Background to this inspection
Updated
6 September 2018
Dr Vishwambhar Sinha (also known as Crane Park Surgery) provides primary medical services in Whitton to approximately 3210 patients and is one of 23 practices in Richmond Clinical Commissioning Group (CCG). The practice is registered as an individual.
The practice population is in the fifth least deprived decile in England. The proportion of children registered at the practice who live in income deprived households is 20%, which is higher than the CCG average of 9%, and for older people the practice value is 17%, which is higher than the CCG average of 11%. The practice has a greater than average proportion of patients aged between 0-44 years and a smaller than average proportion of patients aged 55 years and older.
The practice operates from the first floor of a large purpose-built health centre, which also accommodates another GP practice and other health provision such as a physiotherapy service, district nurses and health visitors. A lift is available to take patients from street level to each floor in the building. A small amount of car parking is available at the practice, and there is space to park in the surrounding streets. The practice consists of a reception desk area and adjoining waiting area, administrative offices, two GP consultation rooms and one nurse consultation rooms.
The practice team at the surgery is made up of one full time male GP principal, one male and one female part time long-term locum GPs. In total 12 GP sessions are available per week. The practice also employs a part time female nurse. The clinical team are supported by a practice manager, and two reception/administrative staff.
The practice operates under a General Medical Services (GMS) contract, and is signed up to a number of local and national enhanced services (enhanced services require an enhanced level of service provision above what is normally required under the core GP contract).
The practice reception is open from 8:30am and 1pm and from 3pm to 6:30pm every weekday apart from Wednesdays when the practice is closed during the afternoon. Appointments are available on weekday mornings from 8:30am until 11:30am and on weekday afternoons (apart from Wednesdays) from 3:30pm until 6:00pm. Extended hours appointments are available on Thursdays from 6:30pm until 8:15pm. When the practice is closed patients are directed to contact the local out of hours service. Patients at the practice can also book appointments to see a doctor between 8am and 8pm at the CCG’s seven day opening hub.
The practice is registered as an individual with the Care Quality Commission to provide the regulated activities of diagnostic and screening services; maternity and midwifery services; treatment of disease, disorder or injury, surgical procedures and family planning.
Updated
6 September 2018
This practice is rated as Good overall. (Previous rating January 2018 – Good overall with Requires Improvement for well led)
The key questions at this inspection are rated as:
Are services safe? – Not inspected
Are services effective? – Not inspected
Are services caring? – Not inspected
Are services responsive? – Not inspected
Are services well-led? - Good
We carried out an announced comprehensive inspection at Dr Vishwambhar Sinha (also known as Crane Park Surgery) on 9 January 2018. During that inspection we found a breach of regulation in respect of Regulation 17 (Good Governance) of the Health and Social Care Act 2014. Following that inspection the practice submitted an action plan, outlining how they intended to address the issues identified. We returned to the practice on 9 August 2018 to carry-out an announced focused inspection, looking at the Well Led key question, in order to check that the practice’s action plan had been implemented and that the issues identified at the previous inspection had been addressed.
At this inspection we found:
- Following the previous inspection in January 2018 the practice had begun to keep minutes of staff meetings, which were made available to all staff. However, the practice’s arrangements in respect of recording discussions about patient care in weekly meetings between the principal GP and long-term locum GPs had not changed. Notes of these discussions were still not comprehensive and were not made available to all participants of the meeting; details of these discussions were not routinely saved in the relevant patient’s records.
- The practice was able to demonstrate that they used available information to assess their performance against other practice’s locally, and clinical audits were completed as required by the CCG medicines team; however, there remained no culture of two-cycle clinical audit as a tool for quality improvement at the practice.
- The practice had up to date policies in place, which were available to all staff.
- Comprehensive records were maintained of activities such as the cleaning of clinical equipment, the monitoring of stocks of equipment and medicines, and the receipt and allocation of prescription stationery.
- The practice had identified 34 patients who had caring responsibilities (compared to 33 patients identified at the time of the previous inspection), this represented approximately 1% of the patients registered at the practice.
- The practice had stocks of all recommended emergency medicines, and there were processes in place to ensure that adequate stocks were maintained and all medicines were in date.
- During the previous inspection we reviewed examples of complaint responses from the practice and noted that these did not contain contact information for the Parliamentary and Health Service Ombudsman (PHSO). At the time of the re-inspection the practice had not received any further complaints; however, following a discussion during the follow-up inspection about the availability of information for patients on how to make a complaint, we saw evidence that the practice had produced a complaints leaflet, which contained contact details for PHSO.
The areas where the provider should make improvements are:
- Introduce a process for recording and sharing with all participants, details of informal discussions about patient care, and where appropriate, record these discussions directly into patient’s medical records.
- Introduce a formal programme of clinical quality improvement activity.
Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice
Please refer to the detailed report and the evidence tables for further information.