Archived: Dr Kulvinder Singh

Updated 19 September 2017

Dr Kulvinder Singh is situated in Shepway, Maidstone, Kent and has a registered patient population of approximately 11,848.

There are more patients registered between the ages of zero and five years than the national average. The practice is located in an area with a lower than average deprivation score.

The practice staff includes a principal GP (male), three salaried GPs (two male and one female), three long term locum GPs (two male and one female), two advanced nurse practitioners (male), a nurse practitioner (female), three practice nurses (female) and three healthcare assistants (female).There was a practice manager and a team of reception/administrative staff. The practice is a training practice and trains two GP registrars, one F2 and one nurse trainer.

There are reception and waiting areas on the ground floor. Patient areas are accessible to patient with mobility issues as well as parents with children and babies.

The practice has a general medical services contract with NHS England for delivering primary care to the local population. The Medical Centre is open Monday to Friday 8am to 6.30pm. Extended hours appointments are offered on alternate Saturdays from 9am to 1pm. Outside of these hours, cover is provided by the out of hours GP service (provided by IC24) which operates from 6.30pm to 8am, seven days a week and is accessed via the NHS 111 service. General medical services are available to patients via an appointments system. There are a range of clinics for all age groups as well as the availability of specialist nursing treatment and support.

Services are provided from:

• The Medical Centre, 10a Northumberland Court, Shepway, Maidstone, Kent, ME15 7LN.

• The Grove Green Medical Centre, Unit 1, Minor Centre, Grove Green, Maidstone, Kent, ME14 5TQ.

We inspected The Medical Centre. We did not inspect The Grove Green Medical Centre.

Updated 19 September 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Kulvinder Singh on 16 December 2016. The overall rating for the practice was good. The practice was rated as requires improvement for providing safe services and rated as good for providing effective, caring, responsive and well-led services. The full comprehensive report on the December 2016 inspection can be found by selecting the ‘all reports’ link for Dr Kulvinder Singh on our website at www.cqc.org.uk.

This inspection was an announced focused inspection conducted on 17 August 2017 to confirm that the practice had carried out their plan to meet the legal requirements, in relation to the breaches in regulations that we identified in our previous inspection on 16 December 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

• The practice had ensured that the arrangements for managing medicines in the practice kept patients safe. Controlled drugs were no longer stored within the practice.

The practice had also taken appropriate action to address areas where they should make improvements:

• The practice had taken appropriate measures to ensure they identified patients who are also carers to help ensure they are offered appropriate support. The practice had identified 100 patients as carers (1% of the practice list).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 17 February 2017

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• There were alerts for long term conditions on patient records.

• At 81%, the percentage of patients with diabetes, on the register, in whom the last IFCC-HbA1c is 64 mmol/mol or less in the preceding 12 months (01/04/2014 to 31/03/2015) was above the CCG and national averages of 79% and 77%

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• The practice had online appointment booking and prescription requests.

• The practice had a palliative care register with monthly reviews completed by the practice. All palliative care patients had care plans.

Updated 17 February 2017

The practice is rated as good for the care of families, children and young people.

• There were systems to identify and follow up children living in disadvantaged circumstances and who were at risk. For example, children and young people who had a high number of accident and emergency (A&E) attendances. Immunisation rates were relatively high for all standard childhood immunisations.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• At 83%, the percentage of women aged 25-64 whose notes recorded that a cervical screening test has been performed in the preceding 5 years (01/04/2014 to 31/03/2015) was comparable to the CCG and national averages of 83% and 82%.

• Appointments were available outside of school hours and the premises were suitable for children and babies. Children and babies were prioritised for same day appointments.

• We saw positive examples of joint working with health visitors.

• A range of family planning services were provided including hormone implants.

Updated 17 February 2017

The practice is rated as good for the care of older people.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• An alert on patient records highlighted elderly patients who were particularly vulnerable.

• The practice case managed elderly patients at risk of admissions through monthly meetings and review of care plans.

Updated 17 February 2017

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

• Same day appointments were available.

• The practice was open from 8am to 6.30pm Monday to Friday and offered weekly Saturday clinics to accommodate working people.

• Telephone consultations were available.

• Online appointment booking and prescription requests were available.

Updated 17 February 2017

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• 92% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the record, in the preceding 12 months (01/04/2014 to 31/03/2015). This was comparable to the CCG average of 88% and the national average of 88%.

• Patients with severe mental health conditions were offered weekly appointments with a named GP.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice carried out advance care planning for patients with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice had a system to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 17 February 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability. There was also an alert on the patient records where a patient was identified as vulnerable.

• The practice offered longer appointments for patients with a learning disability or in vulnerable circumstances...

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• Five of the GPs had a special interest in substance misuse and provided reviews and support.

• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.