Archived: Dr Sangeeta Rathor

We carried out an announced comprehensive inspection at Dr Sangeeta Rathor on 16 January 2020 as part of our inspection programme.

At the last inspection in December 2018, the practice was rated as Requires Improvement. We served the practice with Warning Notices. We undertook a further inspection in March 2019 to check they had complied with the requirements of the Notice. At that inspection, we found that the provider had satisfactorily met the requirements of the notice. During this inspection the improvements were being maintained. However, there are areas that still require improvements.

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 have rated all population groups as requires improvement due to concerns with patient satisfaction.

We rated the practice as requires improvement for providing effective services because:

• Whilst there was monitoring of the outcomes of care and treatment, the practices patient quality outcomes related to Families, children and young people and Working age people were low.

We rated the practice as requires improvement for providing caring and responsive services because:

• Results from the national GP patient survey relating to overall experience of making an appointment and for patients who were satisfied with the type of appointment they were offered were low.

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

• The governance systems in place for safe and effective running of the practice had been improved. However, some work was still required to ensure the leadership of the service was stable.

We also rated the practice as good for providing safe services because:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs.

Whilst we found no breaches of regulations, the provider should:

• Continue efforts to increase the uptake of childhood immunisations, bowel cancer screening and cervical cancer screening.
• Continue to address patient feedback from the National GP National Patient Survey.
• Continue efforts to promote the PPG and patient engagement.

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

We did not review the ratings awarded to this practice at this inspection.

We carried out an announced comprehensive follow up inspection of Dr Sangeeta Rathor on 03 December 2018. We rated the practice as requires improvement for safe, effective responsive and caring; inadequate for well led. In line with our enforcement procedures we issued a warning notice in relation to regulation 12: Safe care and treatment and regulation 17: Good Governance of the Health and Social Care Act 2008.The full comprehensive report on the 03 December 2018 inspection can be found by selecting the ‘all reports’ link for Dr Sangeeta Rathor on our website at https://www.cqc.org.uk/location/1-511237925

This inspection was an announced focused inspection carried out on 07 March 2019 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulation that we identified in our previous inspection on 03 December 2018.

This report covers our findings in relation to those requirements made since our last inspection.

At this inspection we found that actions had been taken to improve the provision safe and well-led services in relation to the warning notices.

Specifically:

•The practice had developed systems and processes to keep patients safe.

•Governance systems had been improved to ensure the leaders had capacity to provide clinical oversight and leadership.

The comprehensive report of the 03 December 2018 inspection which was published on 26 February 2019 should be read in conjunction with this report.

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

We carried out an announced comprehensive inspection at Dr Sangeeta Rathor on 7 June 2016. The overall rating at that time for the practice was good.

This inspection was an announced comprehensive inspection carried out on 3 December 2018. The inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014 as part of our inspection programme. This inspection identified breaches of regulation.

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 did not have clear systems and processes to keep patients safe.
• We found areas of concern related to, safeguarding procedures, a lack of safe management of medicines and lack of monitoring to ensure clinical staff were working within their remit.

We rated the practice as requires improvement for providing effective services because:

• Staff had not all received an annual appraisal in a timely manner.
• The practice could not evidence how they ensured some clinical staff were up to date with current guidance and were provided with appropriate supervision.

We rated the practice as requires improvement for providing caring 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. However, results from the national GP patient survey showed that patient’s satisfaction with how they could access care and treatment were much lower than local and national averages.

We rated the practice as requires improvement for providing responsive services.

• The practice had good facilities and was well equipped to treat patients and meet their needs.
• However, results from the national GP patient survey showed that patient’s satisfaction with how they could access care and treatment were low in all key questions compared to local and national averages.

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

• Leaders could not show that they had the capacity and skills to deliver high quality, sustainable care and lacked the capacity to provide clinical oversight and leadership at the practice.
• The overall governance arrangements were inadequate.
• We found that many systems and processes were not established and operated effectively to provide good governance. We saw no evidence of systems and processes for learning, continuous improvement and innovation.
• We found that though the practice had policies these were not followed.

• The practice was unable to demonstrate that they had actively responded to patient feedback and involved patients in the process.

The areas where the provider must make improvements are:

• Ensure that 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:

• Review and improve the process of identifying carers

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice