We carried out an announced comprehensive inspection at Dr V Paramanathan’s Practice on 14 March 2019.

We previously inspected the practice in September 2016. We rated the practice good for providing a safe, effective, responsive and well led service and requires improvement for providing a caring service. We rated the practice good overall. At the inspection we asked the practice to look at ways to improve their low national patient survey scores for patient satisfaction.

At this inspection 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 practice as Requires improvement for providing safe services because:

• The practice had not undertaken a recent health and safety risk assessment.
• There was a lack of awareness in regard to the need for Patient Group Directions (PGDs) and some (MMR and influenza) had expired in February 2018.
• Defibrillator pads were out of date (expired 2015).
• Calibration of equipment was out of date (last checked in 2016)
• There was no system for checking emergency medicines held on the premises were in date and fit for use.

We rated the practice as Requires Improvement for providing an effective service because:

• The practice had not completed any 2 cycle clinical audits and did not have any other systems to measure and improve outcomes for patients.
• Published child immunisation figures were below the minimum World Health Organisation target of 90%.
• Cancer screening targets were below the national average.

We rated the practice as Requires improvement for providing well-led services because:

• There was a lack of clinical supervision of nursing staff resulting in some governance responsibilities such as checking of emergency equipment and emergency medicines not being completed. In addition, PGDs were not complete and up to date.
• Processes for managing risks, issues and performance had lapsed during the refurbishment of the practice. For example, health and safety risk assessments had not been carried out since 2016.

We rated the practice as good for providing a caring and responsive services because:

• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs.
• Patients could access care and treatment in a timely way.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

(Please see the specific details on action required at the end of this report).

The areas where the provider should make improvements are:

• Consider placing cleaning check lists in a place where they are accessible to staff.
• Consider making significant event forms clearer for review.
• Carry out the planned fire drills.

• Put plans in place to improve outcomes for patients in the cancer screening programme.
• Consider improving systems to identify and support carers.

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 Dr Paramanthan and Partners

Also known as Otterfield Medical Centre on 15 September 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. With the exception of those relating to the monitoring of fridge vaccines.
• 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.

The areas where the provider should make improvement are:

• Ensure adequate systems to monitor fridge temperatures are maintained to ensure the safe storage of vaccines.

• Ensure the practice improves and responds to the national GP patient survey results in low scoring areas.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice