The Care Quality Commission
  • Doctor
  • GP practice

Archived: Dr Kandiah Pathmanathan Also known as Covent Garden Medical Centre

Overall: Good read more about inspection ratings

47 Shorts Gardens, London, WC2H 9AA (020) 7379 7209

Provided and run by:
Dr Kandiah Pathmanathan

Important: The provider of this service changed. See new profile

All Inspections

16 May 2019

During a routine inspection

We carried out an announced comprehensive inspection at Dr Kandiah Pathmanathan (also known as Covent Garden Medical Centre) on 16 May 2019.

We had previously inspected Dr Kandiah Pathmanathan’s practice using our new approach methodology on 5 March 2015, when we had rated the service as requires improvement. We carried out a further announced comprehensive inspection on 8 November 2016.

The overall rating for the service was inadequate and the practice was placed in special measures for a period of six months. We had found that patients were at risk of harm because systems and processes were not in place in a way to keep them safe.

We carried out a focussed inspection on 18 May 2017 and identified other concerns relating to safe care and treatment. Following the period of special measures, we carried out an announced comprehensive inspection on 8 August 2017. We found that although the practice had achieved significant improvement, concerns remained regarding GP national survey patient satisfaction scores and regarding patient outcomes, such that the practice was rated as requires improvement relating to a failure to comply with Regulation 12 (Safe care and treatment) and 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The improvements were sufficient however, for the service to be taken out of special measures. We carried out an announced comprehensive inspection on 10 October 2018 to follow up on these identified breaches of regulations and asked the provider to make improvements because although the care being provided was effective, caring, responsive and well led, it was not being provided in accordance with the relevant regulations relating to safe care.

Specifically, we found the provider had breached Regulation 12 (1) (Safe care and treatment). This was because dosage and patient assessment information contained in the practice’s Patient Specific Directions were not being checked and signed by a registered prescriber prior to their use by the practice’s Health Care Assistant.

Shortly thereafter the service wrote to us to tell us what they would do to make improvements. We undertook this comprehensive inspection to check the service had followed their plan and to confirm they had met the legal requirements.

At the time of our 16 May 2019 inspection, Dr Kandiah Pathmanathan had recently retired and transferred their NHS contract to a new principal GP who was in the process of deregistering the location and registering as a new CQC location.

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.

We found that:

  • Action has been taken since our last inspection such that staff now had the appropriate authorisations to administer medicines.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • Patients could access care and treatment in a timely way.
  • Although we identified some governance concerns regarding safeguarding and regarding how incoming correspondence was actioned, overall the way the practice was led and managed promoted the delivery of high-quality, person-centre care.

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

  • Continue to monitor and take action to improve national GP patient survey satisfaction on the extent to which staff treated patients with care and concern.
  • Continue to monitor and take action to improve patient outcomes regarding childhood immunisations.
  • Continue to monitor recently introduced protocols for safeguarding vulnerable patients and managing incoming correspondence.

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

10/10/2018

During a routine inspection

This practice is rated as Good overall. (Previous rating 8 August 2017– Requires Improvement).

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? – Good

We had previously inspected Dr Kandiah Pathmanathan’s practice using our new approach methodology on 5 March 2015, when we had rated the service as requires improvement.

We carried out a further announced comprehensive inspection on 8 November 2016. The overall rating for the service was inadequate and the practice was placed in special measures for a period of six months. We had found that patients were at risk of harm because systems and processes were not in place in a way to keep them safe. We served Warning Notices under Section 29 of the Health and Social Care Act 2008 relating to the practice’s failure to comply with Regulation 12 (Safe care and treatment) and 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We carried out a focussed inspection on 18 May 2017 and identified other concerns relating to safe care and treatment.

Following the period of special measures we carried out an announced comprehensive inspection on 8 August 2017. We found that although the practice had achieved significant improvement, concerns remained regarding GP national survey patient satisfaction scores and regarding patient outcomes, such that the practice was rated as requires improvement relating to failure to comply with Regulation 12 (Safe care and treatment) and 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The improvements were sufficient however, for the service to be taken out of special measures.

We carried out an announced comprehensive inspection on 10 October 2018 to follow up on these identified breaches of regulations. At this inspection we found:

  • The practice had acted since our last inspection to improve childhood immunisations uptake and to improve care for patients with long term health conditions, such that performance was now comparable with local and national averages.

  • The practice had acted since our last inspection, such that GP patient survey scores were now comparable with local and national averages.
  • The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
  • However, we also noted that systems, processes and practices were not always reliable or appropriate to keep people safe. For example, the service had not introduced a protocol to ensure that its newly appointed Health Care Assistant was working within their professional competency.
  • The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.
  • Staff involved and treated patients with compassion, kindness, dignity and respect.
  • Patients found the appointment system easy to use and reported that they could access care when they needed it.
  • There was a strong focus on continuous learning and improvement at all levels of the organisation.

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

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

The areas where the provider should make improvements are:

  • Continue to monitor its new cervical screening uptake ‘failsafe’ system for identifying where a result has not been logged.
  • Review current baby changing arrangements.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

8 August 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We had previously inspected Dr Kandiah Pathmanathan’s practice using our new approach methodology on 5 March 2015, when we had rated the service as requires improvement.

We carried out a further announced comprehensive inspection on 8 November 2016. The overall rating for the service was inadequate and the practice was placed in special measures for a period of six months. We had found that patients were at risk of harm because systems and processes were not in place in a way to keep them safe. We served warning notices under Section 29 of the Health and Social Care Act 2008 relating to the practice’s failure to comply with Regulation 12 (Safe care and treatment) and 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We carried out a focussed inspection on 18 May 2017 and identified other concerns relating to safe care and treatment.

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 8 August 2017. We found that the practice had achieved substantial improvement, although more was required. The improvement and changes made in respect of governance need to be embedded and sustained. Overall the practice is now rated as requires improvement.

Our key findings were as follows:

  • Although we saw evidence of improvement, outcomes for patients with some long term health conditions and the uptake rate for childhood immunisations remained lower than local and national averages.
  • Some GP patient survey scores remained below local and national averages.
  • Revised procedures had been implemented to manage significant events, infection prevention and control measures, health and safety, and arrangements for dealing with emergencies.
  • The practice had revised its repeat prescribing protocol to ensure that patients on high risk medicines were appropriately monitored.
  • Systems had been introduced to ensure that tests results were reviewed and actioned in a timely manner.
  • Staff had received sufficient training to make effective use of the clinical computer system.
  • The management of patient records had improved, with the recording of full medical histories, notes of consultations, Read coding and correspondence being saved into the records.
  • Procedures had been implemented so that staff assessed patients’ needs and delivered care in line with current evidence based guidance.
  • The practice had carried out a number of competed cycle audits to drive improvement in patient outcomes.
  • Governance procedures and protocols had been reviewed and were saved in a centrally accessible location.

There were areas where the provider needs to make improvements.

The practice must:

  • Ensure the care and treatment of patients is appropriate, meets their needs and reflects their preferences.

In addition, the practice should:

  • Take steps to improve the take up rate for standard childhood immunisations.
  • Consider how patients who wish to see a female practitioner at the practice can do so.
  • Take action to improve patients’ satisfaction over GP consultations.
  • Review record keeping at clinical meetings.

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

Professor Steve Field

CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

18 May 2017

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Kandiah Pathmanathan’s practice on 8 November 2016. The overall rating for the practice was inadequate and the practice was placed in special measures.

We had found that patients were at risk of harm because systems and processes were not in place in a way to keep them safe: -

  • We had concerns in relation to how significant incidents were managed, including learning and reflective practice; with infection prevention and control measures; the management of medicines; health and safety; and arrangements for dealing with emergencies.
  • Risks to patients were not consistently assessed, monitored or managed. We identified a number of pathology test results which had not been reviewed and processed for several weeks; and from a review of patients on high risk medication we found no evidence of regular blood tests being carried out to ensure that patients were being prescribed medication safely.
  • Patients’ care and treatment did not consistently reflect current evidence-based guidelines.
  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were generally below local and national averages.
  • Staff were insufficiently trained to make full and effective use of the practice’s clinical computer system.
  • Patient feedback indicated delays in obtaining routine appointments.
  • The provider told us that due to pressure of work he had to concentrate on patients with acute healthcare issues, leaving the practice nurse to manage patients with long-term conditions.
  • The practice’s aims and objectives were set out in its statement of purpose, but this was out of date and in need of revision. There were no detailed or realistic plans to achieve the aims and objectives.
  • The delivery of high-quality care was not assured by the governance arrangements in place. The practice had a number of policies and procedures to govern activity, but some of these were overdue a review.
  • There was no effective system for monitoring performance by means of frequent audits or effective use of the practice management computer system.

We served warning notices under Section 29 of the Health and Social Care Act 2008 relating to the practice’s failure to comply with Regulation 12 (Safe care and treatment) and 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The full comprehensive report on the November 2016 inspection can be found by selecting the ‘reports’ link for Dr Kandiah Pathmanathan on our website at http://www.cqc.org.uk/location/1-497637421.

After the inspection, the practice sent us a plan of the action it intended to take to improve the quality of care and meet the legal requirements. As a consequence of being placed in special measures, the practice had been receiving support from various agencies, including the Royal College of General Practitioners and specialist consultants. This inspection was an announced focussed inspection carried out on 18 May 2017 looking at the issues for which we had served warning notices to check and confirm that the practice had carried out its plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 8 November 2016. This report covers our findings in relation to those requirements since our last inspection.

Overall the practice remains rated as inadequate.

Our key findings were as follows:

  • We reviewed a number of patients’ records and found that they contained very limited information, by way of medical history and notes of consultations. The provider very rarely made use of Read codes, the standard clinical terminology system for maintaining patients’ records and performance monitoring. These fell below appropriate and acceptable standards of medical record-keeping, putting patients at risk of receiving inappropriate or unsafe care and treatment.
  • Hospital referral letters were not consistently copied onto patients records. The referral letters we saw also contained very little information regarding symptoms and possible diagnoses. This might compromise the effectiveness of the referral and not ensure that patients receive appropriate and safe care and treatment.
  • The practice had commenced reviewing it protocols and procedures. However, the documents had been saved in three different locations on the computer system, making it difficult for staff to access them quickly when they needed to refer to them. Accordingly, there was the possibility that the protocols and procedures might not be followed, putting patients at risk.
  • Staff were still not able to consistently demonstrate a familiarity with the clinical system sufficient to use it effectively, to ensure that safe care and is provided to patients and that performance was monitored.
  • Although we had been told that the practice’s statement of purpose had been revised, it was not available for us to see to establish the practice’s plans for achieving its aims and objectives.
  • We had been told previously that the practice manager was to be given guidance and formal mentoring by the manager of a nearby practice. However, it was not clear that the mentoring plans had been taken any further forward.

Importantly, the practice must:

  • Ensure that patients’ records are maintained to appropriate and acceptable standards, including full medical histories, full and accurate notes of consultations and Read codes.
  • Ensure that hospital referral letters contain sufficient and appropriate information and that the letters are included on patients’ records.
  • Ensure that all procedures and protocols are readily accessible to staff.
  • Ensure that all staff members receive sufficient training to make full and effective use of the practice’s computer system, to ensure patient safety and to monitor performance.

In addition, the practice should:

  • Put in place an effective system for providing full support and mentoring for the practice manager.

The practice is still rated as inadequate for providing safe and well-led services and the overall rating of inadequate remains unchanged. The warning notices remain in place and the practice remains in special measures. Special measures will give people who use the service the reassurance that the care they get should improve. The practice will be kept under review and if needed could be escalated to urgent enforcement action. A further comprehensive inspection of the practice will be carried out before 16 August 2017, and if there is not enough improvement we will move to close the service.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice


8 November 2016

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Kandiah Pathmanathan’s practice on 8 November 2016. We had previously inspected the practice in March 2015. At that inspection we had identified concerns relating to safe, effective and well-led services. We served a requirement notice under Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to Good governance, and we rated the practice overall as Requires Improvement. Following the publication of our inspection report, the practice sent us a plan of the actions it intended to take to address the concerns and to meet the requirements of the Regulations. We carried out this inspection to check on the implementation of the actions. We established that a significant number of actions had not been implemented adequately and, additionally, we identified further concerns.

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 in a way to keep them safe. For example, we had concerns in relation to how significant incidents were managed, including learning and reflective practice; with infection prevention and control measures; the management of medicines; health and safety; and arrangements for dealing with emergencies.
  • Risks to patients were not consistently assessed, monitored or managed. For example we identified a number of pathology test results which had not been reviewed and processed for several weeks; and from a review of patients on high risk medication we found no evidence of regular blood tests being carried out to ensure that patients were being prescribed medication safely.
  • Patients’ care and treatment did not consistently reflect current evidence-based guidelines.
  • Multidisciplinary working was taking place, but record keeping was limited.
  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were generally below local and national averages.
  • Although staff were up to date with mandatory training needs, they remained insufficiently trained to make full and effective use of the practice’s clinical computer system.
  • Patient feedback indicated delays in obtaining routine appointments. There was a lack of clarity regarding the appointments system, including the availability of emergency slots and the discontinued walk in service.
  • The needs of the patient group were not fully taken into account when planning services. For example, the provider told us that due to pressure of work he had to concentrate on patients with acute healthcare issues, leaving the practice nurse to manage patients with long-term conditions. The practice nurse was not present at the inspection and was due to leave the practice in late December 2016
  • The practice’s aims and objectives were set out in its statement of purpose, but this was out of date and in need of revision. There were no detailed or realistic plans to achieve the aims and objectives.
  • The delivery of high-quality care was not assured by the governance arrangements in place. The practice had a number of policies and procedures to govern activity, but some of these were overdue a review. There was no effective system for monitoring performance by means of frequent audits or effective use of the practice management computer system.

The areas where the provider must make improvements are:

Ensure that care and treatment is provided in a safe way, including –

  • Regularly assessing the risks to the health and safety of patients and staff and putting in place appropriate arrangements to mitigate, manage and monitor any risks.
  • Ensuring that sufficient numbers of suitably qualified, competent and skilled staff are deployed and that they receive appropriate support, training and supervision as is necessary to enable them to safely carry out their duties.
  • Ensuring that the emergency medical equipment is safe and is used in a safe way.
  • Ensuring the proper and safe management of medicines.
  • Ensuring that the risk of, and preventing, detecting and controlling the spread of, infections, including those that are health care associated, are assessed and put in place and that there are appropriate arrangements to mitigate, manage and monitor any risks.
  • Ensuring patients’ care and treatment reflects current evidence-based guidelines.
  • Maintaining accurate, complete and contemporaneous records of patients’ care and treatment, including decisions taken in relation to the care and treatment, and ensuring that all patients’ test results are reviewed and processed in a timely manner.
  • Establishing governance systems or processes and operating them effectively to assess, monitor and improve the quality and safety of the services. For example the management, investigation and learning from significant incidents; and having a system of regular clinical audits relevant to the service, with suitable reflection and learning.

In addition the provider should:

  • Continue with efforts to appoint a female GP, or make use of female locums, to provide an appropriate and full healthcare service for female patients.
  • Take steps to improve the standard of recording of both internal meetings and those with other healthcare professionals, such as multi-disciplinary team meetings;
  • Improve methods of communicating with patients, including providing clarification of the appointments system, the availability of emergency slots and the status of the walk-in service. Publicise the available translation service at the premises and on the practice website;
  • Obtain an induction loop to assist patients with a hearing impairment.

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

5 March 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection on the 5 March 2015. Overall the practice is rated as requires improvement.

Specifically, we found the practice to be good for providing caring and responsive services. It required improvement for providing safe, effective and well-led services. Because the practice is rated as requires improvement in the key questions of safe, effective and well-led, these ratings apply to everyone using the practice, including the six population groups - older people, people with long-term conditions, families, children and young people, working age people (including those recently retired and students), people living in vulnerable circumstances and people experiencing poor mental health (including people with dementia).

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.
  • Staff were not sufficiently trained to make full use of the practice’s clinical computer system to monitor, fully assess and manage patient outcomes.
  • Data showed patient outcomes were below average for the locality.
  • Although some audits had been carried out, there was limited evidence that audits were driving improvement in performance to improve patient outcomes.
  • 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 in a format patients could understand.
  • Urgent appointments were usually available on the day they were requested.
  • The practice had a number of policies and procedures to govern activity, but a number of these were in need of review.
  • There was no evidence to confirm that staff received regular appraisals.

The areas where the provider must make improvements are:

  • Continue to access appropriate training and support relating to the new clinical computer system so that staff may make full and effective use of the system to ensure that patient outcomes are assessed and appropriately managed and that risks to patients’ health and welfare are mitigated.

In addition the provider should:

  • Continue carrying out regular audits and ensure that audit cycles are completed to drive improvement in performance to improve patient outcomes.
  • Consider and take appropriate steps to meet the needs of female patients who may be reluctant to see the male GP and male locum doctors at the practice.
  • Review and update as appropriate the practice’s governance policies and procedures.
  • Record staff appraisals and have appropriate evidence available for inspection.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

23 July 2014

During an inspection looking at part of the service

At our last inspection on 22 and 30 August 2013 we found that the practice did not have appropriate arrangements in place to ensure patients were protected against the risk of acquiring health associated infections.

The practice did not have systems in place to monitor the quality of the service including obtaining the views of patients. Patients records were not kept securely.

Following the inspection the provider wrote to us and told us they would make the required improvements by 1 April 2014.

During our follow up inspection we found that the provider had made improvements to protecting people from the risks of infection. Staff had completed infection control training and a cleaning company had been contracted to regularly clean the premises.

The provider had hired a building construction company who were making structural changes at the time of our inspection. Records were now stored securely.

However, the provider had failed to take note of our previous concerns and had not taken any action to put in place a system to assess and monitor the quality of services that people received.

22, 30 August 2013

During an inspection in response to concerns

Patients told us that they were mostly happy with the services provided. However, many spoke about improvements they would like the provider to make. One patient told us that a 'female doctor would be nice.' Other comments made to us included that the 'premises are OK' but that they 'had not been redecorated for years' and the 'toilets are clean.' One person said 'the service did drop.' Another one told us that that the doctor sends them to A&E with a referral letter frequently.

Staff said that 'the place needs to be redecorated', and told us that the provider at times did not act on the feedback received from the patients. They also said that the provider disregarded actions recommended by external professionals in relation to the maintenance of the premises.

We found that patients' care and treatment needs were met. Patients were respected and staff provided them with suitable information regarding their treatment. However, the provider did not take appropriate action to ensure patients were protected against the risk of acquiring health associated infections. Patients were treated in environment which was not suitable maintained.

The provider did not have suitable systems in place to monitor the quality of the service. They did not encourage patients to express their views or act when these were provided.

Patients' records were not kept securely. The provider did not have suitable records in relation to the management of the regulated activity.