This practice is rated as inadequate overall.

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Requires improvement

Are services caring? – Inadequate

Are services responsive? – Inadequate

Are services well-led? – Inadequate

We carried out an unannounced comprehensive inspection at Hina G Trivedi and Partners, known as Evington Medical Centre, on 12 June 2018. The inspection was undertaken in response to concerns we received in relation to management of patients with chronic conditions. Ordinarily we would give providers two weeks’ notice prior to a comprehensive inspection, but we may undertake unannounced inspections when responding to concerns.

At this inspection we found:

• Systems used for monitoring medicines and equipment for use in a medical emergency were not effective.
• There was a lack of oversight of locum GPs clinical practice and record keeping.
• Clinicians were not always in possession of the most up to date and relevant information on patients to enable them to make sound clinical judgements.
• The systems to ensure patients and others were protected from healthcare associated infections was ineffective.
• The practice did not have all the recommended medicines and equipment for use in medical emergencies.
• The practice’s performance on cervical screening was lower than both CCG and national averages.
• The number of identified carers was lower than expected for a practice of this size.
• Governance systems in place were not effective.
• Results from the GP patient survey showed low levels of patient satisfaction with regard to access to services. The practice had not taken any action to address the issues.
• 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.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
• We found GP appointments were available on the day of our inspection and nurse appointments within 48 hours.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure care and treatment is provided in a safe way to patients
• 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 their process to encourage women to take part in the cervical screening program.
• Review their process to help identify more carers.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take 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 a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice