Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Devanna Manivasagam also known as Stone Cross Medical Centre on 21 April 2016. The overall rating for the practice was good; however, the practice was rated requires improvement for providing effective services. This was because clinical performance for some patient population groups such as long-term conditions and mental health were below local and national averages. The full comprehensive report on the April 2016 inspection can be found by selecting the ‘all reports’ link for Dr Devanna Manivasagam on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 7 August 2017; this report also covers our findings in relation to areas in effective where additional improvements had been made since our last inspection. Overall, the practice is rated as good.

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

• There was an open and transparent approach to safety and a system in place, which supported staff to report and record significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety. For example, the practice had arrangements for responding to non-medical major incidents. However, the practice did not consider an alternative medicine in the absence of a specific emergency medicine to manage pain and the practice had not carried out a risk assessment to mitigate risks.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.

• Data from the Quality and Outcomes Framework showed patient outcomes were comparable to the local and national average. However, exception reporting for some clinical domains were above average. However, exception reporting (the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects) for some clinical domains were above average. Staff we spoke with were aware of the practices high exception rates and saw that patient reviews were being managed appropriately.

• In some areas, the practice carried out various quality improvement activities such as clinical audits, which demonstrated areas where improvements had been achieved. However, the practice were not carrying out audits of their minor surgery service.  

• Staff were aware of current evidence based guidance and staff had the skills and knowledge to deliver effective care and treatment.

• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns. However, we saw that staff were not following the practice complaints policy and procedure to its entirety.
• Patients comments from completed Care Quality Commission comment cards we received during the inspection showed that they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

The areas where the provider should make improvement are:

• Ensure that risk is effectively assessed and managed in the absence of specific emergency medicines

• Consider alternative methods to understand and improve exception reporting rates and assess the effectiveness of improvements as part of a continuous improvement cycle.

• Ensure effective oversight of governance arrangements to ensure practice policies and processes are well embedded.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Devanna Manivasagam practice on 21 April 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. However, medical emergencies that had been effectively handled had not been recorded.
• Risks to patients were assessed and well managed. The practice had defined and embedded systems, processes and practices to keep people safe and safeguarded from abuse.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• The practice had a programme of continuous clinical audit to demonstrate and monitor quality improvements.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. However the complaint letter did not signpost patients to external agencies if they were not satisfied with the response received from the practice. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice did not have all the recommended emergency drugs and no risk assessment had been completed.
• The practice had a business continuity plan in place for major incidents, however the plan did not include emergency contact numbers.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

The areas where the provider should make improvement are:

• The provider should ensure all significant events, including medical emergencies are recorded to improve opportunities for learning.

• The provider should complete risk assessments to ascertain what emergency drugs are required.

• The provider should include emergency contact numbers in the business continuity plan.

• The provider should consider providing information on how to escalate complaints that are not satisfactorily resolved.

• Review data in relation to long term conditions and mental health to consider ways of improving uptake.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice