This practice is rated as Good overall. (Previous inspection March 2018 - Requires Improvement and June 2015 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Requires Improvement

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Good

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 – Good

People with long-term conditions – Requires Improvement

Families, children and young people – Good

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

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people living with dementia) - Good

We carried out an announced comprehensive inspection at Dr Naranammalpuram Srinivasan on 21 November 2018 to follow up on breaches of regulations.

At this inspection we found:

• The practice had improved systems to manage risk so that safety incidents were less likely to happen. For example, fire safety training had been provided and fire safety equipment had been regularly checked. However, we found two areas where action plans to minimise risk related to blind cords and hot water had not been implemented. When incidents did happen, the practice learned from them and improved their processes.
• The practice reviewed the effectiveness and appropriateness of the care it provided. Care and treatment was delivered according to evidence based guidelines. However, the practice’s performance on quality indicators for some long-term conditions and cancer indicators for working age people was significantly below local and national averages. Although some progress had been made there was limited improvement seen at the time of inspection.

• The recruitment policy and procedure had been reviewed and improved and pre-employment checks had been completed for recently employed staff.
• There was improvement in staff training and appraisal and systems to monitor staff training had been maintained.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were usually able to access care when they needed it but they reported limited access to pre-bookable appointments.

The areas where the provider should make improvements are:

• Minimise risk relating to blind cords and hot water.
• Develop and implement an infection prevention and control action plan to address shortfalls identified in the audit.
• Maintain records of the immunisation status for staff as per Department of Health Immunisation against infectious disease guidance (the Green Book).
• Review and risk assess the provision of emergency medicines.
• Review systems and processes to improve care and treatment related to patients  long term conditions.
• Review systems and processes to improve uptake of cancer screening for working age patients.
• Review and improve systems for identifying carers.
• Review and improve the access to pre-bookable GP appointments.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

This practice is rated as Requires improvement overall. (Previous inspection June 2015 – Good)

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Requires improvement

Are services caring? – Good

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 living with dementia) - Requires improvement

We carried out an announced comprehensive inspection at Dr Naranammalpuram Srinivasan on14 March 2018 as part of our inspection programme.

At this inspection we found:

• The practice had some systems to manage risk so that safety incidents were less likely to happen. However, some of the systems required improvement, for example, fire safety as staff training had not been provided and fire safety equipment had not been regularly checked. When incidents did happen, the practice learned from them and improved their processes.

• The practice reviewed the effectiveness and appropriateness of the care it provided. Care and treatment was delivered according to evidence- based guidelines although some of the practice clinical guidelines required updating.

• All required pre-employment checks had not always been completed and staff training and appraisal had not been maintained.

• Staff involved and treated patients with compassion, kindness, dignity and respect.

• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.

The areas where the provider must make improvements are:

• Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

• Ensure recruitment procedures are established and operated effectively.

• Ensure care and treatment is provided in a safe way to patients.

The areas where the provider should make improvements are:

• The infection prevention and control policy and procedure should be further developed to include areas such as management of sharps and waste.

• An infection prevention and control action plan should be developed and implemented to address shortfalls identified in the audit.

• The fire risk assessment should be reviewed and updated as necessary.

• The emergency protocol should be reviewed and updated as necessary.

• The risk assessment associated with blind cords should include an assessment of blinds in consulting rooms.

• Records of meetings should record in more detail incidents discussed, learning shared and actions agreed.

• Review systems for identifying carers.

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 The York Road Surgery on 3 June 2015. Overall the practice is rated as good.

Specifically we rated the practice as good in providing safe, effective, caring, responsive and well-led care for all of the population groups it serves.

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. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed, with the exception of those relating to recruitment checks.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• 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.
• 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.

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

Importantly the provider should:

• Ensure Disclosure and Barring Service checks are carried out for staff within the practice.
• Ensure curtains around treatment room couches are laundered in line with national guidance and a record of when this is carried out.
• Continue with their efforts to establish a patient participation group.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Patients expressed their views and were involved in making decisions about their care and treatment. We saw that patients were given information and support with regards to treatment options and that staff maintained patient’s privacy and confidentiality.

We spoke with nine patients they told us they were treated with respect and the care they received was “Excellent,” “First class” and “Absolutely brilliant.” Patients told us they were very happy with their experience of the practice and said “I have been with this practice for 60 years if I was not happy I would have moved and I would not have recommended it to others.” Other patients also said that they had been at the practice for all of their life they said, "The GP’s listen to you and answer all your questions” and “This is a family GP practice, and we are treated like a family member, you are never rushed through your appointment and the practice nurses are very thorough and explain everything to you.”

We found the environment to be clean, tidy and organised. We saw there were appropriate systems in place to reduce the risk and spread of infection.

Staff had received appropriate professional development and training to ensure they could meet the needs of the patients who used the service.

Staff were familiar with the procedures to report any issues or abuse of patients.

The practice had systems in place to assess and monitor the quality of the service that patients received.