The Care Quality Commission (CQC) have suspended Tulasi Medical Centre, a GP service covering Barking and Dagenham following an inspection undertaken in May and June.
CQC inspected the service run by Dr Ravali Krishna Goriparthi which operates from Bennett’s Castle Lane and Parsloes Avenue in Dagenham, and Ripple Road in Barking, after receiving information indicating the practice may not have been ensuring patient safety.
The concerns were substantiated and following the inspection the service’s rating has dropped from good to inadequate.
Following the latest inspection and due to the serious issues identified, CQC suspended the practice. This means it is not currently able to provide care and treatment to people.
NHS North East London, which commissions GP services across north-east London, has arranged a caretaker provider to run GP services from Tulasi Medical Centre’s sites. This means patients can receive care and treatment where they usually would, with assurance their needs can be safely met.
CQC will not lift its suspension of Dr Ravali Krishna Goriparthi as a provider of GP services unless it is assured enough work has been undertaken to ensure patient safety.
Andy Ford, CQC head of primary care service inspection, said:
“People weren’t receiving care and treatment meeting standards they had a right to expect at Tulasi Medical Centre while it was under Dr Ravali Krishna Goriparthi’s leadership.
“This included a lack of processes to keep people safe from poor care and abuse, a lack of collaboration with other services and inconsistent work to help people live healthier lives.
“We also found people couldn’t always access care in a timely way, patient feedback was negative and medication reviews weren’t routinely carried out, which was putting people at risk.
“Following the inspection and due to the serious failings, we rated the practice inadequate overall and suspended its registration.
“We will not lift our suspension unless we are assured patients will receive safe and effective care and treatment.
“In the meantime, GP services are being provided from Tulasi Medical Centre’s sites by another provider.”
The inspection found:
- The practice’s safeguarding arrangements were inadequate, and some staff did not know who the safeguarding leads were
- There was insufficient monitoring of patients on high-risk medication
- There were gaps in recruitment checks, including insufficient employment history for three of the records reviewed. There was also one reference provided for a new member of staff, instead of two as per recruitment policy
- Fire alarm testing records for the main site on Bennett’s Castle Lane showed all six of the tested sounders and beacons failed, and a detector in the reception office failed to test. There was no evidence provided by the practice to show these recommendations were acted upon
- There were some gaps in infection control procedures. Inspectors were not assured all staff had received effective training on infection control as the practice did not provide these to CQC when requested during and after the inspection
- Management of waste and clinical specimens was poor. A biohazard clinical sample box was in the patient waiting within reach of small children
- Inspectors were not assured there was an adequate system for processing new patient information. During the site visit on 25 May, inspectors found 2,504 patient records awaiting processing. This meant CQC could not be assured the practice had full and detailed medical records available for a patient’s first and later consultations
- Systems to refer patients to specialist services were inadequate. Clinicians were not completing referral forms correctly by either not signing them or not ticking every relevant box, meaning these referrals were rejected by the hospital
- Blank prescriptions were not kept securely, and their use was not monitored in line with national guidance
- The practice did not have systems and processes to keep clinicians up to date with current evidence-based practice. There was no evidence of clinical meetings taking place between the GPs and practice nurses where current guidelines were discussed
- Patients’ immediate and ongoing needs were not always fully assessed
- Patients presenting with symptoms which could indicate serious illness were not followed up in a timely and appropriate way. For example, one patient had overdue cancer care and medication reviews, so was at risk of a late cancer diagnosis and complications.
However:
- The practice proactively identified older patients who were living with moderate or severe frailty. These patients received a full assessment of their physical, mental and social needs, either face-to-face or through a home visit
- All patients with a learning disability were offered an annual health check
- There were enough staff to meet patient need. Overtime was monitored to ensure it was in place for cover purposes, not high workload.