1 July 2016
During a routine inspection
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection on 1 July 2016 at Dr Swaminathan Ravi at Cope Street Surgery. The practice was placed in special measures due to non-compliance with the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 following our previous inspection in November 2015.
During this inspection, we found the practice had made some improvements since our last inspection and most of the issues raised had been rectified. However fresh concerns and breaches of regulations were noted.
The provider is in breach of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 12 Safe Care and Treatment, Regulation 17 Good Governance and Regulation 18 Staffing.
We found the practice to be inadequate in areas relating to safe, effective and well led. The practice was rated as requires improvement for areas related to being responsive and was rated as good at caring for patients.
Our key findings across all the areas we inspected were as follows:
- During this inspection we found the practice had reviewed some of their systems to ensure risks to patients were addressed and managed. For example a fire risk assessment had been completed along with Control of Substances Hazardous to Health (COSHH) and Legionella risk assessments. However we found shortfalls in other areas. For example, the safeguarding policy had been updated but did not contain details of local social services and clinical commissioning team safeguarding contacts.
- Staff were not clear about reporting incidents, near misses and concerns and there was no evidence of learning and communication with staff.
- Patient outcomes were hard to identify as little or no reference was made to audits or quality improvement and there was no evidence that the practice was comparing its performance to others; either locally or nationally.
- Patients were positive about their interactions with staff and said they were treated with compassion and dignity.
- The practice had no clear leadership structure, insufficient leadership capacity and limited formal governance arrangements.
The areas where the provider must make improvements are:
- Introduce robust processes for reporting, recording, acting on and monitoring significant events, incidents and near misses.
- To review the findings of the infection prevention and control audit to reflect a true picture of the practice and act in accord with the findings.
- Ensure the guidance from NHS Protect security of prescription forms is implemented and systems established.
- Ensure paper and electronic records are held securely meeting the requirements of the Data Protection Act 1998.
- Ensure that all staff performing chaperone duties have received a disclosure and barring service (DBS) check. DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable.
- Ensure processes are in place for the safe management of returned or unwanted medicines.
- Ensure patient outcomes are reviewed and recommendations made to contribute to a programme of continuous quality improvement.
- To review the staff appraisal process so that all staff have regular appraisals and performance reviews.
The areas where the provider should make improvement are:
- Ensure a GP lone worker risk assessment is completed. The GP was the sole provider for clinical care and took the lead for everything. There was no risk assessment undertaken for the GP being a lone clinical worker nor clear instructions to follow if they were unable to work .
This service was placed in special measures on 30 November 2015. Insufficient improvements have been made such that there remains a rating of inadequate for safe, effective and well led. 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