- GP practice
Dr.A.Singh and Dr.S.Bicha
All Inspections
27 February 2019
During an inspection looking at part of the service
This practice is rated as Good overall. (Previous rating 13 March 2018 – Good)
The effective key question at this inspection is rated as: Good.
We carried out an announced focused inspection at Dr.A.Singh and Dr.S.Bicha on 27 February 2019 to follow up a breach of regulation from our last inspection carried out on 13 March 2018.
The full comprehensive report for the March 2018 inspection can be found by selecting the ‘all reports’ link for Dr.A. Singh and Dr.S. Bicha on our website at .
At the previous inspection of 13 June 2018, we rated the practice as ‘good’ overall but as ‘requires improvement’ in the effective key question. We identified a breach of Regulation 17 HSCA (RA) Regulations 2014 - Good governance. This was because the practice governance systems were implemented and reviewed on an ad hoc basis rather than as part of a clear governance framework. There was limited evidence of continuous clinical and internal audit. The systems and processes to support good governance were not always clearly set out.
This inspection was a follow up inspection to confirm that the provider had carried out their plan to meet the legal requirements. Our key findings were as follows:
- The provider had taken action to meet the breach of regulation.
- The systems and processes in place to ensure good governance had been reviewed and improved.
We also looked at action taken in response to the recommendations we had made to the provider following the last inspection visit. We found:
- New processes had been put into place to ensure all significant events were reviewed on an annual basis to identify themes and trends.
- The system in place for ensuring guidelines from NICE were used and monitored to deliver care and treatment that meet patients’ needs had been reviewed an updated.
- Infection control training opportunities for staff had improved and staff were now attending annual updates.
- Patients on high risk medicines were reviewed and appropriately monitored. An audit had been completed of all patients on high risk medicines and appropriate actions were taken for the results.
- The workload of the practice nurse had been reviewed and feedback given indicated that time was now available to attend local networking meetings and annual training events.
- Patient care plans had been reviewed and updated appropriately.
- Opportunities for staff to attend training relating to the consent and decision-making requirements of legislation and guidance, including the Mental Capacity Act 2005 had improved. All clinical staff had now received this training.
- The provider had sought advice and information from the buildings management team to ensure that appropriate health and safety risk assessments were completed and any issues identified have been addressed. A copy of the latest health and safety risk assessment for the building was presented during inspection.
Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice
Please refer to the evidence table for further information.
13 March 2018
During a routine inspection
This practice is rated as Good overall. There has been a previous inspection at this practice in February 2016 and the practice was rated – Requires Improvement overall.
The key questions are rated as:
Are services safe? – Good
Are services effective? – Requires Improvement
Are services caring? – Good
Are services responsive? – Good
Are services well-led? - Good
As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:
Older People – Good
People with long-term conditions – Good
Families, children and young people – Good
Working age people (including those recently retired and students) – Good
People whose circumstances may make them vulnerable – Good
People experiencing poor mental health (including people with dementia) – Good
We carried out an announced comprehensive inspection at Dr.A.Singh and Dr.S.Bicha on 13 March 2018. Overall the practice is rated as Good.
Our key findings across all the areas we inspected 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. Sharing information and lessons learnt with external providers required improvement.
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The practice had systems, processes and practices in place to minimise risks to patient safety.
- 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.
- Good training opportunities were seen for staff but infection control training had not been completed for staff.
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The practice had systems to keep all clinical staff up to date. Staff had access to guidelines from NICE and used this information to deliver care and treatment that met patients’ needs. However, this was undertaken on an ad hoc basis and there was no robust system to ensure all guidelines issued had been followed.
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Staff sought patients’ consent to care and treatment in line with legislation and guidance. When questioned however, not all staff understood the relevant consent and decision-making requirements of legislation and guidance, including the Mental Capacity Act 2005.
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The practice understood its population profile and had used this understanding to meet the needs of its population
- 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. However, formal action plans were not routinely developed following a patient complaint.
- Patients reported 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.
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Governance systems were implemented and reviewed on an ad hoc basis rather than as part of a clear governance framework. A programme of continuous clinical and internal audit was not evident during the inspection.
- 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 management. The practice proactively sought feedback from staff and patients, which it acted on.
- The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.
We identified regulations that were not being met and the provider must:
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Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
There were areas where the provider could make improvements and should:
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Review all significant events on an annual basis to identify themes and trends. They should review the processes in place for sharing the outcomes of significant investigations with external agencies when required.
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Review the system in place for ensuring guidelines from NICE are used and monitored to deliver care and treatment that meet patients’ needs.
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Review the infection control training opportunities for staff.
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Review the assurance process for ensuring patients on high risk drugs are monitored.
- Review the workload of the practice nurse to ensure adequate time is available to attend local peer group meetings.
- Review how effective care plans can be were used by the practice to deliver care and treatments.
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Review how lessons are learnt and practice is changed and monitored with action plans as a result of patient complaints.
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Review how practice policies and procedures are updated.
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Review the training opportunities for staff relating to the consent and decision-making requirements of legislation and guidance, including the Mental Capacity Act 2005.
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Develop a management system to ensure that the premises are maintained by the host organisation, this should include annual assurance that health and safety risk assessments required have been completed and any issues identified have been addressed.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
23 May 2017
During an inspection looking at part of the service
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Dr Choudhary & Singh on 3 February 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the February 2016 inspection can be found by selecting the ‘all reports’ link for Dr Choudhary & Singh on our website at www.cqc.org.uk.
This inspection was an announced focused inspection carried out on 23 May 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 3 February 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.
Our key findings were as follows:
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The provider had reviewed the recruitment arrangements for the GPs working at the practice and GP locums. Staff files were kept for each GP, but there was missing information viewed on the day and this had to be sent to us the day after our inspection.
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The systems in place for significant event and incident reporting had been reviewed. Systems now included how lessons were learnt and what actions should be taken when things go wrong. However, there had been no staff training completed and an incident reporting form was not available to all staff.
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A practice risk assessment was now in place.
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A revised system of clinical audits was now in place. The provider now used the results of these to monitor and improve patient’s outcomes.
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The practice had an active Patient Participation Group (PPG) that met regularly.
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The systems in place for responding to patient safety alerts had been reviewed and a new lead person was in place.However, there was no effective process in place to ensure all actions required, had been taken.
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Arrangements for ensuring all staff receive appropriate appraisals had been reviewed. All staff had a completed annual appraisal.
There were also areas of practice where the provider should make improvements.
The provider should:
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Undertake significant event training with all staff and introduce an incident reporting form for staff use. The provider should also review the system in place for monitoring significant events, ensuring an annual analysis takes place and actions plans are put into place to prevent reoccurrence.
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Develop a monitoring system for patient safety alerts to ensure that actions as required have been undertaken.
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Develop a system to ensure that all clinical staff are registered with the relevant professional regulator or professional body and that records of these are held on staff files.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
3 February 2016
During a routine inspection
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Dr Choudhary & Singh on 3 February 2016. Overall the practice is rated as requires improvement.
Our key findings across all the areas we inspected were as follows:
- Systems were in place to report incidents and significant events but these were not understood by most staff. The practice did not keep a log of all safety incidents or carry out an analysis of the significant events on an annual basis.
- There were arrangements in place to safeguard adults and children.
- Arrangements were in place to keep medicines safe.
- Urgent appointments wereavailable on the day they were requested.
- Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff received training appropriate to their roles and any further training needs had been identified and planned. Annual appraisals for most but not all staff hadbeen completed.
- Patients care and treatments were monitored, but robust clinical audits were not taking place.
- The practice had good facilities and was well equipped to treat patients and meet their needs. The practice was clean and well maintained.
- Risks to patients were assessed and well managed, with the exception of those relating to the recruitment checks for locum GPs.
- The practice did not have a Patient Participation Group.
- Feedback from patients on the day of the inspection about their care was positive. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
The areas where the provider must make improvements are:
- The provider must ensure recruitment arrangements include all necessary employment checks for staff including for the GPs working at the practice and GP locums.
The areas where the provider should make improvement are:
- The systems in place for significant event and incident reporting requires improvement. The provider should ensure all staff have been trained for this and understand the process for reporting such events. Systems should include how lessons are learnt and what actions should be taken when things go wrong.
- A practice risk assessment should be undertaken.
- The provider should monitor the quality of service patients receive by having a robust system of clinical audits in place. The provider should consider how the results of these can be used to monitor and improve patient’s outcomes.
- Partners should work together to develop a clear vision, business plan and strategy for the practice with cohesive systems in place to monitor this.
- Efforts should be made to establish a Patient Participation Group (PPG) to provide the practice with real time feedback from patients and the public.
- The systems in place for responding to patient safety alerts should be reviewed. A lead person should be identified for this role to ensure that changes are made to patient care when alert information is received at the practice.
- Arrangements for ensuring all staff receive appropriate appraisals should be reviewed.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice