Archived: Dr Kandasamy Sundaram Also known as Roding Lane Surgery

Updated 10 July 2017

Dr Kandasamy Sundaram is a single handed GP practice located at Roding Lane Surgery, Redbridge, Essex and holds a General Medical Services (GMS) contract with NHS England. The practice’s services are commissioned by Redbridge Clinical Commissioning Group (CCG). They are registered with the Care Quality Commission (CQC) to provide the regulated activities of diagnostic and screening procedures, family planning, maternity and midwifery services, surgical procedures and treatment of disease, disorder or injury.

The practice is staffed by one male GP who provides nine sessions a week. Another GP (female) had recently started doing four to six sessions per month at the practice to support the GP and provide patient choice. The practice also employs a locum nurse, who works eight hours a week, and two reception staff. At the time of this inspection there was no practice manager.

The practice is open between 8.00am and 6.30pm on Monday, Tuesday, Wednesday and Friday and between 8.00am and 1.00pm on Thursday. Extended hours appointments are offered on Monday between 6.30pm and 7.00pm. Outside of these hours, the answerphone redirects patients to their out of hours provider.

The practice has a list size of 3,536 patients and provides a range of services including minor surgery, immunisations, screening, health checks, chronic disease management and family planning services.

The practice is located in an area where there is a diverse population of mixed ethnicity and the majority are relatively young, particularly aged between 25 and 49 years of age.

Updated 10 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Kandasamy Sundaram, based at Roding Lane Surgery, on 1 July 2016. Overall, the practice is rated as Inadequate.

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

• Patients were at risk of harm because systems and processes were not in place to keep them safe. Areas of concern were found in relation to significant events, staff training, chaperoning, infection control, medicines management, recruitment checks, health and safety, fire safety, management of unforeseen circumstances in relation to the business continuity plans and dealing with emergencies.
• The practice systems to keep patients safe and safeguarded from abuse were inadequate.
• The arrangements for seeking consent to care and treatment in line with legislation and guidance were inadequate.
• There was no effective programme of quality improvement to monitor and improve clinical outcomes.
• On the day of the inspection patients were positive about their interactions with nurses and reception staff and told us that they were treated with compassion and dignity. However, GP satisfaction scores were lower than average and no action had been taken to address this.
• There were no curtains in consulting rooms to maintain patients’ privacy and dignity during examinations, investigations and treatments.
• There were limited facilities to help patients become involved in decisions about their care, such as interpreting services.
• Patients said they found it easy to make an appointment with a named GP and urgent appointments were available the same day.
• The practice had inadequate formal governance arrangements and the leadership arrangements in place were not effective enough to ensure safe and high quality care.

The areas where the provider must make improvements are:

• Care and treatment must be provided in a safe way for patients. This includes introducing processes for significant events, incidents and near misses, staff training, safeguarding children and vulnerable adults, addressing concerns with medicines management. 
• Systems must be put in place to ensure all clinicians are kept up to date with national guidance and guidelines and provide staff with appropriate policies and guidance to carry out their roles in a safe and effective manner which is reflective of the requirements of the practice.
• The provider must ensure recruitment arrangements include all necessary employment checks for all staff, for example, Disclosure and Barring Service (DBS) checks, or risk assessments for all staff providing a chaperone service for patients.
• The practice must ensure there is a comprehensive, business continuity plan in place.
• The provider must ensure systems or processes are established and operated effectively to carry out quality improvement activity to monitor improvement and implement formal governance arrangements to assess, monitor and mitigate risk and to ensure the quality and safety of services are provided and to take appropriate action where progress is not achieved as expected.
• The provider must establish an effective system for identifying, handling and responding to complaints from people who use the service.
• The provider must ensure compliance with the requirements of the Mental Capacity Act (MCA) 2005.
• The provider must ensure interpreting services are available for patients with communication difficulties.

The areas where the provider should make improvement are:

• The provider should proactively identify and support patients who are carers.
• The provider should review the national GP patient survey scores with the aim of improving patient satisfaction scores on GPs involvement in 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

Updated 10 May 2017

The provider was rated as inadequate for all key questions. The issues identified overall affected all patients including this population group.

The provider was rated as inadequate for the care of people with long-term conditions and improvements must be made.

Updated 10 May 2017

The provider was rated as inadequate for all key questions. The issues identified overall affected all patients including this population group.

The provider was rated as inadequate for the care of families, children and young people and improvements must be made.

• There were no systems to identify and follow up patients who were living in disadvantaged circumstances and who were at risk. For example, there was no child safeguarding register in place and the GP did not attend any safeguarding meetings. There was therefore no evidence that children and young people who had a high number of A&E attendances were being monitored.
• We were not provided with evidence of joint working with midwives, health visitors and school nurses.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• In 2014/15 the percentage of women aged 25-64 who had attended cervical screening within the last five years was 84%, comparable to the local average of 79% and national average of 82%. In 2015/16 the rate was 81%, compared to the CCG average of 78% and national average of 81%

Updated 10 May 2017

The provider was rated as inadequate for all key questions. The issues identified overall affected all patients including this population group.

The provider was rated as inadequate for the care of older people and improvements must be made.

• Nationally reported data showed that the exception reporting for conditions commonly found in older people such as atrial fibrillation were higher than local and national averages. For example, the exception reporting rate for atrial fibrillation in 2014/15 was 19%, compared to the CCG and national average of 11%. There was no evidence of what action had been taken to improve in this area. However, the exception reporting rate for this indicator in 2015/16 was 6%, compared to the CCG average of 5% and national average of 7%.
• The practice offered personalised care to meet the needs of the older people in its population.
• Home visits were available and there was access to appointments.
• The practice had access for those with poor mobility.

Updated 10 May 2017

The provider was rated as inadequate for all key questions. The issues identified overall affected all patients including this population group.

The provider was rated as inadequate for the care of working age people (including those recently retired and students) and improvements must be made.

• The age profile of patients at the practice was mainly those of working age, students and the recently retired but the services available did not fully reflect the needs of this group.
• Although the practice offered extended opening hours for appointments on Monday, patients could not order repeat prescriptions online and there was no practice website.
• Health promotion advice was offered but there was limited accessible health promotion material available through the practice.

Updated 10 May 2017

The provider was rated as inadequate for all key questions. The issues identified overall affected all patients including this population group.

The practice is rated as inadequate for the care of people experiencing poor mental health (including people with dementia) and improvements must be made.

• The 2014/15 Quality and Outcomes Framework performance rate showed that 91% of patients with dementia had their care reviewed in a face-to-face meeting in the last 12 months, which was higher than the local average of 83% and national average of 84%. The 2015/16 performance rate showed that 94% were reviewed, compared to the CCG average of 81% and national average of 84%.
• The practice worked with multi-disciplinary teams in the case management of people experiencing poor mental health but not always those with dementia.
• Performance demonstrated that 100% of the 19 patients with mental health conditions on the register had a comprehensive care plan documented in their notes which was higher than the local average of 90% and national average of 88%. The 2015/16 data remained the same.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Not all staff had received training on how to care for people with mental health needs.

Updated 10 May 2017

The provider was rated as inadequate for all key questions. The issues identified overall affected all patients including this population group.

The practice is rated as inadequate for the care of people whose circumstances may make them vulnerable and improvements must be made.

• The practice did not hold a register of patients living in vulnerable circumstances.
• Not all staff knew how to recognise signs of abuse in vulnerable adults and children and they were not aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies out of normal working hours.
• The arrangements for seeking consent to care and treatment in line with legislation and guidance were inadequate.
• There were no policies or arrangements to allow people with no fixed address to register at the practice.
• The practice did not inform vulnerable patients how to access various support groups and voluntary organisations.