The Care Quality Commission
  • Doctor
  • GP practice

Archived: Dr Bijendra Narayan Singh

Overall: Good read more about inspection ratings

Brompton Medical Centre, 28a Garden Street, Brompton, Gillingham, Kent, ME7 5AS (01634) 845898

Provided and run by:
Dr Bijendra Narayan Singh

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

All Inspections

13 June 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 Bijendra Narayan Singh on 27 September 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the September 2016 inspection can be found by selecting the ‘all reports’ link for Dr Bijendra Narayan Singh on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 13 June 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 27 September 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 introduced a system for the routine management of legionella (a germ found in the environment which can contaminate water systems in buildings).

  • The practice was able to respond to a medical emergency, in line with national guidance, before the arrival of an ambulance.

  • The practice demonstrated that clinical audits were driving quality improvement.

  • The practice had identified an additional 11 patients on the practice list who were also carers. The total number of identified patients on the practice list who were also carers was now 14. This represented 0.7% of the practice list.

  • The provider had created a practice website.

  • The practice had introduced an effective complaints management system.

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

The provider should:

  • Continue to identify patients who are also carers to help ensure eligible patients are offered relevant support.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

27 September 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Bijendra Narayan Singh on 27 September 2016. Overall the practice is rated as requires improvement. This inspection was a follow-up of our previous comprehensive inspection which took place in November 2015 when we rated the practice as inadequate overall. In particular the practice was rated as inadequate for providing safe and well-led services and requires improvement for providing effective services. The practice was rated as good for providing caring and responsive services. The practice was placed in special measures for six months.

After the inspection in November 2015 the practice wrote to us with an action plan outlining how they would make the necessary improvements to comply with the regulations.

The inspection carried out on 27 September 2016 found that the practice had responded to the concerns raised at the November 2015 inspection and was continuing to implement their action plan in order to comply with the requirement notice issued.

Our key findings across all the areas we inspected were as follows:

  • There was an open and transparent approach to safety and an effective system for reporting and recording significant events.
  • Significant improvements to risk management had been made and most risks to patients were now being assessed and well managed.
  • The practice carried out infection control audits. However, the practice was unable to demonstrate they had a system for the routine management of legionella (a germ found in the environment which can contaminate water systems in buildings).
  • The practice was unable to demonstrate they were able to respond to a medical emergency, in line with national guidance, before the arrival of an ambulance.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
  • The practice had introduced a system to help ensure governance documents were kept up to date.
  • The practice was unable to demonstrate that clinical audits were driving quality improvement.
  • Staff training had been revised and records demonstrated that staff had been trained 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.
  • Vaccines were now being stored in line with national guidance.
  • Records showed that staff were working with multidisciplinary teams to understand and meet the range and complexity of patients’ needs.
  • Information about services and how to complain was available and easy to understand. However, the practice was unable to demonstrate they had an effective complaints management system.
  • Patients said they were able to book an appointment that suited their needs. Pre-bookable, on the day appointments, home visits and a telephone consultation service were available. Urgent appointments for those with enhanced needs were also provided the same day.
  • Appropriate recruitment checks were now being undertaken prior to the employment of staff, including GPs recruited directly by the practice.
  • The practice had good facilities and was equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt supported by management. The practice gathered feedback from staff and patients, which it acted on.
  • The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider must make improvements are;

  • Ensure the practice has a system for the routine management of legionella (a germ found in the environment which can contaminate water systems in buildings).

  • Ensure the practice is able to respond to a medical emergency, in line with national guidance, before the arrival of an ambulance.

  • Ensure the practice implements their action plan to carry out clinical audits to drive quality improvement.

  • Ensure the practice has an effective system to manage complaints.

The areas where the provider should make improvements are;

  • Continue to identify patients who are also carers to help ensure they are offered appropriate support.

  • Create a practice website.

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

24 November 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Bijendra Narayan Singh (also known as Brompton Medical Centre) on 24 November 2015. Overall the practice is rated as inadequate.

Our key findings across all the areas we inspected were as follows:

  • There was an open and transparent approach to safety and a system for reporting and recording significant events.

  • Significant issues that threatened the delivery of safe care were not identified or adequately managed.

  • Risks to patients were not consistently assessed and well managed.

  • The practice was unable to demonstrate they carried out infection control risk assessments or infection control audits.

  • The practice was unable to demonstrate they were able to respond to a medical emergency, in line with national guidance, before the arrival of an ambulance.

  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance.

  • Not all staff were up to date with attending mandatory courses such as basic life support, safeguarding and infection control.

  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

  • Vaccines were not stored in line with national guidance.

  • Staff told us they worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

  • Information about services and how to complain was available and easy to understand.

  • Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.

  • Appropriate recruitment checks had not been undertaken prior to the employment of locum GPs recruited directly by the practice.

  • There was a clear leadership structure and staff felt supported by management. The practice sought feedback from staff and patients, which it acted on.

  • The provider was aware of and complied with the Duty of Candour.

There were areas of practice where the provider needs to make improvements.

The provider must:

  • Ensure risk assessment activities include all infection control and fire risks.

  • Ensure the practice is able to respond to a medical emergency in line with national guidance.

  • Revise governance processes and ensure that all documents used to govern activity are up to date.

  • Ensure all staff are up to date with attending mandatory training courses and have regular apprisals.

  • Revise medicines management to help ensure Department of Health guidance is followed when storing vaccines.

  • Revise systems to help ensure records of multidisciplinary meetings to assess and plan the on-going care and treatment of patients are maintained.

  • Revise recruitment processes to ensure appropriate checks are undertaken prior to the employment of all staff.

  • Revise clinical audit activity to ensure improvements to patient care are driven by the completion of clinical audit cycles.

The provider should:

  • Raise staff awareness of the practice statement of purpose.

  • Have a patient participation group.

  • Have a website.

I am placing this practice in special measures. Practices placed in special measures will be inspected again within six months. If sufficient improvements have not been made so a rating of inadequate remains 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.

Special measures will give people who use the practice the reassurance that the care they receive should improve.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice