questions and requires improvement for the effective key question.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Dr K Anantha-Reddy’s practice on our website at www.cqc.org.uk

Why we carried out this inspection

We carried out this inspection to follow up breaches of regulation from a previous inspection and in response to risk identified.

This was a focused inspection focusing on whether:

• Care and treatment was being provided in a safe way to patients.
• There were effective systems and processes in place to ensure good governance in accordance with the fundamental standards of care.

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 and
• information from the provider, patients, the public and other organisations.

We have rated this practice as Requires improvement overall.

We have rated this practice as Inadequate for providing safe services because:

• We found issues with the monitoring of patients prescribed some high risk medicines.
• We found that the system for managing and acting on Medicines and Healthcare Products Regulatory Agency (MHRA) alerts was not always effective.
• We identified issues with the monitoring and management of over-usage of medicines.
• We identified some gaps in relation to staff member immunisations. We found that the staff immunisation programme was not implemented as per UK Health Security Agency guidance.
• We found gaps in staff training records in relation to safeguarding, infection prevention and control and information governance training. We did not see evidence that the practice nurse had completed safeguarding adults and children training. We found that non-clinical staff had not completed safeguarding children training to the appropriate level.
• We found that the system for the storage of vaccinations was not consistent with Public Health England guidance.
• We found that the practice did not have an effective system for the monitoring of fridge temperatures.
• We found that the process for monitoring emergency medicines was not sufficient as we found out of date medicines and supplies.
• We identified that the system for monitoring two week wait referrals was not effective.

We have rated this practice as Requires improvement for providing effective services because:

• We identified issues with the monitoring and management of long-term conditions, in particular in relation to patients with chronic kidney disease (CKD) stages four or five, patients with hypothyroidism, patients with acute exacerbation of asthma and potential missed diagnosis of diabetes.
• The practice had worked towards providing effective care for patients during the Covid-19 pandemic.
• The practice had not met the minimum 90% uptake for all of the childhood immunisation uptake indicators. The practice had not me the WHO based national target of 95% (the recommended standard for achieving herd immunity).
• The practice uptake for cervical screening was below the 80% coverage target for the national screening programme.
• The practice was working towards improving uptake and reducing barriers to childhood immunisations and cervical screening.

We have rated this practice as Requires improvement for providing well-led services because:

• The practice had a governance framework, however it was not always effectively managing risks. These included the risks associated with the monitoring of patients on high risk medicines, actioning of patient safety alerts, ensuring that staff training was up to date and to the correct level, ensuring staff immunisations were in line with guidance, having an effective system for monitoring of two week wait referrals, monitoring of emergency medicines and vaccinations, ensuring an effective system for storage of vaccinations and management of long-term conditions.
• The practice was not always keeping comprehensive clinical records, with medication reviews not always completed in detail in the medical records, including not displaying that all monitoring was up to date or requested and that any relevant safety information or advice had been addressed.
• Actions were taken to support the maintenance of the service during the Covid-19 pandemic.
• Staff spoke positively about their employment at the practice and felt supported.

We found breaches of regulations. The provider must:

• Ensure that care and treatment is provided in a safe way.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

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

In addition to the above, the provider should:

• Continue to conduct routine fire, health and safety and legionella risk assessments and follow up on actions identified in the reports.
• Continue with plans to improve uptake of childhood immunisations and cervical screening.
• Review infection control processes, in particular in relation to storage of cleaning products and assembly of sharps bins.
• Continue to arrange training for an additional member of staff in the summarising of notes to allow for appropriate cover.
• Review the internal data logger and ensure that it was functional.
• Review the process for the reporting and recording of significant events.
• Review the process for the recording and coding of do not attempt resuscitation (DNACPR) decisions and review decisions on an annual basis.
• Improve engagement with the patient participation group (PPG).

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