Archived: Dr H Singh & Partners

Updated 1 November 2017

Dr H Singh and Partners is registered with the Care Quality Commission (CQC) as a partnership provider in Newcastle-under-Lyme, North Staffordshire. The practice holds a General Medical Services (GMS) contract with NHS England. A GMS contract is a contract between NHS England and general practices for delivering general medical services and is the commonest form of GP

Contract. The practice area is one of high deprivation when compared with the national and local Clinical Commissioning Group (CCG) area. At the time of our inspection the practice had 5,065 patients. Demographically the practice population has a higher proportion of patients aged over 65 (21%) and 75 (9%) when compared with the national averages of 17% and 8% respectively. The percentage of patients with a long-standing health condition is 62% which is above the local CCG average of 57% and national average of 54%. This could mean increased demand for GP services.

The practice is located in a purpose built single storey building. It also offers on-site parking, disabled parking, a disabled toilet, wheelchair and step-free access. The opening times at the practice are between 8am and 6pm Monday to Friday except Thursdays when it closes at 1pm.

GP appointments are from 9am to 11.30am every morning and 3pm to 5.50pm daily (except Thursday afternoon when the practice is closed). On the day appointments are available and patients can book appointments two weeks in advance. The practice does not routinely provide an

out-of-hours service to their own patients but patients are directed to the out of hours service, Staffordshire Doctors Urgent Care, via NHS 111, when the practice is closed. The practice staffing comprises of:

• Two full time male GP partners

• Two female practice nurses providing 1.8 whole time equivalent hours

• A full time practice manager

• An assistant practice manager

• An Elderly Care Facilitator (non-clinical role)

• A team of administrative staff working a range of hours.

• Cleaner

The practice provides a number of specialist clinics and services. For example long term condition management including asthma, diabetes and high blood pressure. It also offers services for family planning, childhood immunisations, travel vaccinations and smoking cessation support. The practice is an approved training practice for GP registrars.

Updated 1 November 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Dr H Singh & Partners on 25 April 2017. The overall rating for the practice was Good with Requires Improvement in Well Led. The full comprehensive report on the 25 April 2017 inspection can be found by selecting the ‘all reports’ link for Dr H Singh & Partners on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 10 October 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 25 April 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is rated as Good.

Our key findings were as follows:

• The practice had ensured that staff at the practice were up to date with their routine immunisations and took appropriate action as required.

• The practice demonstrated that they had introduced a system for the receipt, monitoring and implementation of National Institute for Health and Care Excellence (NICE) updates and guidelines. However, we found that the actions taken were not consistently documented.

• A GP’s bag contained three medicines which exceeded their expiry dates. During the inspection these were replaced and immediately following the inspection we received confirmation that appropriate remedial actions had taken place.

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

Importantly, the provider should:

• Consistently document the actions taken by the practice following receipt of MHRAand guidance such as NICE guidelines with an auditable trail of any actions taken.

• Consider changes to the process in place to monitor medicines held in the GP bags to make it more robust.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 30 May 2017

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

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

• Performance for diabetes related indicators were comparable to other practice in the local CCG and the national averages. For example, 73% of patients with diabetes, on the register, had a blood pressure reading that was within recognised limits. This was comparable with the CCG average of 77% and the national average of 78%. However, their exception reporting rate of 19% was higher than the CCG average of 8% and the national average of 9% meaning fewer patients had been included. The exception reporting had improved from 2014/15 which had been 24%.

• Performance for patients with asthma, on the register, who had had an asthma review in the preceding 12 months, was 88%. This was higher than the local CCG average of 77% and the national average of 76%. The exception reporting rate of 28% was significantly higher than the CCG and national average of 8% but had improved from the exception reporting in 2014/15 of 37%.

• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

• All these patients had a named GP and there was a system to recall patients for 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.

Updated 30 May 2017

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

• From the sample of documented examples we reviewed we found 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.

• There were systems in place to follow up children who failed to attend for hospital appointments were not in place.

• Immunisation rates were relatively high for all standard childhood immunisations.

• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice worked with midwives, health visitors and school nurses to support this population group.

• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 30 May 2017

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

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

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

• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.

• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

• Where older patients had complex needs, the practice shared summary care records with local care services.

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

Updated 30 May 2017

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

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, telephone consultations.

• 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

Updated 30 May 2017

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

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

• At a previous inspection in January 2015 we found that only 16.7% of patients diagnosed with dementia had had their care reviewed in a face-to-face review in the preceding 12 months. In September 2016 we found that this had increased to 76% which was comparable with the CCG and national averages of 85%. However, their exception reporting rate of 31% was significantly higher than the CCG average of 9% and the national average of 8%. On 25 April 2017 we found further improvement had been made with 80% of patients diagnosed with dementia had had their care reviewed in a face-to-face review in the preceding 12 months, compared with the local CCG average of 87% and national average of 84%. The practice exception rate of 9% was comparable to the CCG average of 9% and the national average of 7%.

• At our previous inspection we found that only 35% of patients with a recognised mental health diagnosis had a comprehensive, agreed care plan documented in their record, in the preceding 12 months. At this inspection we found that data for 2015/16 showed this had significantly increased to 76% but remained lower than the CCG average of 89% and the national average of 89%. The exception report rate had significantly improved however, from 34% to 13% compared to the CCG average of 10% and national average of 13%.

• The practice specifically considered the physical health needs of patients with poor mental health and dementia. The practice hosted a cognitive behavioural clinic once a week enabling patients experiencing poor mental health to be seen in an environment they knew.

• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

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

• Patients at risk of dementia were identified and offered an assessment.

• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

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

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

Updated 30 May 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 those with a learning disability.

• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.

• The practice offered longer appointments for patients with a learning disability.

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

• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.

• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.