- GP practice
Archived: Dr H Singh & Partners
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All Inspections
10 October 2017
During an inspection looking at part of the service
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:
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The practice had ensured that staff at the practice were up to date with their routine immunisations and took appropriate action as required.
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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.
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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:
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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.
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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
25 April 2017
During a routine inspection
Letter from the Chief Inspector of General Practice
We previously carried out an announced comprehensive inspection at Dr H Singh & Partners on 20 September 2016. The overall rating for the practice was Requires Improvement but inadequate for providing a Safe service. The inspection on the 20 September 2016 found breaches of legal requirements and a warning notice was served for Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Safe care and treatment. A Requirement notice was served in relation to Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 - Fit and proper persons employed.
We undertook a focused follow up inspection on 2 December 2016 to check that the practice had taken urgent action to ensure they met the legal requirements of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, safe care and treatment. We found at this inspection that the practice had taken appropriate action to meet the regulations.
The full comprehensive report from the 20 September 2016 inspection and the inspection report from 2 December 2016 can be found by selecting the ‘all reports’ link for Dr H Singh & Partners on our website at www.cqc.org.uk.
This announced comprehensive inspection took place on 25 April 2017. Overall the practice is now rated as good.
Our key findings were as follows:
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There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
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The practice had clearly defined and embedded systems to minimise risks to patient safety with one exception. The practice needed to review whether staff were up to date with their routine immunisations and take appropriate action as required.
- Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment. A systematic approach to receipt of NICE guidance was required.
- Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
- Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
- Patients we spoke with said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
- The practice had good facilities and was well equipped to treat patients and meet their needs.
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There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
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The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.
However there are areas of practice where the provider needs to make improvements.
The provider must:
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Review whether staff are up to date with their routine immunisations and take appropriate action as required.
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Introduce a systematic approach for the receipt, monitoring and implementation of NICE updates and guidelines.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
2 December 2016
During an inspection looking at part of the service
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection of Dr H Singh & Partners on 20 September 2016. Breaches of legal requirements were found and a warning notice was served for Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Safe care and treatment.
A Requirement notice was served in relation to Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Fit and proper persons employed.
You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Dr H Singh & Partners on our website at www.cqc.org.uk.
We undertook a focused follow up inspection on 2 December 2016 to check that the practice had taken urgent action to ensure they met the legal requirements of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, safe care and treatment. This report only covers our findings in relation to the warning notice. A follow up inspection will be carried out within six months to check that the practice had followed their action plan for the requirement notice and to confirm they meet legal requirements.
Our key findings were as follows:
- Effective systems had been put in place to mitigate risks to patients who took high risk medicines.
- Hepatitis B immunisation records were available for all relevant staff.
- The practice held sufficient quantities of suitable emergency medicines.
- There were records to show that clinical equipment had been serviced and calibrated.
- Patient Group Directions which allow nurses to administer medicines in line with legislation were complete and up to date.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
20 Septenber 2016
During a routine inspection
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection of Dr H Singh & Partners on 19 January 2015. A total of two breaches of legal requirements were found and two requirement notices were served. After the comprehensive inspection, the practice was rated as requires improvement. The practice sent us an action plan to say what they would do to meet legal requirements in relation to:
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Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014: Safe care and treatment.
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Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014: Good Governance.
You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Dr H Singh & Partners on our website at www.cqc.org.uk. We undertook an announced comprehensive inspection on 20 September 2016 to check that the practice now met legal requirements. Overall the practice is rated as requires improvement.
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 in place for reporting and recording significant events.
- At our previous inspection we found that safety alerts were not effectively acted upon. At this inspection we saw that a system had been introduced and staff were aware of recent safety alerts.
- Some risks to patients were assessed and well managed. However we found examples where risk assessments were required but had not been completed to ensure the safety of patients.
- Staff assessed patients’ needs and delivered care in line with current evidence based guidance. 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.
- At our previous inspection we found that clinical audits were not driving quality improvements. At this inspection we found that clinical audits had improved the prescribing rates of antibiotics.
- Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
- The practice had recruited an additional GP partner and an advanced nurse practitioner to improve access to appointments.
- The practice had good facilities and was well equipped to treat patients and meet their needs.
- There was a clear leadership structure and staff felt supported by the management.
- The practice sought 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 improvement are:
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Ensure that systems are in place to protect patients from potential health care associated infections including provision of immunisations, thorough risk assessments and appropriate screening.
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Introduce systems to ensure that patients who are regularly prescribed medicines for high blood pressure receive timely monitoring before repeat prescriptions are issued. Ensure there are systems in place to risk assess the safety of patients who fail to attend their reviews for many years.
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Ensure Patient Group Directions to allow nurses to administer medicines in line with legislation are current and in date.
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Ensure the required recruitment checks are undertaken in line with current legislation prior to employment. Where issues are found, ensure appropriate risk assessments are carried out to protect patients from the risk of harm.
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In the absence of an emergency medicine needed to treat diabetic patients with low blood glucose levels, carry out a risk assessment to demonstrate how the practice would safely provide urgent care and treatment for these patients.
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Ensure all clinical equipment at the practice is calibrated to ensure it is working properly.
The areas where the provider should make improvements are:
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Review and update the practice’s safeguarding vulnerable adults policy to reflect the latest guidance regarding the categories and definitions of the types of abuse.
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Implement a consistent system for recording that blood monitoring checks for patients, who take long term medicines on a shared care basis, have been carried out before the medicines are issued.
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Focus on clinical performance and target areas of high exception reporting. Ensure that patients understand the need for their long term condition, such as asthma or diabetes, to be reviewed.
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Ensure that minutes from multi-disciplinary meetings identify the responsible professional to carry out actions required and that appropriate information is transferred into the patient’s electronic record for other clinicians to have ready access to.
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Ensure the practice’s three year business plan reflects the changes the practice has planned.
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Put systems in place to improve and monitor patient satisfaction so that it is in line with national survey results.
Where a service is rated as inadequate for one of the five key questions or one of the six population groups or overall, it will be re-inspected within six months after the report is published. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group or overall, we will place the service into special measures. Being placed into special measures represents a decision by the Care Quality Commission (CQC) that a service has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.
Special measures will give people who use the service the reassurance that the care they get should improve.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
19 January 2015
During a routine inspection
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Dr H Singh & Partners on 19 January 2015. Overall the practice is rated as Requires improvement.
Specifically, we found the practice required improvement for providing safe, effective, caring and being well led. It also required improvement for providing services for older people, people with long term conditions, families, children and young people, the working age population and those recently retired, people in vulnerable circumstances and people experiencing poor mental health. It was good for providing responsive services.
Our key findings across all the areas we inspected were as follows:
- Patients were at risk of harm because systems and processes were not consistently implemented to keep them safe. For example appropriate recruitment safety checks were not completed on non-clinical staff who were involved in the direct care of patients such as chaperone duties. The practice could not demonstrate that all clinicians had reviewed and acted on safety alerts.
- Staff were clear about reporting incidents, near misses and concerns, however there was no evidence of shared learning and communication with staff.
- Data showed that patient outcomes specifically related to the management of poor mental health were below average for the locality.
- Patients were positive about their interactions with staff and said they were treated with compassion and dignity. However, not all felt supported and listened to.
- Urgent appointments were usually available on the day they were requested. However patients said that they found it difficult to get through the practice when telephoning to make an appointment.
- The practice had limited formal governance arrangements.
Importantly the provider MUST:
- Ensure effective governance systems are in implemented for monitoring and managing potential risks to patients safety and performance related to patient outcomes. This includes:
- having a robust system in place for acting on all safety alerts, including medicine alerts.
- Developing a clinical audit process that drives improvement in patient care.
- Ensure that appropriate protocols are in place to monitor and confirm the accuracy of medicine changes recorded in patient records by administration staff following their discharge from hospital.
Action the provider SHOULD take to improve:
- Implement systems to demonstrate learning from significant events.
- Review recruitment procedures to ensure that non-clinical staff who are involved in the direct care of patients such as chaperone duties are risk assessed to determine if a Disclosure and Barring Service (DBS) check is required.
- Develop appropriate protocols to share information about patients care and treatment needs with health professionals in a secure and timely manner.
- Provide appropriate training for staff to ensure accurate data related to patient medical diagnosis is recorded into the patient IT system.
- Store blank prescription pads securely at all times.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice