Littlelever Health Centre 2

We carried out an announced full comprehensive inspection of Dr Thirrupathy Subramanian on 15, 17 and 20 February 2023. All key questions were inspected. Although we saw significant improvements since the previous inspection, we have rated the practice requires improvement overall with the following ratings for individual key questions, reflecting the improvements that are further required:

Safe – Requires Improvement

Effective – good

Caring - good

Responsive – good

Well-led – Requires Improvement

We previously inspected at Dr Thirrupathy Subramanian also known as Little Lever Health Centre 2, on 18 February 2022 when the practice was rated as Requires Improvement and the following ratings were given.

Safe - Requires Improvement

Effective – Requires Improvement

Caring - Good

Responsive - Good

Well-led – Requires Improvement

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Dr Thirrupathy Subramanian on our website at www.cqc.org.uk

Why we carried out this inspection

This inspection was a comprehensive inspection of all five key questions. We also followed up on the breaches of regulations we found in our previous inspection.

How we carried out the inspection/review

This inspection was carried out in a way which enabled us to spend a less amount of time on site.

This included:

• Conducting staff interviews using video conferencing.
• Completing clinical searches on the practice’s patient records system remotely? (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 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 rated the provider as requires improvement for providing safe services:

• The practice provided care in a way that mostly kept patients safe and protected them from avoidable harm. Systems introduced to manage safety within the practice were improved. Meetings which had been implemented to regularly monitor and discuss safety concerns were now embedded. However, the systems to oversee and manage medicines and safety alerts was still not failsafe and we found that further improvements were required.

We rated the provider as requires improvement for providing well led services:

• The practice was able to evidence that improvements had been made. Systems had been implemented and the practice was being managed in a way which better promoted the delivery of good quality person centred care. However, further improvements were required to ensure staff were sufficiently trained in all areas of their work. Staff wellbeing was promoted until numbers could be increased and risks were identified and managed at all times.

We rated the provider as good for providing effective, caring and responsive services.

We also found that:

• Patients received effective care and treatment that met their needs. There was evidence of two-cycle audits and future defined clinical audit plans.
• There was a system to formally discuss clinical outcomes and ensure treatment was delivered according to evidence-based guidance.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• Patients could access care and treatment in a timely way.

We found a breach of regulation. The provider must:

• 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

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