All inspections: Drs. Sreelatha and Thachankary

We carried out an announced follow up comprehensive inspection at Drs. Sreelatha and Thachankary on 13 and 14 June 2023. Overall, the practice is rated as good.

Safe - requires improvement

Effective - good

Caring - good

Responsive - good

Well-led - good

Following our previous inspection on 9 December 2021, the practice was rated requires improvement overall. The key questions for the provision of safe, caring and well-led services were rated as requires improvement, and the ratings for the provision of effective and responsive services were rated as good.

As a result of the December 2021 inspection we issued the provider with a requirement notice for a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 for Regulation 12: Safe care and treatment.

During this inspection, undertaken on 13 and 14 June 2023, we saw the provider had taken action to tackle the issues raised in the requirement notice. However, we found new areas of concern with regard to aspects of medicines management which necessitated the issue of a further requirement notice for a further breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 for Regulation 12: Safe care and treatment. We also found that the provider had improved caring and well-led services and these were no longer rated as requires improvement. Responsive remained as good.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Drs. Sreelatha and Thachankary on our website at www.cqc.org.uk

Why we carried out this inspection

We carried out this inspection to follow up concerns and a breach of regulation from the previous inspection.

The inspection included:

All key questions.

A review of the actions taken to address the breach of Regulation 12 Safe care and treatment.

A review of progress on actions we told the provider they should take in relation to:

improving processes for dealing with incidents of abusive behaviour from patients to staff.
improving uptake rates for cervical screening.
developing ways to improve patient satisfaction.
taking steps to increase clinical capacity.

How we carried out the inspection

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

This included:

Conducting staff interviews using video conferencing.
Completing clinical searches on the practice’s patient records system (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.
Undertaking a visit to the practice location.

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 found that:

Improvements had been made since the last rated inspection undertaken in December 2021. However, there were still areas which needed further improvement regarding medicines management.
Patients’ needs were assessed. However, care and treatment had not always been delivered in line with current standards and evidence-based guidance in relation to medicines management, and reviews and support of patients with long-term conditions.
Internal clinical capacity and the ability to meet patient demand had increased since the last inspection.
Antibiotic prescribing rates had shown an over reduction over the past 4 years.
The practice had developed and implemented a sophisticated assurance framework, which gave them an improved ability to oversee and effectively manage the operation of the practice in key areas.
Staff informed us that they had witnessed or been subject to abusive and aggressive behaviour from patients.
Patient feedback indicated that access to care and treatment could be difficult at times. The provider had responded to this and made a number of improvements such as adding additional incoming telephone lines and recruiting additional staff.
The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

We found one breach of regulations. The provider must:

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

In addition, the provider should:

Embed improvements to improve patient access to services.
Continue to work to improve cervical cancer screening rates.
Complete actions required to comply with the most recent Infection Prevention and Control (IPC) audit and fire safety risk assessment.
Develop an approach to the management of patients who have not engaged with the practice for necessary medicines monitoring checks.

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

We carried out an announced comprehensive inspection at Drs. Sreelatha and Thachankary between 6 December 2021 and 9 December 2021. Overall, the practice is rated as Requires Improvement.

Safe - Requires Improvement

Effective - Good

Caring - Requires Improvement

Responsive – Good

Well-led - Requires Improvement

We previously carried out an announced focused inspection at Drs. Sreelatha and Thachankary between 23 March and 25 March 2021. The overall rating (and for the key questions of safe, effective and well led) was inadequate and the service was placed into special measures. We carried out a focused inspection on 29 July 2021 to assess compliance with breaches identified during the March 2021 inspection. This focused inspection was not rated.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Drs. Sreelatha and Thachankary on our website at www.cqc.org.uk

Why we carried out this inspection

This inspection was a comprehensive inspection to follow-up on concerns identified during the inspection undertaken in March 2021, this included:

A failure to ensure that care and treatment was provided in a safe way to patients.
The provider had failed to establish effective systems and processes within the practice, to ensure good governance in accordance with the fundamental standards of care.
The provider had failed to ensure that persons employed in the provision of the regulated activities had received the appropriate support, training, professional development, supervision, and appraisal necessary to enable them to carry out the duties.

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

Conducting staff interviews using telephone and video conferencing.
Completing clinical searches on the practice’s patient records system and discussing findings with the provider.
Reviewing patient records to identify issues and clarify actions taken by the provider.
Requesting evidence from the provider.
A short 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 found that:

Many improvements had been made since the last rated inspection undertaken in March 2021. However, there were still areas which needed further improvement, or which needed additional time to be embedded within the practice.
The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. Patients could access care and treatment in a timely way.
Patients’ needs were assessed. However, care and treatment had not always been delivered in line with current standards and evidence-based guidance in relation to medicines management, and reviews of patients with long-term conditions.
Clinical supervision of the nursing team had improved, although this was still limited.
The summarising and incoming correspondence backlog noted in March 2021 had been significantly reduced. In addition, records handling and storage procedures had been reviewed, and a member of staff given responsibility for records management.
Internal clinical capacity and the ability to meet patient demand was limited at the time of inspection due to reduced staffing numbers. Additional capacity was being met by the use of locum GPs and other agency staff. It was noted at the time of inspection that a recruitment exercise was underway.
The practice had developed and implemented a sophisticated assurance framework, which gave them an improved ability to oversee and effectively manage the operation of the practice in key areas.
On some occasions the healthcare assistant had undertaken tasks during early morning clinics, without the appropriate registered clinical support being available to support them if required.
When we examined patient files, we found that these were detailed and comprehensive.
Staff mentioned that protected time for additional duties and training was limited.
Staff informed us that they had witnessed or been subject to challenging and aggressive behaviour from patients.
The Patient Participation Group had begun to meet again, this increased the input of stakeholder and patient views into the practice.

We found one breach of regulations. The provider must:

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

In addition, the provider should:

Improve processes for dealing with incidents of challenging or abusive behaviour from patients to staff and, when required, improve support for staff when they experienced this.
Take steps to further increase clinical capacity and patient access within the practice.
Improve cervical screening performance.
Improve patient satisfaction in relation to interactions that patients have with staff during their care and treatment.

I am taking the service out of special measures. This recognises the improvements made to the quality of care provided by the service. Details of our findings and evidence supporting our decisions and ratings are set out in the evidence table.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced focused inspection at Drs. Taylor, Sreelatha and Thachankary, also known as Stuart Road Surgery, between 23 March and 25 March 2021. The overall rating for the practice was inadequate and the service was placed into special measures. Warning notices were subsequently served on the provider for breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Regulations 12 Safe care and treatment and Regulation 17 Good governance. The full report of this focused inspection can be found by selecting the “all reports” link for Drs. Taylor, Sreelatha and Thachankary on our website at www.cqc.org.uk

Why we carried out this inspection

This inspection was an announced focused inspection carried out on 29 July 2021 to check that the provider had responded to the warning notices dated 29 April and 4 May 2021 and met the legal requirements in relation to the breaches of Regulation 12 and Regulation 17. The provider was required to be compliant with the matters documented in the warning notices by 26 July 2021.

This report covers our findings in relation to those requirements. The inspection has not resulted in any new rating and the practice remains rated as inadequate and in special measures.

How we carried out the inspection

Throughout the pandemic the Care Quality Commission (CQC) has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

Conducting staff interviews during a short on-site visit.
Reviewing patient records to clarify actions taken by the provider.
Requesting and reviewing information from the provider.

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 the provider.

We found that:

The provider had made the required improvements in most areas identified in the warning notices However, the provider had not sufficiently dealt with the backlog of summarising of new patient records, and of incoming non-clinical correspondence. At the time of inspection, the practice had a backlog of over 270 new patient records (this had previously been 422 at the time of the last inspection) which needed to be summarised, and incoming non-clinical correspondence had a backlog of four weeks.
We saw that new processes had been put in place which ensured that patients who showed a potential diagnosis of a long-term condition had received further care and treatment appropriate to their needs.
We saw evidence that essential policies and procedures had been reviewed and updated, and that processes were in place to give assurance that these will be reviewed and managed on a regular basis.
The provider had systems in place for the effective handling of medicine and patient safety alerts, recent alerts had been reviewed and actioned as appropriate.
The provider had implemented new operating procedures which ensured that medicines were being effectively managed, and that patients had been effectively monitored. However, it was noted that the provider had experienced difficulties in downloading test results taken at external clinics but was working with others to resolve this issue.
The provider had improved coding processes for the authorisation of repeat medicine requests, this had made it clear that the person who authorised the prescribing was competent to do so.
The provider had improved the oversight and management of infection prevention and control (IPC) within the practice. Cleaning schedules were in place which were monitored, and additional resources had been allocated for cleaning and infection control purposes. The practice was in a clean condition at the time of our inspection.
The provider had put in place arrangements for seeking and acting on feedback from staff and patients. For example, the Patient Participation Group had been reformed and had met on two occasions since the last inspection. Staff appraisals and meetings had been held.
Significant event and incident processes had been reviewed and the process embedded in the practice. We saw that events and incidents had been recorded and investigated, and that learning points had been identified and shared with staff.
The provider had undertaken quality improvement work since the last inspection. We saw that they had carried out clinical audits and had put systems and processes in place to improve services as a result of patient complaints and staff feedback.
The provider had put measures in place which ensured that health and safety, and fire safety risks were effectively managed. For example, a fire risk assessment had been undertaken, and new health and safety risk assessments had been completed.
New processes had been put in place which ensured that referrals to other services had been fully completed prior to submission to the relevant body.

We found one continued breach of regulation. The provider must:

Ensure that the provider has systems or processes in place to maintain securely an accurate, complete and contemporaneous record in respect of each service user.

The area where the provider should make improvement was:

Continue work to resolve the issue in relation to downloading test results from external clinics and services.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

We carried out an announced focused inspection at Drs. Taylor, Sreelatha and Thachankary (at the time of inspection operating as Drs. Taylor and Sreelatha) between 23 March and 25 March 2021. Overall, the practice is rated as Inadequate.

We have rated the practice as follows:

Safe - Inadequate

Effective - Inadequate

Caring – Not inspected or rated

Responsive – Not inspected or rated

Well-led - Inadequate

Following our previous inspection on 10 May 2016, the practice was rated Good overall and for all key questions.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Drs. Taylor, Sreelatha and Thachankary on our website at www.cqc.org.uk

Why we carried out this inspection

This inspection was a focused inspection to follow up on concerns which had been raised about the operation of the practice. In light of these concerns we inspected the following key questions:

Safe
Effective
Well-led

The ratings in relation to Caring and Responsive are carried forward from the inspection undertaken in 2016 and remain Good.

How we carried out the inspection

Throughout the pandemic the Care Quality Commission (CQC) has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

Conducting staff interviews by telephone
Completing clinical searches on the practice’s patient records remotely
Reviewing patient records to identify issues and clarify actions taken by the provider
Requesting and reviewing evidence from the provider
Reviewing information received from third parties
A short 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
information from the provider, patients, the public and other organisations.

We have rated this practice as Inadequate overall, and inadequate for all population groups

We found that:

The provider did not review all patients after they had an unplanned admission to hospital.
Searches of patient records showed that the practice had not ensured that all patients who showed a potential diagnosis of a long-term condition had received further care and treatment appropriate to their needs.
Several protocols, procedures and policies were found to be out of date. In addition, it proved difficult for staff to find a number of these documents on the practice computer system.
There was no risk assessment in place to support decisions made into which emergency medicines the practice held.
The provider did not have adequate systems in place for the dissemination of medicine and patient safety alerts.
The provider did not ensure that medicines were being effectively managed. For example, blood test results had not been updated on patient records. There was evidence in some patient records of the incorrect coding of authorisations in respect of medicine reviews and repeat prescription requests.
The provider did not ensure that the premises was kept clean. The last infection prevention and control (IPC) audit had been undertaken in June 2019.
Staff engagement was ineffective; meetings were not being held on a regular basis.
The significant event and incident processes were not consistent or effective. Not all events had been recorded and learning from events was not disseminated. In addition, there was limited evidence that learning and actions resulting from complaints had been undertaken.
The provider had undertaken limited quality improvement work. The last clinical audit had been undertaken in August 2019 and lacked detail and depth.
The provider did not ensure that health and safety, and fire safety were being effectively managed. For example, there was no evidence that either a fire evacuation drill, or a fire safety risk assessment had been recently undertaken.
There was a backlog in dealing with incoming correspondence and a significant backlog of new patient records being summarised. At the time of inspection, the incoming correspondence backlog dated to 22 February 2021.
We found evidence that some referrals to other services had not been fully completed prior to submission to the relevant body.
Patient engagement in the practice was low, and the patient participation group had not met for some time.
There was evidence that non-clinical staff had been tasked to undertake duties which required some clinical knowledge. Staff had been trained to undertake these duties, however there was no monitoring in place to give assurance that these duties were being effectively and safely undertaken.
Supervision and support for staff was found to be limited. Staff appraisals had not been undertaken for around three years.
Some training was found to be out of date or had not been undertaken. For example, the last infection prevention and control (IPC) training we saw recorded was in 2017.
Leadership visibility and engagement with practice staff was reported to be limited.
Staff reported low morale and high workloads. The practice was undertaking additional recruitment at the time of the inspection.

We found three breaches of regulations. The provider must:

Ensure that 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.
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.

The provider should:

Maintain records to demonstrate that staff are vaccinated in line with Public Health England Guidance.
Re-examine the decision to not develop a Safeguarding Register of vulnerable children and adults.
Undertake care reviews of patients who had received a new diagnosis of cancer, and patients who had been subject to an unplanned admission.
Develop, embed, and monitor a practice business plan.
Undertake a risk assessment to determine the range of emergency medicines to be held within the practice.
Develop processes to give assurance that professional staff continue to meet the standards set by their own regulating bodies.

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

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Doctors Taylor, Syam and Sreelatha at Stuart Road Surgery on 10 May 2016. Overall the practice is rated as good.

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

There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
Risks to patients were assessed and well managed.
Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
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. Improvements were made to the quality of care as a result of complaints and concerns.
Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
The practice had good facilities and was well equipped to treat patients and meet their needs.
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.
The provider was aware of and complied with the requirements of the duty of candour.

We saw two areas of outstanding practice:

The practice had established a duty doctor system and nurse led minor injuries clinics as a way of managing urgent demand. It had been successful in meeting demand and provided more flexible access to medical care.
The practice provided a diabetic clinic that was delivered in conjunction with a local secondary care provider. The service offered specialist care management and enhanced services such as insulin initiation. The provision of these services withinprimary care meant that patients do not need to attend secondary care settings such as hospitals to receive treatment.

There was an area where the provider should make improvement:

The practice should ensure that fire training and information governance training was up to date and delivered for all members of staff.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice

The practice is registered with CQC to provide the following regulated activities:

Diagnostic and screening procedures

Family planning

Maternity and midwifery services

Surgical procedures

Treatment of disease, disorder or injury

We spoke with 13 patients and reviewed 40 CQC comment cards which were completed by patients on the day of the inspection. The majority of the feedback we received was positive. Patients said they were treated with dignity, empathy and respect.

Some aspects of the service are safe. Appropriate arrangements for managing safeguarding are in place. Most areas of the practice are clean. Medicines are mostly well managed. Disclosure and barring checks (DBS) are not always carried out before employment commences. We have asked the provider to address these issues.

Some aspects of the service are effective.

Patients told us they receive a caring service and are treated with dignity and respect.

Some aspects of the service are responsive. The practice has an active patient participation group (PPG) in place, actively seeks patient feedback and is responsive to it. However, no records are available to show complaints have been investigated and by whom.

Some aspects of the service are not well led. Leadership roles and responsibilities were not clear, there were few systems in place for monitoring quality and there was a lack of staff engagement.

Drs. Sreelatha and Thachankary Also known as Stuart Road Surgery

All Inspections

14 June 2023

During a routine inspection

09 December 2021

During a routine inspection

29 July 2021

During an inspection looking at part of the service

25 March 2021

During an inspection looking at part of the service

10 May 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

Professor Steve Field (CBE FRCP FFPH FRCGP)

9 July 2014

During a routine inspection