Letter from the Chief Inspector of General Practice

On 23 March 2016 we carried out an announced comprehensive inspection at

Dr Nithyanandam Muthu Krishnan’s practice

. The overall rating for the practice was requires improvement, having being judged as requires improvement for providing Safe, Effective and Well Led services. The full comprehensive report on the March 2016 inspection can be found by selecting the ‘all reports’ link for

Dr Nithyanandam Muthu Krishnan

on our website at www.cqc.org.uk.

After the comprehensive inspection the practice wrote to us to say what they would do to meet the following legal requirements set out in the Health and Social Care Act (HSCA) 2008:

• Regulation 12 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 Safe care and treatment.

• Regulation 17 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 Good governance.

This announced comprehensive inspection was carried out on the 2 March 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 23 March 2016.

Overall the practice is now rated as good.

• S

  taff understood and fulfilled their responsibilities to raise concerns, and report incidents and near misses.

• Risks to patients were assessed and well managed.

• Data from the Quality and Outcomes Framework (QOF) from 2015/16 showed that the practice had achieved 91.5% of the total number of points available to them. This was below the local and national averages. The practice felt this was due to problems encountered in recruiting a practice nurse. They were in the process of auditing the data to ensure it was being recorded correctly.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance.

• Staff were consistent and proactive in supporting patients to live healthier lives through a targeted approach to health promotion. Information was provided to patients to help them understand the care and treatment available.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• The practice had a system in place for handling complaints and concerns and responded quickly to any complaints.

• Patients said that access to appointments was good with appointments usually available on the same day.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• There was a leadership structure in place and staff felt supported by management. The practice sought feedback from staff and patients, which they acted on.

• The practice was aware of and complied with the requirements of the Duty of Candour regulation.

The area where the provider should make improvements is:

• Take steps to develop a succession plan to ensure the practice could continue to provide services to patients in the future if staffing arrangements changed.

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 Nithyanandam Muthu Krishnan’s practice on 23 March 2016. Overall the practice is rated as requires improvement.

Our key findings were as follows:

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. However, clinical staff undertook their own learning to keep up to date; there were no formal systems in place to ensure a consistent approach throughout the practice.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
• Risks to patients were assessed and managed with the exception of those relating to medicines management and infection control.
• The outcomes of patients’ care and treatment was not monitored regularly. Some clinical audits had been undertaken; there was little evidence the audits were driving improvements to patient outcomes.
• 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.
• Patients said they were able to get an appointment with a GP when they needed one, with urgent appointments available the same day.
• Staff did not always have the complete information they needed. We found a number of written patient records were held in the GP’s consultation room, separate from other patient records.
• Staff throughout the practice worked well together as a team.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Ensure appropriate arrangements are in place for the proper and safe management of medicines; including ensuring all medicines are in date and fit for purpose, monitoring the temperatures of the refrigerators used to store vaccines and ensuring appropriate supplies of emergency medicines held within the practice and when carrying out home visits.

• Ensure equipment, including needles and syringes, is suitable for use; and within expiry dates.

• Ensure that there are formal governance arrangements in place, including developing the clinical audit programme and ensuring clinical audit cycles are completed. Take action to develop a succession plan to ensure the practice could continue to provide services to patients in the future if staffing arrangements changed. Staff did not always have the complete information they needed. We found a number of written patient records were held in the GP’s consultation room, separate from other patient records.

In addition, the provider should:

• Take action to ensure staff have appropriate training to carry out their roles in a safe and effective manner.

• Maintain appropriate standards of cleanliness and hygiene; some of the chairs in the consultation rooms were heavily stained.

• Review the arrangements to enable patients to summon support to access the premises.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice