The Care Quality Commission
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Archived: Dr Durairaj Jawahar and Partners Also known as ManorPark Medical Practices

Overall: Inadequate read more about inspection ratings

122 Parker Drive, Leicester, Leicestershire, LE4 0JF (0116) 235 3148

Provided and run by:
Dr Durairaj Jawahar and Partners

All Inspections

13/01/2022 17/01/2022

During a routine inspection

We carried out an announced focussed inspection at Dr Durairaj Jawahar and Partners, Manor Park Medical Centre on 12th January 2022 to 17th January 2022. We did not visit the practice situated at 122 Parker Drive, Leicester, LE4 0JF

Overall, the practice is rated as Inadequate .

Safe - Inadequate

Effective - Inadequate

Well-led - Inadequate

Following our previous inspection on 8 April 2021, the practice was rated Requires Improvement overall and for all key questions and population groups except for people with long term conditions which was rated Inadequate. A breach of regulation 12 was identified regarding safe care and treatment.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Dr Durairaj Jawahar and Partners on our website at www.cqc.org.uk

Why we carried out this inspection

This focused inspection, including a remote review of clinical records and a site visit, was conducted following concerns which were received to the CQC around a backlog of correspondence and tasks and low staffing numbers. We inspected the key questions of safe, effective and well led.

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

  • Completing clinical searches on the practice’s patient records system and discussing findings with the provider
  • Reviewing patient records to identify issues and clarify actions taken by the provider
  • A site visit

Our findings

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 Inadequate overall

We found that:

  • Patients were not receiving safe care and treatment at the practice.
  • Actions to review and monitor patients had not been implemented including regular reviews and ongoing monitoring. This left patients at risk of harm.
  • Safeguarding concerns, including adults and children, were not appropriately recorded, acted on or monitored which left people at risk of harm.
  • The practice did not always recognise and act on patients who needed clinical care or urgent reviews.
  • There was a lack of suitably competent staff to carry out roles within the practice.
  • There was a lack of clinical oversight and governance within the practice.
  • The practice did not recognise incidents or risks to patients and did not effectively mitigate any risks they were aware of.
  • There was a lack of clarity around appointments being offered with the GP’s and staff reported that GP’s often finished early leaving them unable to carry out other appointments without a GP on site.
  • The system in place to deal with significant events was not effective.
  • There was no system to deal with complaints.

We found seven breaches of regulations. The provider must:

  • Ensure the care and treatment of patients is appropriate, meets their needs and reflects their preferences
  • Ensure care and treatment is provided in a safe way to patients
  • Ensure patients are protected from abuse and improper treatment
  • Ensure that any complaint received is investigated and any proportionate action is taken in response to any failure identified by the complaint or investigation. Ensure there is an effective system for identifying, receiving, recording, handling and responding to complaints by patients and other persons in relation to the carrying on of the regulated activity
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care
  • Ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons are deployed to meet the fundamental standards of care and treatment
  • Act in accordance with the Duty of Candour

As a result of the inspection team’s findings from the announced focused inspection and the risk to service users’ life, health and wellbeing, the Commission decided to apply to Leicester Magistrates’ Court to cancel the providers registration to carry out these regulated activities under section 30 of the Health and Social Act 2008.

Section 30 of The Health and Social Care Act 2008 is one of the most severe enforcement powers available to the Commission. Section 30 allows the Commission to make an urgent application to the Magistrates Court seeking urgent cancellation of registration, if, unless the order is made, there will be a serious risk to a person’s life, health or wellbeing. The order for cancellation was granted by the Magistrates Court on Thursday 20 January 2022 and served upon the provider with immediate effect. The provider, which was a partnership of five GP’s, is therefore unable to carry on the regulated activities.

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

8 April 2021

During a routine inspection

We carried out a comprehensive inspection at Dr Durairaj Jawahar and Partners on 8 April 2021. Due to the impact of the COVID-19 pandemic, the majority of evidence reviewed, and staff interviews were undertaken remotely following the 8 April 2021.

The practice had previously received a comprehensive inspection in October 2015 when it received an overall rating of good with all domains rated as good.

You can read the comprehensive inspection reports by selecting the 'all reports' link for Dr Durairaj Jawahar and Partners on our website at www.cqc.org.uk

Following our inspection in April 2021, the practice is now rated as requires improvement overall. The practice is rated as requires improvement for safe, caring, effective, responsive and well led services.

All population groups under the responsive domain are requires improvement.

Population groups under the effective domain are requires improvement for older people, Working age people, People whose circumstances make them vulnerable, People experiencing poor mental health and Families, children and young people. People with long-term conditions was rated as inadequate in the effective domain.

The service is now rated as requires improvement for providing safe services because:

  • At this inspection we found there were systems and processes in place, however they were not embedded as part of a regular system to ensure prescribing was safe.
  • For example, when an alert was received from the Medicines and Healthcare products Regulatory Agency (MHRA) an audit would be conducted to ensure patients’ care was in line with the alert and changes made where appropriate. However, the audit was not regularly run to ensure patients new to the practice or prescribed medicines after the alert were receiving safe care. As a result, we found small numbers of patients being prescribed medicines against best practice guidelines.

The service is now rated as requires improvement for providing effective services because:

  • At this inspection we found there were monitoring and diagnoses concerns when we looked into patients’ records.
  • Patients had not all received a regular medicines review and the ones who had were not completed in a standardised way.
  • Patients were not always coded correctly with a diagnosis which meant they did not always receive the care they might need in line with best practice guidelines.

The service remains rated as requires improvement for providing caring services.

  • At this inspection we found there were lower than local average results to the patient survey results. Although due to the pandemic the practice had not been able to complete a patient survey to see if things they had changed, such as the telephone system, had improved the service they provided.

The service remains rated as requires improvement for providing responsive services.

  • At this inspection we found data indicated some indicators were below the local and national average for the patient national survey. Although the practice had made changes; these were yet to show improvement through surveys.

The service is now rated as requires improvement for providing well-led services because:

  • At this inspection we found there was a lack of consistent oversight of patient care. For example, management of long-term conditions to best practice guidelines and recognising newly diagnosed patients with conditions such as diabetes and kidney disease. This had led to some patients not having annual reviews and medicine reviews.
  • However, once we highlighted this during the inspection process the practice were proactive in making appropriate changes to the way patients were coded and to the relevant medicines patients were prescribed.

In addition, the provider must:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

16 July 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr S M Arolker and Partners on 16 July 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, well-led, effective, caring and responsive services. It was also good for providing services for all the population groups.

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

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
  • Risks to patients were assessed and well managed.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand.
  • Patients said they found it difficult to make an appointment with a named GP but urgent appointments were available the same day.
  • There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

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

Importantly the provider should:

  • Consider improved ways to deliver effective multi-disciplinary working in relation to safeguarding and palliative care patients.
  • Ensure a whistleblowing policy is in place and that staff know how to access it.
  • Ensure the defibrillator at Parker Drive is accessible to staff at all times.
  • Ensure that reception staff know how to act appropriately when patients with urgent treatment needs contact the surgery, for example breathlessness.
  • Ensure action plan for learning disability reviews is monitored through the practice meetings.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

16 July 2014

During a routine inspection

Dr Arolker and partners provides primary medical services for a local population of approximately 15,000 patients.  A branch surgery is also provided at The Manor Medical Centre and the practice population is split between the two sites. We did not inspect the Manor Medical Centre branch surgery as part of this inspection.

We spoke with nine patients and reviewed fifteen completed comment cards. These had been completed by patients before the inspection and were used to gather information about the experiences of patients who used the service. We spoke with one local care home to find out what their views of the practice were. On the day of inspection we spoke with the chair of the patient participation group (PPG), three GPs and other staff including the practice manager from Parker Drive Medical Centre and the practice manager from the Manor Medical Centre, a practice nurse, health care assistant and administration staff.  We observed how staff interacted with patients.

As part of the planning of this inspection, we looked at the data provided by the local Clinical Commissioning Group (CCG).  During the inspection we looked at procedures and systems used and all of this information helped us to identify whether the practice was safe, effective, caring, responsive to people’s needs and well-led.

We noted that the practice serves predominantly a working age population. However we found that the practice responded to the needs of older people; people with long term conditions; mothers, babies, children and young people; the working age population; people in vulnerable circumstances; and, people who were experiencing poor mental health.

We found that although some systems were in place to ensure patients were safe, medication management systems were not all robust. There were no checks in place to ensure medication in GP’s bags was within its expiry date and available for use. Records to demonstrate that ‘cold chain’ had been maintained for travel vaccinations transported to the branch surgery were not available.

The inspection found that the practice was in breach of the regulations relating to:

Management of medicines

Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.