Background to this inspection
Updated
20 December 2019
East Ham Memorial Hospital, also known as Dr Krishnamurthy's Practice, is situated within NHS Newham Clinical Commissioning Group (CCG). The practice provides services to approximately 2,174 patients under a General Medical Services (GMS) contract (an agreement between NHS England and general practices for delivering primary care services).
The practice operates from the East Ham Memorial Hospital building, which it shares with another GP practice. The location is served by local buses and underground and overground stations. The premises are owned and maintained by NHS Property Services and there is step-free access and parking spaces for patients with a disability.
The practice does not have a website.
The practice is registered with the CQC to carry on the following regulated activities: Diagnostic and screening procedures; Maternity and midwifery services; and Treatment of disease, disorder or injury.
The clinical team at the practice consists of two male GP partners collectively providing 10 clinical sessions per week, and two female practice nurses. The clinicians are supported by a practice manager, a deputy practice manager and three administrative/reception staff members.
The practice is open on Monday and Tuesday from 9am to 7pm, on Wednesday and Friday from 9am to 6.30pm, and on Thursday from 9am to 12pm. Appointments are available on Monday and Tuesday from 9am to 1pm and from 2pm to 7pm, on Wednesday and Friday from 9am to 6.30pm, and on Thursday from 9am to 12pm.
Appointments include home visits and telephone consultations. Patients telephoning when the practice is closed are directed to the local out-of-hours service provider. Patients can also access appointments Monday to Sunday from 8am to 8pm through the local Newham GP Co-operative.
Information published by Public Health England rates the level of deprivation within the practice population group as three, on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. In England, people living in the least deprived areas of the country live around 20 years longer in good health than people in the most deprived areas. National General Practice Profile describes the practice ethnicity as being 13.7% white, 69.1% Asian, 11.5% black, 2.8% mixed race, and 2.8% other ethnicities.
Updated
20 December 2019
We carried out an announced comprehensive inspection of East Ham Memorial Hospital (also known as Dr Krishnamurthy's Practice) on 7 November 2019 as part of our inspection programme.
At this inspection we followed up on breaches of regulations identified at a previous inspection on 12 April 2019. At the last inspection in April 2019 we rated the practice as inadequate overall and the practice was placed into special measures.
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 rated the practice as inadequate for providing safe services because:
- There were gaps in recruitment and induction checks, including in relation to Disclosure and Barring Service (DBS) checks, references, checks of professional registration, and immunity status.
- The health and safety risk assessment was not practice-specific and a fire risk assessment was overdue.
- There were gaps in staff training, including for fire safety, safeguarding, basic life support and infection control.
- There was inconsistent recording in nurse consultations of whether chaperones had been offered, accepted or declined.
- One of the clinicians was not able to demonstrate how to assemble or use a piece of emergency equipment.
- Staff did not have the appropriate authorisations to administer medicines.
We rated the practice as inadequate for providing well-led services because:
- Staff reported that leaders were approachable, however there were weaknesses in leaders’ capacity to deliver high quality sustainable care.
- There were weaknesses in the overall governance arrangements, for example in relation to oversight of recruitment checks and staff appraisals, monitoring of staff training, and authorisation of medicines.
- Some of the practice’s policies had not been updated in line with specified timeframes or did not contain all the necessary information.
- The systems for managing risks were not effective, as some risks has not been identified or dealt with, including breaches of regulations identified at the previous CQC inspection which had not been addressed.
We rated the practice as requires improvement for providing effective services because:
- We found examples in nurse consultations where consent had not been recorded.
- We identified gaps in staff training and the induction process, and therefore the practice was not able to demonstrate that all staff had the skills, knowledge and experience to carry out their roles effectively.
- The practice’s clinical performance data was generally above or in line with national averages.
- The practice had also carried out clinical audits and non-clinical quality improvement projects.
These areas affected all population groups, so we rated all population groups as requires improvement for providing effective services.
We rated the practice as good for providing caring services because:
- Staff treated patients with kindness, respect and compassion.
- Feedback from patients was positive about the way staff treated people.
- Staff helped patients to be involved in decisions about care and treatment.
- The practice respected patients’ privacy and dignity.
We rated the practice as good for providing responsive services because:
- The practice organised and delivered services to meet patients’ needs.
- Patients had timely access to the service.
- Complaints were listened and responded to and used to improve the quality of care.
These areas affected all population groups, so we rated all population groups as good for providing responsive services.
The areas where the provider must make improvements 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.
- Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.
- Ensure recruitment procedures are established and operated effectively to ensure only fit and proper persons are employed.
(Please see the specific details on action required at the end of this report).
The areas where the provider should make improvements are:
- Improve the arrangements for monitoring the work of the nurses through documented reviews of their consultations.
- Improve the system for recording safety alerts to make it easier to monitor and evidence the action taken by the practice.
- Review where adrenaline is stored when vaccines are being administered to ensure it is easily accessible and clarify the dosage instructions for different age groups.
- Ensure that Control of Substances Hazardous to Health (COSHH) risk assessments are completed accurately.
- Improve how carers are identified to ensure information, advice and support is made available to them.
Due to the overall rating of inadequate, this practice will remain 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 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 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 table.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care