Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Sukumaran and Partners on 04 November 2015. Safe and well-led services were inadequate, effective services required improvement, caring and responsive services were good. The practice was rated inadequate overall and placed into special measures for six months.

We carried out a further announced comprehensive inspection at Dr Sukumaran and Partners on 22 July 2016 to check whether sufficient improvements had been made to take the practice out of special measures. Safe and well-led services were inadequate, effective caring and responsive services required improvement. The practice was rated inadequate overall and was placed into an extended period of special measures for six months.

The practice has been kept under review and told urgent enforcement action could be escalated if necessary, and another inspection would be conducted within six months. We told Dr Sukumaran and Partners if they had not carried out enough improvement we would move to close the practice by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

The full reports for 04 November 2015 and 22 July 2016 can be found by selecting the ‘all reports’ link for Dr Sukumaran and Partners on our website at www.cqc.org.uk.

We carried out an announced comprehensive follow-up inspection at Dr Sukumaran and Partners on 06 June 2017. The practice was rated as good, for all domains making the practice good overall.

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

• Staff members knew how to raise concerns, and report safety incidents. However, they had not been reviewed or analysed them to monitor trends and avoid re-occurrences.
• Safety information was appropriately recorded; learning was identified and shared with all staff members.
• The infection control policy met current guidance with audits having been undertaken to review, analyse and monitor effectiveness.
• Clinical audits were undertaken but only one was a completed cycle to enable improvements to be measured.
• Risks to patients and staff members had been assessed, documented and acted on appropriately. These had not been reviewed to check for themes or trends.
• Staff members assessed and delivered patient care in line with current evidence based guidance. However, the monitoring of patients suffering from poor mental health required strengthening despite considerable improvements having been made.
• Staff showed they had the skills, knowledge, and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity, respect, and involved in their care and treatment decisions.
• Information about the practice services and how to complain was available at the reception desk and on the practice website in easy to understand formats. Although, complaints were not monitored to understand any trends, or to avoid re-occurrences.
• The practice was aware of and complied with the requirements of the duty of candour when dealing with complaints and significant events in an open and honest approach.
• Patients said they were able to make an appointment with a named GP and they received continuity of care. We were also told they had access to urgent appointments on the day.
• The practice facilities, and equipment was appropriate to treat patients and meet their needs.
• There was a clear leadership structure and in addition, staff members felt supported by the GPs and practice management team.
• The practice patient participation Group (PPG) worked proactively with the practice.

The areas where the provider should make improvements are:

• Analyse and review safety incidents, risk assessments and complaints to monitor themes and trends to avoid re-occurrences.
• Continue to monitor and improve patient satisfaction about the services provided.
• Continue to improve the performance of the practice in relation to patients suffering from poor mental health.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

On 4 November 2015, we carried out a comprehensive announced inspection. We rated the practice as inadequate overall. The practice was rated as inadequate for providing safe and well-led services, requires improvement for providing effective services and good for providing caring and responsive services. As a result of the inadequate rating overall the practice was placed into special measures for six months.

At this time we identified several areas of concern including:

• The building was in a poor state of repair.
• Recruitment checks were incomplete.
• Significant events were not recorded in detail.
• Some staff acting as chaperones had not received a disclosure and barring service check (DBS).
• Most staff had not received any infection control training.
• Prescriptions were not stored securely.
• There was insufficient evidence of a programme of continuous audit to demonstrate improvement.
• The Quality and Outcomes Framework showed practice performance and patient outcomes were below average.
• National patient survey data showed patient satisfaction was below average.
• Complaints were not always discussed or shared with staff to drive improvement.
• There was a lack of leadership from the GP partners.

Practices placed into special measures receive another comprehensive inspection within six months of the publication of the report so we carried out an announced comprehensive inspection at Dr Sukumaran and Partners on 22 July 2016 to check whether sufficient improvements had been made to take the practice out of special measures. Overall the practice is rated as inadequate.

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

• There had been significant improvements to the building; this included work to the roof, new windows and doors, new lighting and new emergency lighting. Clinical waste was now stored securely and security measures had been put in place. There had also been improvements carried out in some of the clinical rooms which included new flooring and general decoration.
• There was no significant event policy available. Records of significant events were incomplete.
• There was no robust system in place to ensure medicine and patient safety alerts were actioned.
• Risks to patients were assessed and well managed, with the exception of those relating to health and safety.
• Some members of the clinical team had not received an appropriate level of safeguarding training.
• Data showed patient outcomes were low compared to the national average. We were told the practice was aware of this but little had been done to improve this data.
• A programme of clinical audit had been started.
• The practice did not regularly meet with other health and social care professionals in order to deliver a multidisciplinary approach to patient care. There had only been one palliative care meeting in the last 12 months.
• Patients we spoke with said they were treated with compassion, dignity and respect and felt cared for, supported and listened to.
• The national GP patient survey results were mixed.
• There was a low number of patients who had been identified as carers.
• Information about how to complain was available but not easily accessible.
• We found patients who complained got an adequate response; however this was not always in the timeframe set in the practice policy. Complaints were not routinely discussed.
• The practice was able to offer weekend appointments, at an alternative location, through the local GP Alliance.
• Online services such as appointment booking were not available.
• The practice had a number of policies and procedures to govern activity, but some were not dated and did not have review dates in place.
• There was no business plan in place to address the practice’s concerns for the future.
• There was a lack of leadership in place from the GP partners.

The areas where the provider must make improvements are:

• Ensure significant events are recorded adequately and actioned appropriately.
• Implement a robust system to acknowledge and action medicines and patient safety alerts.
• Carry out a health and safety risk assessment.
• Ensure all clinical staff have received an appropriate level of safeguarding training.
• Ensure complaints are dealt with in line with the practice policy and that complaints are analysed and discussed to drive improvement.
• Ensure there is robust leadership in place to run the practice.

In addition the provider should:

• Address areas of poor performance relating to patient outcomes highlighted through the Quality and Outcomes Framework.
• Address areas of patient satisfaction identified as below average via the national GP patient survey.
• Increase engagement with other health and social care providers to deliver a multidisciplinary approach to the care of patients with complex needs.
• Continue to identify carers and offer additional support.
• Consider the need for online services to improve access for patients.
• Review and update policies as required.

This service was placed in special measures in January 2016. Insufficient improvements have been made such that there remains a rating of inadequate. Therefore we are taking action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

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 Sukumaran and Partners on 04 November 2015. Safe and well-led services were inadequate, effective services required improvement, caring and responsive services were good. The practice was rated inadequate overall and placed into special measures for six months.

We carried out a further announced comprehensive inspection at Dr Sukumaran and Partners on 22 July 2016 to check whether sufficient improvements had been made to take the practice out of special measures. Safe and well-led services were inadequate, effective caring and responsive services required improvement. The practice was rated inadequate overall and was placed into an extended period of special measures for six months.

The practice has been kept under review and told urgent enforcement action could be escalated if necessary, and another inspection would be conducted within six months. We told Dr Sukumaran and Partners if they had not carried out enough improvement we would move to close the practice by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

The full reports for 04 November 2015 and 22 July 2016 can be found by selecting the ‘all reports’ link for Dr Sukumaran and Partners on our website at www.cqc.org.uk.

We carried out an announced comprehensive follow-up inspection at Dr Sukumaran and Partners on 06 June 2017. The practice was rated as good, for all domains making the practice good overall.

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

• Staff members knew how to raise concerns, and report safety incidents. However, they had not been reviewed or analysed them to monitor trends and avoid re-occurrences.
• Safety information was appropriately recorded; learning was identified and shared with all staff members.
• The infection control policy met current guidance with audits having been undertaken to review, analyse and monitor effectiveness.
• Clinical audits were undertaken but only one was a completed cycle to enable improvements to be measured.
• Risks to patients and staff members had been assessed, documented and acted on appropriately. These had not been reviewed to check for themes or trends.
• Staff members assessed and delivered patient care in line with current evidence based guidance. However, the monitoring of patients suffering from poor mental health required strengthening despite considerable improvements having been made.
• Staff showed they had the skills, knowledge, and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity, respect, and involved in their care and treatment decisions.
• Information about the practice services and how to complain was available at the reception desk and on the practice website in easy to understand formats. Although, complaints were not monitored to understand any trends, or to avoid re-occurrences.
• The practice was aware of and complied with the requirements of the duty of candour when dealing with complaints and significant events in an open and honest approach.
• Patients said they were able to make an appointment with a named GP and they received continuity of care. We were also told they had access to urgent appointments on the day.
• The practice facilities, and equipment was appropriate to treat patients and meet their needs.
• There was a clear leadership structure and in addition, staff members felt supported by the GPs and practice management team.
• The practice patient participation Group (PPG) worked proactively with the practice.

The areas where the provider should make improvements are:

• Analyse and review safety incidents, risk assessments and complaints to monitor themes and trends to avoid re-occurrences.
• Continue to monitor and improve patient satisfaction about the services provided.
• Continue to improve the performance of the practice in relation to patients suffering from poor mental health.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice