The Care Quality Commission
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Archived: Dr Muthulingam Sathananthan Also known as Manor House Practice

Overall: Inadequate read more about inspection ratings

Feltham Centre for Health, 3rd Floor, The Centre, Feltham, Middlesex, TW13 4GU (020) 8630 3747

Provided and run by:
Dr Muthulingam Sathananthan

All Inspections

8 February 2018

During a routine inspection

This practice is rated as Inadequate overall. (Previous inspection 17 January 2017 – Requires improvement)

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Inadequate

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Inadequate

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Inadequate

People with long-term conditions –Inadequate

Families, children and young people – Inadequate

Working age people (including those recently retired and students – Inadequate

People whose circumstances may make them vulnerable – Inadequate

People experiencing poor mental health (including people with dementia) - Inadequate

We carried out an announced comprehensive inspection at Dr Muthulingam Sathananthan on 8 February 2018. The inspection was carried out to follow up on breaches of regulations identified at our inspection of 17 January 2017 and confirm that the practice was now meeting legal requirements.

At this inspection we found:

  • The practice had made improvements in the provision of safe services since our previous inspection in January 2017. However, some of our concerns had not been addressed sufficiently in relation to staff training; the system for managing emergency medicines; medicines management as a whole; and staff recruitment.

  • The practice ensured that care and treatment was delivered according to evidence-based guidelines.

  • Despite some improvement in QOF performance overall and in areas found to be below average at our previous inspection, performance remained below average for several clinical indicators at our latest inspection.

  • There was no formal ongoing programme of quality improvement, including clinical audit. The practice carried out ad hoc clinical audit but no audits currently in train were completed full audit cycles to show improved patient outcomes.

  • Staff involved and treated patients with compassion, kindness, dignity and respect.

  • Patients who were carers were identified and offered appropriate support.

  • The practice organised and delivered services to meet patients’ needs. It took account of patient needs and preferences.

  • Patients found the appointment system easy to use and the majority reported that they were able to access care when they needed it.

  • The principal GP lacked sufficient management support and this had impacted on his capacity to lead effectively and consistently deliver high-quality, sustainable care.

The areas where the provider must make improvements as they are in breach of regulations are:

  • 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.

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.


Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

17 January 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Muthulingam Sathananthan on 17 January 2017. Overall the practice is rated as requires improvement.

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

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However, there was no written protocol to support investigations and lessons learned were not communicated widely enough to support improvement.
  • Although risks to patients were assessed, the systems to address these risks were not implemented well enough to ensure patients were kept safe. There were deficiencies in the systems for infection control and medicines management. Staff had received some training to provide them with the skills and knowledge required for their roles. However, there were gaps in training for safeguarding children, infection control, basic life support and fire safety.
  • There were shortcomings in the practice’s recruitment processes, especially evidence of pre-employment identity and reference checks.
  • Data showed patient outcomes were low compared to the national average in a number of areas. There was some evidence that audit was driving improvement in patient outcomes but there was no ongoing programme of quality improvement.
  • The majority of patients said they were treated with compassion, dignity and respect. However, there was no system in place to proactively identify carers and provide them with support.
  • Information about services and how to complain was available and easy to understand. However, the complaints policy was in need of review and updating.
  • 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 a clear vision to deliver high quality care and promote good outcomes for patients. However, the supporting strategy and business plan were informal and not articulated in any written documentation.
  • The practice had a number of policies and procedures to govern activity, but some were overdue a review.

The areas where the provider must make improvements are:

  • Ensure the proper and safe management of medicines, including monitoring and checking vaccine fridges and emergency medicines and maintaining the security of blank prescriptions forms is in line with guidance.
  • Ensure there are effective arrangements for assessing the risk of, and preventing, detecting and controlling the spread of, infections, including regular audits.
  • Ensure recruitment arrangements include all necessary employment checks for all staff. Arrange through the practice for new Disclosure and Barring Service (DBS) checks to be completed for staff whose checks have been made by their previous employer. Where DBS checks have not been carried out for administrative staff, complete and document a risk assessment to evidence why.
  • Ensure that all staff have the competence and skills to provide services safely by addressing gaps in training for safeguarding, infection control, basic life support and fire safety and arranging appraisal for all staff.
  • Ensure leadership and governance systems are able to assess, monitor and improve the quality and safety of the services provided. Specifically ensure that: significant events are discussed and learning shared within the practice; an effective follow up system is established to improve quality outcomes for patients, in particular those with diabetes, mental health problems, osteoporosis and those receiving palliative care; and consider the introduction of a formal ongoing programme of quality improvement, including clinical audit.

In addition the provider should:

  • Introduce a written protocol to support the investigation of significant events.
  • Arrange for instructions on action to take if vaccine fridge temperatures exceeded the required range to be kept by the fridges.
  • Implement a written business continuity plan.
  • Implement an action plan to address the relatively low scores for some of the caring questions on the GP survey.
  • Review systems to improve the identification of carers and provide support.
  • Formally document the practice’s strategy and business plan.
  • Arrange for the practice mission statement to be put on display at the practice for patients and staff.
  • Review and update procedures and guidance, including the complaints policy.
  • Arrange support training to raise awareness of the duty of candour requirements and communicating with patients about notifiable safety incidents.


Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice