Archived: Dr AK Sinha's Medical Practice

This practice is rated as Good overall. (In January 2018, the practice was previously rated Good, with requires improvement in providing safe care and treatment.)

The key questions at this inspection are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

We previously carried out an announced comprehensive inspection at Dr AK Sinha's Medical Practice on 3 May 2017. The overall rating for the practice was good with requires improvement in safe. Breaches of legal requirements were found and requirement notices were served in relation to safe care and treatment and recruitment. We carried out an announced focused inspection at Dr AK Sinha's Medical Practice on 3 January 2018 to check that the previous breaches had been met. At that inspection we rated the practice good overall with requires improvement in safe. Breaches of legal requirements were found and a requirement notice was served in relation to good governance. The full comprehensive report on the May 2017 and January 2018 inspections can be found by selecting the ‘all reports’ link for Dr AK Sinha's Medical Practice on our website at www.cqc.org.uk.

We carried out an announced comprehensive inspection at Dr AK Sinha's Medical Practice on 6 November 2018 to follow up on breaches of regulations.

At this inspection we found:

• The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• Staff had completed appropriate safeguarding training. Safeguarding policies did not support staff in safeguarding patients at risk of abuse from female genital mutilation. The practice had not reconciled their children’s safeguarding register with the health visiting team.
• Systems for acting on Medicines and Healthcare products Regulatory Agency (MHRA) alerts had been put in place.
• Staff recruitment checks had improved following our previous inspection.
• The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines. However, guidelines for the treatment of patients with gestational diabetes or patients with gout needed to be reviewed.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they could access care when they needed it.
• There was continuous learning and improvement at all levels of the organisation and the practice engaged with local Clinical Commissioning Group initiatives.

The areas where the provider should make improvements are:

• Reconcile safeguarding registers with the health visiting team. Update safeguarding policies and procedures to support staff in safeguarding patients at risk of abuse from female genital mutilation.
• Increase the percentage of medication reviews for patients on repeat prescriptions.
• Develop processes to embed historic Medicines and Healthcare products Regulatory Agency alerts into the practice’s medicine monitoring systems.
• Review guidelines for the treatment of patients with gestational diabetes or patients with gout.

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.

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Dr AK Sinha’s Medical Practice on 3 May 2017. The overall rating for the practice was Good with Requires Improvement for providing safe services. The full comprehensive report on the 3 May 2017 inspection can be found by selecting the ‘all reports’ link for Dr AK Sinha’s Medical Practice on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 3 January 2018 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 3 May 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

At this inspection we found that the practice had not addressed all of the concerns previously identified and therefore continues to be rated as Requires Improvement for providing safe services.

Our key findings were as follows:

• The practice had implemented a formal system to log, review, discuss and act on external alerts that may affect patient safety. Relevant searches had been carried out to identify patients at potential risk; however the action taken by the practice had not been fully documented in patients’ records.

• The practice had reviewed and improved its recruitment procedures and had obtained evidence of immunisation status, safeguarding and basic life training certificates for the locum staff. However, further improvements were still required.

• The GP had considered acquiring an automated external defibrillator (AED) as recommended in current external guidance and national standards. We saw the practice manager had researched the various options available in preparation for purchasing an AED imminently.

• The practice had updated their register of vulnerable children in conjunction with external agencies. A system had been implemented to audit, monitor and follow up children who did not attend hospital appointments. The outcome of the audit identified none of the children had safeguarding concerns. However, further improvements were still required, entries made in patient records could be more detailed.

• All staff were aware of the safeguarding lead for the practice however, not all staff members had attended safeguarding refresher training.Staff were booked to attend refresher safeguarding training in early 2018 appropriate to their role.

• An analysis of significant events had been undertaken to identify and evaluate any trends. Arrangements were in place for sharing the learning outcomes from significant events, incidents and near misses with staff.

• There was a system in place for tracking blank prescriptions throughout the practice and for ensuring the improved security of these. A protocol for dealing with uncollected prescriptions had been developed and implemented.

• The practice had completed the outstanding actions identified in the Legionella risk assessment and also had an annual water test carried out since our last inspection.

• The practice had strengthened their practice business continuity plan and included staff telephone numbers and arrangements in the event of unplanned absence of clinicians.

We also saw the following best practice recommendations we previously made in relation to providing effective and responsive services had been actioned:

• The practice had formalised the arrangements for the clinical supervision of the practice nurse and had arranged a date for their annual appraisal.

• The complaints procedure was more readily accessible and complainants were advised of the escalation process should they not be satisfied with the management or the outcome of their complaint.

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

Importantly, the provider must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. For example, those in relation to the procedures to record MHRA alerts and outcome for patients, procedures in the event of a medical emergency, safeguarding and recruitment in particular in relation to clinical staff. For details, please refer to the requirement notice at the end of this report.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice