The Care Quality Commission
  • Doctor
  • GP practice

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

Overall: Requires improvement read more about inspection ratings

1-2 Yeading Court, Masefield Lane, Hayes, Middlesex, UB4 9AJ (020) 8845 1515

Provided and run by:
Dr K Anantha-Reddy's Practice

All Inspections

04 May 2023

During an inspection looking at part of the service

We carried out an announced inspection at Dr K Anantha-Reddy's Practice on 4 May 2023. This inspection was undertaken to confirm that the practice had carried out their plan to meet the legal requirements regarding the breaches in regulation set out in the Warning Notice we issued to the provider in relation to Regulation 12 (Safe care and treatment).

At the last inspection in October 2022, the practice was rated requires improvement overall and for the key questions effective and well-led. The practice was rated inadequate for providing a safe service. This will remain unchanged until we undertake a further rated inspection.

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

This inspection was a focused inspection to follow up on compliance with the Warning Notice in respect of breaches of Regulation 12 (Safe care and treatment).

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 found that:

  • Action had been taken to address the breaches identified in the Warning Notice. For example:
  • The practice had taken action to improve systems for the appropriate and safe use of medicines.
  • The practice had improved the monitoring and management of long-term conditions, in particular in relation to patients with chronic kidney disease, hypothyroidism, and asthma.
  • In relation to the areas focused on at this inspection, the practice provided care in a way that kept patients safe and protected them from avoidable harm. For example, in relation to recruitment systems and urgent referrals.

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

  • Take action to monitor the new protocol to follow-up patients to check response to treatment within a week of an acute exacerbation of asthma.

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 Health Care

19 October 2022

During an inspection looking at part of the service

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

21/11/2019

During an inspection looking at part of the service

We carried out an inspection of this service following our annual review of the information available to us including information provided by the practice. Our review indicated that there may have been a significant change to the quality of care provided since the last inspection.

We also carried out the inspection to follow-up on a breach of regulation identified at the previous inspection of the service in December 2018 in relation to the systems in place to improve quality outcomes for patients which was ineffective.

This inspection focused on the following key questions: effective and well-led.

Because of the assurance received from our review of information we carried forward the ratings for the following key questions: safe, caring and responsive.

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 with the exception of working age people (including those recently retired and students) and families, children and young people population groups which we rated as requires improvement.

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. However, although there had been improvement in clinical governance since the last inspection the practice’s performance for child immunisations and cervical screening remained below national targets.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
  • The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

The areas where the provider must make improvements are:

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

The areas where the provider should make improvements are:

  • Further develop quality improvement including clinical audit to drive improvement in patient outcomes.
  • Continue to improve Quality and Outcomes Framework performance (QOF) for long-term conditions in particular for diabetes.

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

4 December 2018

During a routine inspection

We carried out an announced comprehensive inspection at Dr K Anantha-Reddy's Practice, also known as Yeading Court Surgery, on 4 December 2018.

At the last inspection in January 2018 we rated the practice as requires improvement for providing safe, caring and well-led services because:

  • Prescription stationery was not stored securely and there was no system to monitor their use.
  • There was no system to review uncollected repeat prescriptions, particularly for vulnerable patients and those with complex health needs.
  • Staff were unclear on which method to use when recording significant events, and completed significant event forms lacked detail of the lessons learned and follow-up of the event.
  • Data from the national GP patient survey 2017 showed patients rated the practice below local and national averages for satisfaction with GP consultations.
  • Privacy was not always maintained between the treatment room and a consultation room as some consultations could be overheard.
  • There were weaknesses in governance systems relating to safety areas.
  • Exception reporting for cervical screening was high.

At this inspection, we found that the provider had satisfactorily addressed most of these areas.

We based our judgement of the quality of care at this service is 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.

We rated the practice as requires improvement for providing effective services because:

  • There had been insufficient improvement in uptake rates for childhood immunisations and cervical screening.
  • Exception reporting for cervical screening had marginally reduced but remained above the local and national average.
  • There was no system to ensure clinical coding was consistent.

These areas affected the families, children and young people population group and the working age group.

We rated the practice as good for providing safe, caring, responsive and well-led services because:

  • The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
  • Staff dealt with patients with kindness and respect. Feedback from patients we spoke with and CQC comment cards stated staff involved and treated patients with compassion, kindness, dignity and respect. Although, results from the national GP patient survey showed some patients did not feel involved in decisions about their care and treatment.
  • The practice organised and delivered services to meet patients’ needs. Feedback from patients we spoke with and CQC comment cards showed patients found the appointment system easy to use, however some patients reported difficulties getting an appointment. The practice was aware of this feedback and had taken action to improve access.
  • The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

The areas where the provider must make improvements are:

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

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

  • Take interim action to minimise the outstanding risks identified in the infection prevention and control audit.
  • Continue to review and improve uptake rates for bowel cancer screening.
  • Continue to review and improve patient satisfaction with consultations and access to appointments.

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

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

9 January 2018

During a routine inspection

Letter from the Chief Inspector of General Practice

This practice is rated as requires improvement overall.

We carried out an announced comprehensive inspection at Dr K Anantha-Reddy's Practice on 15 December 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the December 2016 inspection can be found by selecting the ‘all reports’ link for Dr K Anantha-Reddy's Practice on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 9 January 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 15 December 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

We found the practice had made improvements since our last inspection. However we identified shortfalls in other areas. Overall the practice remains rated as requires improvement.

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Requires improvement

Are services responsive? – Good

Are services well-led? - Requires improvement

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Requires improvement

People with long-term conditions – Requires improvement

Families, children and young people – Requires improvement

Working age people (including those recently retired and students – Requires improvement

People whose circumstances may make them vulnerable – Requires improvement

People experiencing poor mental health (including people with dementia) - Requires improvement

At this inspection we found:

  • The practice had implemented a system to ensure safety alerts were disseminated and acted on.
  • The practice had systems to manage risk so that safety incidents were less likely to happen. However, there were weaknesses in monitoring uncollected repeat prescriptions and managing prescription stationery.
  • The practice had implemented a system to manage significant events. However, this required improvement as staff were unclear of which process to follow.
  • When incidents did happen, the practice learned from them and improved their processes. However, the completed significant event forms we reviewed lacked detail of the lessons learned and follow-up of the event.
  • The practice was equipped to treat patients and meet their needs. Privacy curtains in consultation rooms were now disposable and changed every three months.
  • The practice reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines.
  • The practice had demonstrated improvements in performance for the Quality and Outcomes Framework and breast cancer screening.
  • Improvements were still required in relation to exception reporting and uptake for the cervical screening programme, and bowel cancer screening rates.
  • The practice had used clinical audit to drive improvements in patient outcomes.
  • The practice had continued to identify and support more patients who were also carers.
  • Staff involved and treated patients with compassion, kindness, dignity and respect. However, we found privacy was not maintained in the treatment room as conversations could be overheard from a consultation room.
  • Patients found the appointment system easy to use but reported increased waiting times to access routine appointments. The practice had made changes to the appointment system in response to patient feedback.
  • The practice had taken steps to develop their patient participation group and had recruited more members to the group.
  • There was a focus on continuous learning and improvement at all levels of the organisation.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

  • Ensure that all patients are treated with dignity and respect.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

  • Review the processes for recording significant events.
  • Establish a system to ensure results are received for cervical screening samples and monitor inadequate rates for sample takers.
  • Continue to review patient satisfaction with the availability and punctuality of appointments, and consultations with the GPs.
  • Review the complaints response template.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

15 December 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

Following a comprehensive inspection of Dr K Anantha-Reddy’s Practice on 17 February 2016 the practice was given an overall rating of requires improvement. Specifically the practice was rated as inadequate for providing safe services, requires improvement for providing effective, caring and well-led services and good for providing responsive services. The provider was found to be in breach of three regulations of the Health and Social Care Act 2008. The breaches related to shortfalls in the systems in place to keep people safe, the delivery of effective care and the governance arrangements at the practice.

We then carried out a comprehensive inspection of Dr K Anantha-Reddy’s Practice on 15 December 2016 to consider if the regulatory breaches from the previous inspection had been addressed and to assess what additional improvements had been made. At this inspection we found some evidence of improvement particularly in relation to the practice providing safe services, however further improvement was still necessary. Overall the practice is rated as requires improvement with a continuing area of non-compliance with respect to demonstrating good governance.

Our key findings across all the areas we inspected were as follows:

  • There was a new system in place for reporting and recording significant events however it had not been consistently implemented and not all staff were clear on the procedures.
  • Lessons were shared to make sure action was taken to improve safety in the practice.
  • There was no system in place to ensure safety alerts from the Medicines & Healthcare products Regulatory Agency (MHRA) were received, disseminated to the clinicians and acted on.
  • Staff assessed needs and delivered care in line with current evidence based guidance, although there was no system in place to disseminate and learn from updates in NICE guidance.
  • Data showed patient outcomes were below average compared to local and national figures although there had been some improvement since our previous inspection.
  • Clinical audit was limited however it did demonstrate some quality improvement.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • The majority of patients said they were treated with compassion, dignity and respect.
  • Information about services was available and easy to understand and accessible.
  • The practice had a number of policies and procedures to govern activity, but some were overdue a review and some key policies were missing.

The areas where the provider must make improvements are:

  • Review systems and processes to ensure safety alerts from the Medicines & Healthcare products Regulatory Agency (MHRA) are disseminated and acted on, significant events are managed consistently and updates in evidence based guidance including the National Institute for Health and Care Excellence (NICE) are disseminated and learning shared.
  • Review and update all policies and procedures.

In addition the provider should:

  • Continue to identify and support more patients who are also carers.
  • Continue to improve Quality and Outcomes Framework performance to bring in line with local and national averages.
  • Consider ways to reduce exception reporting for cervical screening.
  • Improve breast and bowel cancer screening rates to bring in line with local and national averages.
  • Address the lack of GP provision for gender specific requests.
  • Develop the patient participation group and proactively recruit new members.
  • Develop a program of quality improvement including clinical audit to drive improvements in patient outcomes.
  • Continue to improve services based on patient feedback.
  • Maintain an audit trail for the cleaning of privacy curtains in the consultation rooms.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

17/02/16

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr K Anantha-Reddy's Practice, also known as Yeading Court Surgery, on 17 February 2016. Overall the practice is rated as requires improvement.

Our key findings across all the areas we inspected were as follows:

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
  • Risks to patients were not assessed or well managed. For example, those relating to staff training, health and safety, the safe handling and storage of liquid nitrogen, and fire safety.
  • Although infection control risks had been assessed, the systems and processes to address these risks were not implemented well enough to ensure patients were kept safe.
  • There was evidence of appraisals and personal development plans for staff. However, some staff had not received training specific to their roles.
  • Data showed patient outcomes were low compared to the locality and nationally.
  • Audits had been carried out to demonstrate quality improvement.
  • Patients were positive about their interactions with staff and said they were treated with compassion and dignity. However, the national GP patient survey showed satisfaction scores for consultations with the GPs were below local and national averages.
  • Information about services and how to complain was available and easy to understand.
  • Urgent appointments were usually available on the day they were requested.
  • The practice had a number of policies and procedures to govern activity, but some were overdue a review.
  • The practice had sought feedback from patients and had an active patient participation group.

The areas where the provider must make improvements are:

  • Ensure risk assessments related to fire safety, health and safety, and business continuity are reviewed, and action is taken to ensure patients are kept safe.

  • Ensure staff receive training to enable them to undertake their role, including training in safeguarding children and vulnerable adults, infection prevention and control, and chaperoning.

  • Ensure governance arrangements are in place to: address the areas for improvement identified in the infection control audits; review performance data and take action to improve patient outcomes; review patient feedback and ensure continuous improvement relating to how patients felt they were treated by the GPs.

In addition the provider should:

  • Review the access arrangements for wheelchair users.

  • Consider GP provision for gender specific GP requests.

  • Ensure the practice actively identifies patients who are also carers.

  • Advertise that translation services are available to patients on request.

  • Maintain a record of decisions and actions arising from practice meetings.

  • Review and update procedures and guidance.

  • Ensure staff are aware of the vision and strategy for the practice and involve them in making improvements on how the practice is run.

Where a practice is rated as inadequate for one of the five key questions or one of the six population groups the practice will be re-inspected within six months after the report is published. If, after re-inspection, the practice has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group, we will place the practice into special measures. Being placed into special measures represents a decision by CQC that a practice has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice