The Care Quality Commission
  • Doctor
  • GP practice

Harraton Surgery

Overall: Inadequate read more about inspection ratings

3 Swiss Cottages, Washington, Tyne And Wear, NE38 9AB (0191) 416 1641

Provided and run by:
Dr Inder Singh

Important:

We served a Notice of Decision to impose conditions on the registration of Dr Inder Singh on 21 November 2024 for failing to meet the regulations in relation to good governance at Harraton Surgery.

All Inspections

14 and 18 April 2023

During a routine inspection

We carried out an announced inspection at Harraton Surgery on 14 and 18 April 2023. Overall, the practice is rated as Inadequate.

The key question ratings were as follows:

Safe - Inadequate

Effective – Requires improvement

Caring – Good

Responsive - Requires improvement

Well-led – Inadequate

Following our previous inspection on 28 July 2021, the practice was rated Good overall and for all key questions apart from whether the service was well-led, which we rated as requires improvement. This was because the leadership, governance and culture did not always support the delivery of high-quality sustainable care.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Harraton Surgery on our website at www.cqc.org.uk.

Why we carried out this inspection

This inspection was a follow-up inspection, to check what progress the provider had made to improve on those areas we said they should at the last inspection. We had also received some information of concern.

How we carried out the inspection/review

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included:

  • Conducting staff interviews using video conferencing
  • 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.
  • Requesting evidence from 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 have rated the key questions of safe and well-led services as Inadequate. We rated the practice as Requires improvement for providing effective and services. We rated the practice as Good for providing caring services.

We rated the practice as inadequate for providing safe and well led services because:

  • The practice did not always have clear systems, practices and processes to keep people safe and safeguarded from abuse.
  • The provider failed to assess the risk of the prevention, detection, and control of the spread of infections.
  • We found that safety and operating procedures were not always sufficient or effective.
  • We were concerned there were not enough staff to provide nursing appointments and to prevent staff from working excessive hours.
  • The practice did not have systems in place for the appropriate and safe use of medicines.
  • The provider could not demonstrate that they had the capacity and skills to deliver high quality sustainable care.
  • Communication mechanisms within the practice continued to be ineffective.
  • The practice continued to struggle to build a sustainable and stable clinical team and there was low morale amongst staff.
  • Governance arrangements were ineffective.
  • There were not clear and effective processes for managing risks, issues and performance.

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

  • Care and treatment at the practice did not always reflect current evidence-based guidance, best practice during assessment and when managing long term conditions.
  • Few clinical audits had been carried out and treatment was not always monitored regularly or robustly, including cervical screening. Results of monitoring were not always used effectively to improve quality.
  • The practice were not actively supporting carers.
  • Patients had not been formally consulted on their needs and what they thought of the service.
  • The premises had not been maintained to an appropriate standard to meet patient’s needs.

We rated the practice as good for providing caring services because:

  • The National GP Survey results were close to the England averages.
  • The practice had 5% of their practice population registered as carers.

The areas where the provider must make improvements as they are in breach of regulations are:

  • Ensure care and treatment is provided in a safe way to patients.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

This is in accordance with the fundamental standards of care.

A final version of this report, which we will publish in due course, will include full information about our regulatory response to the concerns we have described.

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 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.

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

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services

28 July 2021

During an inspection looking at part of the service

We carried out an announced inspection at Harraton Surgery on 28 July 2021. Overall, the practice is rated as good.

The key question ratings were as follows:

Safe - Good

Effective – Good

Well-led – Requires Improvement

Following our previous inspection on 1 October 2019, the practice was rated Good overall and for all key questions apart from whether the service was well-led, which we rated as requiring improvement. This was because we had a concern about the capacity of the lead GP providing sessions across all four sites and the sustainability of this going forward.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Harraton Surgery on our website at www.cqc.org.uk.

Why we carried out this inspection

This inspection was a follow-up inspection, to check what progress the provider had made to improve on those areas we said they should at the last inspection. As we had received some information of concern, we inspected the three key questions, Safe, Effective and Well Led as part of our new methodology to carry out more focused inspections for those practices rated as good overall. All other ratings were carried forward from the October 2019 inspection.

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:

  • Conducting staff interviews using video conferencing
  • 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
  • Requesting evidence from the provider
  • A short 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 good overall and good for all population groups, apart from people with long-term conditions, which we rated as requires improvement.

We rated the practice as requires improvement for being effective for people with long term conditions because:

  • Care and treatment was not always delivered in line with current best practice.

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

  • The leadership, governance and culture did not always support the delivery of high-quality sustainable care
  • There was a culture of blaming others for incidents rather than looking objectively at what the practice could change to improve the care and support they offered to patients.
  • Communication mechanisms within the practice were ineffective.
  • The practice continued to struggle to build a sustainable and stable clinical team and there was low morale amongst staff.

We also found that:

  • The practice provided care in a way that kept patients safe and protected them from avoidable harm.
  • Staff worked together and with other organisations to deliver effective care and treatment.
  • Staff were not always given protected time to complete learning and development, because of the pressures of work.
  • The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic.

Whilst we found no breaches of regulations, the provider should:

  • Develop a culture of effective communication, which encourages candour, openness and honesty, supports effective learning and improvement and builds team morale.
  • Develop the process for significant events to build in effective identification and sharing of learning, which supports the duty of candour.
  • Continue to develop clinical governance processes to provide assurance that care and treatment are delivered in line with good practice and evidence-based guidance.
  • Develop and implement an effective strategy to build a sustainable and stable clinical team. Provide support for staff by continuing with the planned work on appraisals and the competence-based staff development framework.
  • Put in place appropriate authorisations to administer medicines via Patient Group Directions.

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

1 October 2019

During a routine inspection

We previously carried out an announced comprehensive inspection at Harraton Surgery on 21 February 2019. Overall the practice was rated as requires improvement. The domains of safe, and well-led were rated as requires improvement and the domains of effective, caring and responsive were rated good.

We carried out an announced comprehensive inspection on 1 October 2019.

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 rated the practice as good overall, the domains of safe, effective, caring and responsive rated as good, we rated the domain for being well-led as requires improvement.

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

  • Whilst the practice had taken steps to try to address issues identified during our inspection in February 2019 the current working pattern of the lead GP was not sustainable in the long-term which could have an impact on the standard and safety of care delivered.

We rated the practice as good for providing safe, effective, caring and responsive services because:

  • The practice provided care in a way that kept patients safe and protected them from avoidable harm.
  • Patients received effective care and treatment that met their needs.
  • 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 should make improvements are:

  • Continue to recruit additional staff to alleviate the unsustainable working pattern of the lead GP.

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

21 Feb tp 21 Feb

During a routine inspection

We carried out an announced comprehensive inspection at Harraton Surgery on 21 February 2019.

At this inspection we followed up on breaches of regulations identified at a previous inspection on 11 January 2018 when the practice was rated as requiring improvement overall.

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 requiring improvement for providing safe services because:

  • Whilst the practice had taken steps to address issues identified during our inspection in January 2018 in relation to the provision of a safe service we found during this inspection that they did not have appropriate systems in place for the safe management of medicines.

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

  • Whilst the practice had taken steps to address issues identified during our inspection in January 2018 in relation to the provision of a well-led service we found during this inspection that they did not have a clear vision supported by a credible strategy to provide high quality sustainable care.

We rated the practice as good for providing effective, caring and responsive services because:

  • Patients received effective care and treatment that met their needs.
  • 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:

  • Review the practice home visit policy to clearly reflect that requests for home visits should be assessed by a clinical member of staff.
  • Continue with plans to establish an effective patient participation group and seek members views on the running and development of the practice.

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

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

11 January 2018

During a routine inspection

Letter from the Chief Inspector of General Practice

This practice is rated as Requires Improvement overall. (Previous inspection May 2016 – Good)

The key questions are rated as:

Are services safe? – Requires Improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires Improvement

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Requires Improvement

People with long-term conditions – Requires Improvement

Families, children and young people – Requires Improvement

Working age people (including those recently retired and students – Requires Improvement

People whose circumstances may make them vulnerable – Requires Improvement

People experiencing poor mental health (including people with dementia) - Requires Improvement

We carried out an announced comprehensive/focused inspection at Harraton Surgery on 11 January 2018 as part of our inspection programme.

At this inspection we found:

  • The practice systems to manage risk required review to ensure that risks were more effectively identified and managed. We found that when incidents did happen, the practice learned from them and improved their processes.
  • Quality Outcomes Framework (QOF) for 2016/17 showed the practice had achieved 99.5% of the points available to them for providing recommended treatments for the most commonly found clinical conditions.
  • The practices governance system did not always support clinical effectiveness. We saw that these arrangements did not always ensure that care and treatment would be delivered according to evidence-based guidelines. Clinical staff had access to guidelines but the arrangement to ensure all staff were aware of changes were not clear. The arrangements to ensure all clinical staff acted in line with guidance on the management of sepsis were not effective.
  • Staff involved and treated patients with compassion, kindness, dignity and respect.
  • Most patients found the appointment system easy to use and reported that they were able to access care when they needed it.
  • The practice had merged with another local practice operated by the same provider on 4 October 2017; they were not able to demonstrate that they had a plan in place to manage the changes required within the practice.

The areas where the provider must make improvements are:

  • Ensure care and treatment are being provided in a safe way for service users. (See Requirement Notice Section at the end of this report for further detail).
  • Ensure effective systems and processes are in place to ensure good governance in accordance with the fundamental standards of care. (See Requirement Notice Section at the end of this report for further detail).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

6 May 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out a previous announced inspection of this practice on 22 September 2015. Breaches of legal requirements were found. Overall, we rated the practice as inadequate. After the comprehensive inspection the practice wrote to us to say what they would do to address the identified breaches.

We undertook this comprehensive inspection to check that the practice had followed their plan and to confirm that they now met legal requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Harraton Surgery on our website at www.cqc.org.uk.

Overall, the practice is rated as good.

Our key findings were as follows:

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had improved access to training to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • 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. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice had taken action to address the concerns raised at their previous CQC inspection. They had developed a clear vision, strategy and plan to deliver high quality care and promote good outcomes for patients.
  • The provider was aware of and complied with the requirements of the duty of candour.
  • We found the practice needed to further develop their approach to staff and patient engagement, to foster an open culture, where staff felt able to express their views and were confident that they would be acted upon.

There were also areas where the practice should make improvements. The practice should:-

  • Consider the practice approach to appraisal so all staff have the benefit of a collaborative appraisal, which clearly identifies performance and learning needs.
  • Continue with the progress made with staff training to address any remaining gaps, to ensure staff have the knowledge and skills needed to do their job.
  • Consider how they can ensure the sustainability of improvements made and have robust and effective succession planning in place.
  • The practice should continue to improve their approach to seeking and acting on feedback from patients and staff, to demonstrate continuous improvement and that they are a ‘listening’ organisation.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

22 September 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Harraton Surgery on 22 September 2015. Overall the practice is rated as inadequate.

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.

Our key findings were as follows:

  • The practice carried out assessments and treatment in line relevant and current evidence based guidance and standards.
  • Patients were positive about their interactions with staff and said they were treated with compassion and dignity.
  • Patients said they felt involved in decisions made about their care and treatment.
  • Information about services and how to complain was available and easy to understand.
  • Patients said they were able to get an appointment with a GP when they needed one, with urgent appointments available the same day, although some felt they waited too long to be called in for their appointment.
  • Staff said managers were approachable but they were not involved in discussions about how to run and develop the practice, or encouraged to identify opportunities to improve the service delivered by the practice.
  • When things went wrong, reviews and investigations were not sufficiently thorough and lessons learned were not communicated widely enough to support improvement .
  • Staff had not received the training necessary to carry out their roles effectively.

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

Importantly, the provider must:

  • Put effective systems in place to manage and monitor the prevention and control of infection.
  • Take action to ensure the fridges used for storing vaccines are fit for purpose and minimum and maximum temperatures are checked.
  • Ensure that there are formal governance arrangements in place, including systems for assessing and monitoring the quality of the service provision. Staff must have appropriate policies and guidance to carry out their roles in a safe and effective manner This should include putting in place a practice specific safeguarding policy for staff to follow.
  • Provide appropriate training for all staff, including training on fire safety, infection control, safeguarding and information governance.
  • Review staffing levels within the administrative and cleaning staff teams to ensure sufficient staff are deployed. This should include ensuring that appropriate numbers of staff are trained to complete referral letters.

In addition the provider should:

  • Update the business continuity plan to include relevant contact details and reference to current NHS organisations.
  • Ensure that recruitment information is available for each person employed.

I am placing this practice in special measures. Practices 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 practice 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 vary the provider’s registration to remove this location or cancel the provider’s registration.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice