The Care Quality Commission
  • Doctor
  • GP practice

Archived: Dr Binoy Kumar Also known as St Pauls Surgery

Overall: Inadequate read more about inspection ratings

36-38 East Street, Deepdale, Preston, Lancashire, PR1 1UU (01772) 252409

Provided and run by:
Dr Binoy Kumar

All Inspections

25 July 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Binoy Kumar, also known as St Paul’s Surgery, on 25 July 2017. This was to check that the practice had taken sufficient action to address a number of significant concerns we had identified during our previous inspections in June 2016 and August 2015. Following the inspection in August 2015, the practice was rated as inadequate for providing safe and well-led services, and as requires improvement for providing effective, responsive and caring services. Overall the practice was rated as inadequate. We issued a warning notice and two requirement notices under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and placed the practice in special measures as a result.

At our inspection in June 2016, we saw that the practice had taken action to meet the actions needed for the warning notice and requirement notices, however, we found that there were still areas that required improvement. We rated the practice as inadequate for providing effective services, requires improvement for providing caring, responsive and well-led services and good for providing safe services. Overall the practice was then rated as requires improvement and remained in special measures.

At this most recent inspection we saw that the practice had taken steps to address most of the concerns identified at our previous inspection, however, some significant concerns remained and we saw evidence that concerns regarding the safe recruitment of staff previously identified at our inspection in August 2015 had re-occurred. We also identified new concerns related to the clinical care of patients.

Overall the practice is now rated as inadequate.

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

  • The practice had not followed the practice recruitment policy in the recruitment of three new staff. There had been insufficient checks made for the practice nurse on recruitment, key staff documents were missing from staff files and the use of the staff confidential health questionnaire had been discontinued.
  • Processes for the safe monitoring of some patients taking high-risk medicines were lacking and patients were being prescribed these medicines without timely review.
  • The practice had not engaged patients in the national screening programmes for breast and bowel cancer. Figures showed a lower uptake for breast screening at 49% compared with 65% locally and 73% nationally and bowel screening was also low; 36% compared with 58% both locally and nationally. These figures had dropped when compared to 2014/15 figures of 52% for breast screening and 40% for bowel screening.
  • We saw evidence that knowledge of and reference to national guidelines and guidance for patients’ clinical care was lacking.
  • There was evidence that patient treatment records had insufficient details to give assurance that an adequate assessment of the patient had been made and there was a lack of recording of the patient medical history and clinical signs. We saw that a referral to another service lacked detail.
  • Although some audits had been carried out, none of the audits that we saw were completed audits, where improvements were implemented and monitored.

However:

  • The practice had improved the number of patient medicines reviews undertaken in a timely fashion. Unverified data from the practice showed that 89% of reviews had been undertaken for any patient who was taking medication.
  • The practice had streamlined appointments for patients with long-term conditions and we saw evidence that these were being undertaken in a timely way.
  • The practice maintained care plans for vulnerable patients and these were updated following patient reviews.
  • Cervical screening uptake had significantly improved. As the result of work by the practice nurse to increase uptake, we saw unverified data that figures had increased from 50% in 2015/16 to 72% at the time of our inspection (practice unverified data).
  • The improved, open and transparent approach to safety and effective system for reporting and recording significant events had been maintained since our last inspection.
  • There were regular staff meetings with standing agenda items although some minutes lacked detail, for example for identifying which significant events had been discussed.
  • The practice had recruited a female locum GP to provide one surgery each week so that patients could access a female clinician. They had also increased administration staff.
  • There was evidence of an improved staff appraisal process and training needs were more clearly identified.

The areas where the provider must make improvements 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.

In addition the provider should:

  • Enable sufficient records to be kept for discussion in meetings to allow learning to be shared.
  • Review the timescale for new staff mandatory training, in particular safeguarding training.
  • Improve the system for monitoring quality improvement in the practice, particularly in the area of clinical audit.

This service was placed in special measures in 2015 and remained in special measures following an inspection in June 2016. Insufficient improvements have been made such that there remains a rating of inadequate for providing safe, effective and well led services. Therefore we are taking 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 with the Care Quality Commission.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

14 June 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Binoy Kumar, also known as St Paul’s Surgery, on 14 June 2016. This was to check that the practice had taken sufficient action to address a number of significant concerns we had identified during our previous inspection in August 2015. Following this inspection in August 2015, the practice was rated as inadequate for providing safe and well-led services, and as requires improvement for providing effective, responsive and caring services. Overall the practice was rated as inadequate.

We also issued a warning notice and two requirement notices under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and placed the practice in special measures as a result.

At this inspection we found the practice had made significant improvements in the safe domain and had taken the required action to meet the warning notice and the requirement notices issued in August 2015. However we found that there were still areas that required improvement.

Overall the practice is now rated as requires improvement

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

  • We found there were still shortfalls in the clinical review of patients with long term conditions. Care plans were not always up dated.

  • There were incomplete clinical assessments, for example clinical reviews were not always evidenced following results of blood tests.

  • There were still shortfalls in the medication reviews for patients on multiple or high risk medications. Random selection of patient records indicated that medication reviews were overdue.

  • Data showed some patient outcomes were comparable to the Clinical Commissioning Group (CCG) and national average but had shown some deterioration in most indicators compared to the 2014/2015 data

  • The uptake for cervical screening remained a major concern. The practice was approximately 30% below both the CCG and national averages.

  • Although some audits had been carried out, it was too early to determine that audits were driving improvements to patient outcomes.

However:

  • There was an improved open and transparent approach to safety and a more effective system in place for reporting and recording significant events.
  • Risks to patients were more effectively assessed and governance systems were improved.

  • Patients unanimously told us they were treated with compassion, dignity and respect and that they were involved in their care and decisions about their treatment.

  • Patients said they found it easy to make an appointment with the GP, with urgent appointments available the same day. No issues about access to appointments were raised.

  • Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment and training was more comprehensively recorded.
  • The practice had good facilities, was clean and well organised and was well equipped to treat patients and meet their needs.
  • There was well established Patient Participation Group (PPG). Members we spoke with spoke emphatically about how highly regarded the GP was amongst not only his patient population but the local community.
  • The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvements are:

  • Ensure that reviews for patients with long term conditions and more complex needs are consistently undertaken in a timely manner and appropriately documented in the patient electronic record.

  • Ensure that medication reviews for patients on multiple or high risk medication are undertaken and documented in the patients electronic record in a more timely manner

  • Ensure that care plans for patients with long term conditions and for older patients where required, are reviewed and documented in a timely manner.

  • Ensure that the practice proactively seeks any initiative that could potentially increase the uptake of cervical screening.

The areas where the provider should make improvements are:

  • Proactively seek the provision of a female clinician to improve access for female patients

  • Continue to carry out clinical audits including re-audits to ensure improvements have been achieved.

  • Document more clearly any performance management discussions during staff appraisals.

  • Continue to improve the checking of expiry dates for emergency drugs

  • Sustain the improvements found to ensure the required fundamental standards of health and social care are met

The service remains in special measures. The practice will be inspected in 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

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

19 August 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out a comprehensive, follow up inspection on 19 August 2015. This was undertaken following an inspection on 17 February 2015 when compliance actions (now known as requirement notices) were issued. This was due to shortfalls identified in care and treatment and governance of the practice.

We found at the August 2015 inspection that there had been little improvement, with the practice still not meeting the required regulations of The Health and Social Care Act 2008(Regulated Activities) Regulations 2014.

At this inspection we found the practice to be inadequate in the safe, effective and well led domain and requires improvement for the caring and responsive domains.

Overall we have rated the practice Inadequate.

Our key findings were as follows:

  • The maintaining of accurate and up to date records of clinical treatment, particularly medicines reviews, for patients was still not effective.
  • The system to review policies and procedures had not improved and was still not efficient.
  • There was still no central register of policies
  • There was still no central register of training to demonstrate training which staff had undertaken or were due to complete.
  • The GP had still not implemented a Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) policy.
  • There was no consent policy in the policy folder provided. We were not provided with an updated policy or any guidance that related to the taking of consent or in relation to the Mental Capacity Act 2005
  • The recording and analysis of, and learning from any incident remained ad hoc, with little evidence of learning disseminated to staff.
  • There was still little evidence that demonstrated the practice continually assessed, monitored and improved the quality and safety of the service provided.
  • The practice was clean and tidy
  • Patients we spoke with said the GP and nurse explained treatments well
  • Staff responded well to any safeguarding incident and were supported by effective safe guarding procedures

Importantly, the provider must:

  • Maintain an accurate record of patient’s care and treatment, particularly in relation to medication reviews
  • Implement a more effective systematic approach to assessing and monitoring the quality of the service provided.
  • Implement a clear written protocol or policy for responding to any medical emergency
  • Implement a Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) policy.
  • Implement a more effective systematic approach to identifying and managing risks within the practice
  • Implement a more systematic approach to record and evidence staff training

On the basis of the ratings given to this practice at this inspection, (and the concerns identified at two previous inspections in July 2014 and February 2015 which remain outstanding), I am placing the provider into special measures. This will be for a period of six months. We will inspect the practice again in six months to consider whether sufficient improvements have been made. If we find that the provider is still providing inadequate care we will take steps to cancel its registration with CQC.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

17 February 2015

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We had previously inspected this practice under the pilot inspections undertaken in Greater Preston Clinical Commissioning Group in July 2014. A number of improvements were required and we issued compliance actions and a warning notice at that time.

We undertook an inspection of Dr Binoy Kumar on 17 February 2015 as part of our new comprehensive inspection programme and to determine the actions taken since the last inspection.

Our key findings were as follows:

  • We found that there had been some improvements made since the last inspection, by which the practice could identify safety issues and take appropriate action
  • Appropriate systems were in place for the management of medicines.
  • The practice was clean and tidy and equipment was maintained appropriately
  • Improvements had been made in the safe recruitment of staff
  • The practice had an active Patient Participation Group (PPG). Feedback about the responsiveness of the practice to comments and suggestions was good.
  • Feedback from patients about their care and treatment was consistently positive.

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

Importantly, the provider must:

  • Ensure that there is appropriate equipment to respond to a medical emergency. Staff must have written guidance on how to respond to such emergencies.
  • Ensure there are systems in place to effectively monitor the quality of care and clinical treatments and the service provision by way of clinical audit and regular reviews

In addition the provider should:

  • Ensure that medication reviews are undertaken consistently and recorded as required
  • Ensure that all staff have regular appraisals in order to identify personal or professional development and monitor individual performance
  • Ensure that staff receive training in the principles of the Mental Capacity Act 2005
  • Ensure that staff training is effectively recorded and monitored
  • Ensure policy guidance is current and readily available to staff, with a system to verify the staff‘s understanding of policies and procedures.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

9th July 2014

During a routine inspection

Dr Binoy Kumar is registered with the Care Quality Commission (CQC) to provide the regulated activities of Diagnostic and Screening Procedures, Treatment of Disease, Disorder and Injury, Family Planning and Maternity and Midwifery Services.

Patients told us they found it easy to access appointments, both routine and urgent. Patients commented on the friendliness of all the staff and the professionalism of the doctor and nurse. Patients told us they did not feel rushed and were treated with dignity and respect

Systems and procedures to ensure the practice is safe are inadequate. There is a lack of evidence to show how the practice learned from incidents.

Systems in place did not ensure the individual care and welfare of patients in any emergency situation would be appropriately managed.

The Patient Participation Group within the practice is used to consider and respond to patient feedback. The patients we spoke with were happy with the access to appointments and how the practice was run to meet their needs.

Systems to monitor and reduce risks within the practice are ineffective. Policies and clear procedures for staff to follow are either not in place or require updating.

The practice recruitment policy and processes are not followed.  Staff files are inconsistently maintained and did not demonstrate staff are recruited and employed safely.

The GP is not meeting Regulation 9 of the Health and Social Care Act 2008: Care and Welfare of people who use services.

The GP is not meeting Regulation 10 of the Health and Social Care Act 2008: Assessing and monitoring the quality of service provision.

The GP is not meeting Regulation 21 of the Health and Social Care Act 2008: Requirements relating to workers.