Archived: Dr Asha Sen Also known as Dr A Sen

Updated 15 June 2017

The practice operated from one site in Plumstead. It was one of 42 GP practices in the Greenwich Clinical Commissioning Group area. There were approximately 3,900 patients registered at the practice at the time of our inspections. The practice was previously registered with the Care Quality Commission (CQC) to provide the regulated activities of diagnostic and screening procedures, family planning, maternity and midwifery services, and treatment of disease, disorder or injury.

The provider had a personal medical services contract with the NHS and was signed up to a number of enhanced services (enhanced services require an enhanced level of service provision above what is normally required under the core GP contract). These enhanced services included influenza and pneumococcal immunisations.

The provider had a higher than average population of female patients aged from birth to 59 years, and male patients aged from birth to 29 years and from 45 to 54 years. Income deprivation levels affecting children and adults registered at the practice were above the national average.

The clinical team included a female GP. The GP was not providing any clinical sessions at the time of the two most recent inspections due to the suspension, and subsequent cancellation, of their registration with the CQC. There were four female salaried practice nurses. The clinical team was supported by a practice manager and four reception/administrative staff.

The practice is now closed. It was previously open between 8.00am and 6.30pm Monday to Friday and was closed on bank holidays and weekends. It offered extended hours from 6.30pm to 8.00pm Thursday. Appointments were available from 9.00am to 1.00pm and from 4.00pm to 6.30pm Monday to Friday. There are two consulting rooms and a treatment room on the ground floor. On the first floor there is a consulting room used by an external counsellor and an osteopath.

There was wheelchair access and baby changing facilities. There was car parking available in the surrounding streets, and limited parking on the premises.

The practice directed patients needing care outside of normal hours to call the NHS non-emergency number 111.

Updated 15 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Dr Asha Sen at the location of 12 The Slade, Plumstead, London, SE18 2NB, on 10 March 2016. Overall the practice was rated as inadequate and placed into special measures. Being placed into special measures represents a decision by the Care Quality Commission (CQC) that a provider has to improve their service within six months to avoid the CQC taking steps to cancel their registration. Because of the concerns we found during the inspection we also served the provider with a notice to impose an urgent suspension of the provider’s regulated activities for a period of six months from 18 March to 18 September, under Section 31 of the Health and Social Care Act 2008. The comprehensive report was published on 26 May 2016 and can be found by selecting the ‘all reports’ link for Dr Asha Sen on our website at www.cqc.org.uk. During the March 2016 inspection our key findings were as follows:

• There was insufficient leadership capacity and limited governance arrangements. Policies had not been updated and there was no evidence of regular staff meetings. Some staff were not aware of their roles.

• Systems and processes in relation to infection control, assessing and managing risks, fire safety, responding to serious incidents, recruitment processes, medicines management and prescribing practices were not effective enough to keep patients safe.
• Confidential information had not been stored securely.
• The provider did not have sufficient amounts of emergency medicines and equipment.
• There was no evidence to demonstrate that complaints had been handled appropriately.
• There was no evidence to show that audits were driving improvement.
• Patients rated the provider significantly below local and national averages for several aspects of care, and there was minimal engagement with people who used the service.
• Training needs had not been identified and there were gaps in key training.
• Recruitment processes were not effective.

Practices placed in special measures are inspected again within six months. The provider submitted an action plan to tell us what they would do to make improvements and meet the legal requirements. We undertook an announced focused follow-up inspection on 5 September 2016 to check the provider had followed their action plan, and to confirm that they had met the legal requirements. Because the provider had made very limited improvements and had not addressed key issues which affected the safety and wellbeing of patients, they remained rated as inadequate and in special measures. We took action in line with our enforcement procedures to begin the process of preventing the provider from operating the service by extending their suspension for a further period of six months. We also issued the provider a notice informing them that we intended to cancel their registration with the CQC. The follow-up inspection report was published on 17 November 2016 and can be found by selecting the ‘all reports’ link for Dr Asha Sen on our website at www.cqc.org.uk. Our key findings across all the areas we inspected in September 2016 were as follows:

• Governance arrangements were still not effective, and the provider had made very limited improvements. Policies required updating. There was still no evidence of regular staff meetings.

• The provider had still not established an effective system for recording and sharing learning from serious incidents.

• Systems and processes in relation to infection control, assessing and managing risks, fire safety, responding to serious incidents, recruitment processes, medicines management and prescribing practices were still not effective.
• The provider still did not have sufficient amounts of emergency medicines and equipment.
• There was still not established a programme of quality improvements including clinical audits.
• Training needs had not been identified and there were still gaps in key training.
• The provider had still not reviewed or addressed areas of performance that patients had rated as being significantly below local and national averages.
• Recruitment processes had not been improved.

The provider submitted an updated action plan. They were kept under review and on 17 February 2017, while the practice remained suspended and rated as inadequate, we carried out an announced focused follow-up inspection of the service to check whether the provider had made sufficient improvements to allow the suspension to end, and if any further enforcement action was necessary. The provider had made further improvements but was still not addressing key issues that affected the safety and wellbeing of patients, and we took the decision to close the service by cancelling the provider’s registration with the CQC. The provider remains rated as inadequate.

This report only covers our findings in relation to our focused inspection in February 2017, which are as follows:

• The provider was still not addressing key issues affecting the health and safety and wellbeing of service users. There was a lack of cohesion and shared understanding between the practice’s leaders.

• Serious incidents had still not been recorded or discussed with practice staff to share learning and prevent similar occurrences from happening again.

• The provider had still not established effective arrangements for assessing, managing and monitoring risks, and had not established a schedule of quality improvement.

• Several members of staff had either not received key training, or required training updates.

• Some policies were still not fit for purpose.

• The provider had taken some positive steps to improve medicines management, holding and documenting meetings, the availability of emergency medicines and equipment, and they had begun to address an aspect of feedback from patients.

During this inspection we identified breaches of regulations 12 (safe care and treatment), 17 (good governance) and 18 (staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Had we not cancelled the provider’s registration, we would have advised that they must:

• Ensure effective and sustainable clinical governance systems and processes are implemented to assess, monitor and improve the quality of the services provided, and implement an effective strategy to ensure the delivery of high quality care. This includes establishing a programme of audits including clinical audits, recording and discussing serious incidents, ensuring there are appropriate policies to enable staff to carry out their roles, practice policies are followed, relevant records for persons employed are obtained, and all records pertaining to the running of the service are suitably maintained.

• Establish an effective system to assess the training needs of staff, ensure all staff receive training relevant to their roles, and ensure this training is appropriately updated.

• Assess, mitigate and monitor risks to the health and safety of service users and others that may be at risk. This is particularly in relation to fire safety, Legionella infection, and the availability of medicines.

We would also have advised that the provider should:

• Continue efforts to address feedback from patients and implement actions to improve patient satisfaction, and advertise translation services to inform patients that they were available.

We cancelled the registration of this provider on 29 March 2017.