Archived: Dr Gangadhar Duddukuri Also known as Burscough Family Practice

We carried out an announced comprehensive inspection at Dr. Gangadhar Duddukuri’s practice on 18 December 2018 as part of our inspection programme to see whether the breaches we identified at our previous inspection on 18 June 2018 had been addressed.

At the last inspection in June 2018 we rated the practice as requires improvement for providing safe and well-led services because:

• Fridge temperatures increased the risk of vaccines being damaged and patients were put at risk.
• There was no accountable person for infection control and prevention and an audit had not been carried out since November 2016.
• Staff had not received training in awareness of sepsis and clinical staff were unfamiliar with best practice management protocols. We also saw no evidence of the required equipment for the management of suspected sepsis.
• Recruitment processes had not been followed and were lacking.
• Not all staff who had chaperone duties had undertaken a criminal record check.
• There was no documentation to demonstrate joint working or multidisciplinary care coordination.
• The practice did not have a strategy or business plan to make improvements.

At this inspection, we found that the provider had addressed the majority of these areas, however we identified further areas of concern.

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. There was no management oversight of staff training, vaccination status or membership of professional bodies. Risk assessment processes were incomplete.
• The management of infection prevention and control was incomplete; there had been no full infection prevention and control audit carried out since November 2016.
• The documentation of significant incidents in the practice was not comprehensive; there was no ongoing summary of incidents.
• Records of discussion of patient safety alerts and guideline changes were not kept.

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

• There was limited monitoring of the outcomes of care and treatment. There was little evidence of reflective practice by clinicians or quality improvement activity.
• The practice was unable to show that staff had the skills, knowledge and experience to carry out their roles.
• There was limited evidence clinical learning was shared.

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

• Leaders could not always show they had the capacity and skills to deliver high quality, sustainable care.
• While the practice had a clear vision, that vision was not supported by any strategy for its delivery. There was no succession or business plan for the future development of the practice.
• The overall governance arrangements were ineffective.
• The practice did not have clear and effective processes for managing risks, issues and performance.
• We saw little evidence of systems and processes for learning, continuous improvement and innovation.

These areas affected all population groups so we rated all population groups as requires improvement.

We rated the practice as good for providing 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 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:

• Improve the documentation of patient complaints, including for verbal complaints.

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

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice