Dr G Singh and Partners Also known as Guru Nanak Medical Centre

Updated 8 November 2016

Dr G Singh and Partners provides primary care services to approximately 11500 registered patients in the surrounding areas of Southall and Hayes. The service is provided through a personal medical services (PMS) contract.

The practice is led by three GP partners and employs another three salaried GPs and an associate GP. Male and female GPs are available. The practice also employs three part time nurses and a health care assistant, business and practice managers, receptionists and administrators. In total the GPs typically provide 42 sessions per week.

The practice is run from a main practice, Guru Nanak Medical Centre in Southall, and a branch practice Botwell Medical Centre at 238 Botwell Lane, Hayes, UB3 2AP which is around three miles away. The main practice is located in purpose built premises and the branch practice in a smaller, converted property. Both sites have good access for patients with a disability. The GPs work across both sites and patients can attend either site as they wish.

The practice telephone lines are open from 9.00am to 1.00pm and 3.30pm to 6.00pm from Monday to Friday. Appointments can be booked from 9.30am until 1.00pm and 3.00pm until 6.30pm at both sites. The practice offers late night opening at the Botwell Medical Centre on Wednesday with appointments available between 4.00pm and 7.30pm. The Guru Nanak Medical Centre additionally opens on Saturday morning between 9.00am and 1.00pm.

Out of hours primary care is contracted to a local out of hours care provider. The practice provides patients with information in the practice leaflet and by answerphone about how to access urgent care when the practice is closed. Patients are advised to ring “111” to access the out of hours primary care service.

The practice population has expanded rapidly in recent years and is currently characterised by relatively high proportions of male patients and young adults aged under 40. The population is ethnically diverse, with a high proportion of black, Asian and minority ethnic patients particularly in the Southall area. The practice has a multilingual staff team and the associate GP was recruited in part because they were fluent in a number of Indian languages.

The practice is registered to provide the following regulatory activities: diagnostic and screening procedures; treatment of disease, disorder or injury; surgical procedures; maternity and midwifery services and family planning.

The practice has not previously been inspected by the Care Quality Commission.

Updated 8 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr G Singh and Partners on 14 June 2016. We visited both the main and branch surgery sites. Overall the practice is rated as good. 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. The provider was aware of and complied with the requirements of the duty of candour.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained and had the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion and respect and they were involved in their care and decisions about their treatment.
• 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.
• The service was accessible to patients experiencing urgent problems the same day. Patients said they found it easy to make an appointment although it might take much longer to see their preferred GP.
• The practice had good facilities and was well equipped to treat patients and meet their needs. This was true of both the main and branch sites.
• There was a clear leadership structure and staff felt supported by management. The practice sought feedback from staff and patients and had responded positively to concerns and suggestions for improvement.

The areas where the practice should make improvements are:

• The practice should ensure that recent improvements in its performance, for example in relation to the management and control of diabetes are sustained.
• Increase its use of clinical audit as a driver for quality improvement within the practice.
• Establish regular multidisciplinary meetings to ensure patients with complex health needs receive well coordinated care.
• Improve patient uptake of bowel and breast cancer screening.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 8 November 2016

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

• The practice kept registers of patients with long term conditions and carried out regular reviews of patients. Nursing staff took a lead role in chronic disease management. The practice was rolling out and had almost completed end of life training for all clinicians.
• There were high prevalence rates of diabetes in the practice population. Practice performance for diabetes tended to be lower than average for key indicators in 2014/15. For example, only 58% of diabetic patients had adequately controlled blood sugar levels compared to the CCG average of 74% and the national average of 78%. The practice was able to provide evidence of improvement in 2015/16.
• The practice employed an associate GP who was fluent in a range of languages. We were told this was particularly helpful, for example when discussing the management of longer term conditions with affected patients and their families.
• Longer appointments and home visits were available when needed.

Updated 8 November 2016

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

• There were systems in place 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 A&E attendances.
• Immunisation rates were high for all standard childhood immunisations.
• Practice performance for asthma was in line with the national average. Seventy three percent of patients with asthma had an annual review compared to the national average of 75%.
• The practice observed strict confidentiality and age specific competency protocols to encourage teenagers and young people to engage with the practice and its services.
• Appointments were available outside of school hours at both the main and branch sites.
• The practice had emergency slots in every GP session available for young children.
• The premises at both the main and branch surgery sites were suitable for children and babies.

Updated 8 November 2016

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 had a lead GP for the care of patients over 75.
• The practice was responsive to the needs of older people, and offered home visits by the GPs and urgent appointments for those with enhanced needs.
• The practice used risk stratification to identify older patients at raised risk of unplanned hospital admission. The practice developed care plans for patients identified at high risk and referred to relevant services such as the 'Home Ward'.

Updated 8 November 2016

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 and flexible.
• The practice was proactive in offering online services.
• The practice offered a full range of health promotion and screening that reflected the needs for this age group.
• The practice coverage for the cervical screening programme in 2014/15 was 78% which was the same as the CCG average. Bowel and breast screening uptake was lower than the national average in 2014/15.
• The practice offered late evening and weekend appointments at the time of the inspection. These appointments were proving popular with working patients.

Updated 8 November 2016

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

• The practice was performing in line with national average for indicators of mental health. For example 81% of patients diagnosed with a psychosis had a care plan compared to the national average of 88%.
• The practice participated in a programme 'Shifting the setting of care' to meet patients' needs closer to home. The local NHS primary care mental health practitioner visited the practice monthly to see patients on this programme.
• In 2014/15, 23 of 28 patients diagnosed with dementia (82%) had attended a face to face review in the previous year compared to the national average of 84%. The practice referred these patients to specialist services for diagnosis and further support. The practice provided evidence that these figures had improved in 2015/16.
• The practice informed patients experiencing poor mental health how to access various support groups and voluntary organisations.
• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

Updated 8 November 2016

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

• The practice held a register of patients with a learning disability. The practice offered longer appointments for patients with a learning disability and an annual health check.
• The practice actively identified patients who were carers, for example by asking patients about this when they registered at the practice. Carers were signposted to the local carers resource centre.
• The practice added alerts to the records of patients known to be vulnerable for example, patients who were homeless; those experiencing drug or alcohol problems or domestic violence.
• The practice coordinated with other health and social services professionals in the case management of vulnerable patients. Cases were discussed in clinical meetings and in local network multidisciplinary meetings. Changes to care plans were agreed and documented.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
• 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.
• Patients in vulnerable circumstances were booked at quieter times when convenient, for example the Saturday morning clinics.