Archived: Dr Surendra Kumar Dhariwal Also known as Manor Park Medical Centre

Letter from the Chief Inspector of General Practice

This inspection was a follow up to earlier inspections carried out on 29 June 2016 and 22 March 2017.

Following the inspection on 29 June 2016 the practice was rated inadequate in the provision of safe, effective and well-led and requires improvement in caring and responsive services. It was rated inadequate overall and placed in special measures. There were breaches in relation to the following regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 - Regulation 11 the Need for consent, Regulation 12 Safe care and treatment, Regulation 15 Premises and equipment, Regulation 17 Good governance, Regulation 18 Staffing, and Regulation 19 Fit and proper persons employed. After the inspection the provider submitted an action plan detailing how it would make improvements and when the practice would be meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

Following the inspection on 22 March 2017, which we carried out to consider whether sufficient improvements had been made and to identify if the provider was meeting legal requirements and associated regulations, the practice was rated inadequate in the provision of safe, effective and well-led, requires improvement in caring, good in responsive and inadequate overall and remained in special measures. The provider had made improvements; however there continued to be breaches of Regulation 12 Safe care and treatment, Regulation 17 Good governance, Regulation 18 Staffing, and Regulation 19 Fit and proper persons employed. After the inspection the provider submitted an action plan detailing how it would make further improvements and when the practice would be meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

This inspection was undertaken following the period of special measures and was an unannounced comprehensive inspection on 3 July 2017. Overall the practice remains rated as inadequate.

At our inspection on 3 July 2017 we found:

• Staffing arrangements were unclear and there were gaps in maintaining relevant staff checks or information such as Disclosure and Barring Service (DBS) and clinician’s medical indemnity insurance and immunity.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance but there were weaknesses in staff appraisal procedures and training.
• There were gaps in safety arrangements such as safety alerts follow up and managing unforeseen staff absence.
• Areas of the premises were dusty and some items were visibly dirty or out of date.
• A significant amount of medicines and equipment were not fit for use and there were no effective systems in place to address this.
• There was no evidence of clinical or other quality improvement activity.
• There was a system in place for reporting and recording significant events but it was ineffective. Significant events had not been captured to make improvements or monitor trends to take action to prevent future recurrence.
• The mission statement, vision and strategy were unclear and there were no business plans and operational structures had weaknesses.
• Staff were aware of current evidence based guidance and worked with other health care professionals to understand and meet the range and complexity of patients’ needs.
• Patients said they were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• 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.
• There was no evidence of the duty of candour or that lessons were learned from individual concerns and complaints or analysis of trends and action taken as a result to improve the quality of care.

Importantly, the provider must:

• Ensure care and treatment is provided in a safe way to patients.
• Ensure all premises and equipment used by the service provider is fit for use.
• 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.
• Maintain all necessary employment checks for all staff.

In addition the provider should:

• Review arrangements for patient’s access to information and services online.
• Review systems for signposting carers and embed polices and guidance.
• Ensure the most recent CQC rating is clearly displayed and provide accurate information to the CQC as required.
• Review reception staffing and chaperoning cover arrangements.
• Review and improve arrangements for relevant staff safeguarding and administering vaccinations updates or training.

This service was placed in special measures on 3 November 2016. Insufficient improvements have been made such that there are ratings of inadequate for safe, effective, caring, responsive, well-led and overall. We took enforcement action and decided to cancel the providers’ registration and the provider appealed this decision. The case was heard in court at a First Tier Tribunal that decided it was not disproportionate for CQC to cancel the providers’ registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

This inspection was a follow up announced comprehensive inspection carried out on 22 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 29 June 2016. Following that inspection, the practice was rated inadequate overall with ratings of inadequate for the provision of safe, effective and well led services and requires improvement for provision of caring and responsive services and placed into special measures for a period of six months.

This report covers our findings from our inspection on 22 March 2017. The overall rating from this inspection was inadequate and the practice will remain in special measures. Our key findings across all the areas we inspected were as follows:

• Staffing arrangements were unclear and there were gaps in maintaining relevant staff checks or information such as Disclosure and Barring Service (DBS) and clinician’s medical indemnity insurance.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance but there were gaps in staff appraisal procedures and training.
• There were weaknesses in safety arrangements such as safety alerts follow up, failsafes for cervical screening and managing unforeseen staff absence.
• Cleanliness had improved but areas of the premises were dusty and some items were visibly dirty or out of date.
• Medicines and equipment were fit for use but there were no effective systems in place to ensure this was sustained.
• Quality improvement activity was limited to engagement with the Patient Participation Group (PPG) and there was no evidence that audit was driving improvement in patient clinical outcomes.
• There was an effective system in place for reporting and recording significant events, improvements for individual patients took place but the practice had not monitored trends or taken action to prevent future recurrence.
• The practice had a mission statement but their vision and strategy were unclear, there were no business plans and operational structures had weaknesses.
• Staff were aware of current evidence based guidance and worked with other health care professionals to understand and meet the range and complexity of patients’ needs.
• Patients said they were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment, but information for patients with difficulties communicating in English was not easily accessible.
• 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.

There were areas of practice where the provider needs to make improvements.

Importantly, the provider must:

• Ensure effective management of safe and care and treatment such as safety alerts, infection prevention and control and maintenance of premises, equipment or items in use.
• Implement effective systems to monitor and improve the safety of services provided including cervical screening, significant events, chaperoning, prescriptions monitoring, and in the event of unforeseen circumstances.
• Ensure effective processes to maintain, monitor or improve the quality services including with regard to clinical care, confidentiality and patient feedback.
• Ensure sufficient numbers of suitably competent, skilled and experienced persons are deployed.

• Maintain all necessary employment checks for all staff.

In addition the provider should:

• Review arrangements for patient’s access to information and services online.
• Review systems for signposting carers and embed polices and guidance.
• Seek to understand and improve performance for female patient’s breast cancer screening.
• Review arrangements for services provided to a local care home including care planning and repeat prescribing to improve the quality of services.

This service was placed in special measures on 3 November 2016. Insufficient improvements have been made such that there remains a rating of inadequate for safe, effective, well led and overall. The service will be kept under review and where necessary, another inspection will be conducted within six months and if needed could be escalated to urgent enforcement action. 

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice