We carried out an announced comprehensive inspection at Dr Singh`s Surgery on 30 April 2019 as part of our inspection programme.

At the last inspection in June 2018 we rated the practice as requires improvement for providing safe and well-led services because:

• There were shortfalls in the systems for monitoring patients on high risk medicines.
• There was no evidence of action taken in response to safety alerts.
• There was no system to manage uncollected repeat prescriptions or an audit trail to monitor the use of blank prescriptions.
• There was a lack of understanding about assessing risks associated with fire, infection prevention and control, and the storage of hazardous substances.
• There were no records to confirm monitoring of emergency medicines, emergency equipment, and vaccines.
• There was a lack of management oversight in managing risks relating to health and safety matters.
• There was a lack of engagement with patients.
• Not all staff were aware of the practice’s vision.

At this inspection, we found that the provider had satisfactorily addressed these areas.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as good overall and good for all population groups.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

Whilst we found no breaches of regulations, the provider should:

• Continue to review and improve uptake rates for childhood immunisations and cervical screening.
• Continue to review and improve patient satisfaction with telephone access and access to appointments.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

This practice is rated as requires improvement overall. (Previous rating 06/2015 – Good)

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Requires improvement

We carried out an announced comprehensive inspection at Dr Singh’s Surgery on 5 June 2018 as part of our inspection programme.

At this inspection we found:

• There were risk assessments in relation to some safety issues. However, there was a lack of understanding about the practice areas of responsibility in relation to fire safety, infection prevention and control, and health and safety matters.
• The practice had some 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.
• The practice had some systems for appropriate and safe handling of medicines. However, the systems for managing high risk medicines, safety alerts and uncollected repeat prescriptions needed to be addressed.
• 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.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Most patients found the appointment system easy to use and could access care when they needed it, although some patients reported difficulties accessing the practice via telephone and poor interactions with reception staff. The practice was aware of this feedback and were taking action to improve the service.
• The practice took account of the National GP patient survey data, but they did not proactively involve patients and the public to support good quality sustainable services.
• There was a focus on continuous learning and improvement at all levels of the organisation. However, there was a lack of management oversight in managing risks relating to health and safety matters.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

• Review and improve reception staff training for their role in the management of patients with severe infections such as sepsis, and customer service skills.
• Review and improve uptake rates for cervical, breast and bowel cancer screening.
• Improve the numbers of patients identified as carers.
• Review and improve patient engagement and satisfaction with the service.
• Develop supporting business plans to achieve practice priorities and share the vision with staff.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Singh’s Surgery, also known as Clifford Road Surgery, on 16 June 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, well-led, effective, caring and responsive services. It was also good for providing services to the six population groups we inspect - People whose circumstances may make them vulnerable; Older people; People with long-term conditions; Families, children and young people; Working age people (including those recently retired and students); and People experiencing poor mental health (including dementia).

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Most risks to patients were assessed and well managed, with the exception of fire safety.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.
• Staff had received training appropriate to their roles and any further training needs had been identified, although not all staff had received training in safeguarding vulnerable adults.
• There was a good skill mix amongst the GPs with some clinicians having specialised areas of expertise.
• Patients said they were treated with compassion, dignity 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.
• Patients said they could make an appointment when they needed one, although some found it difficult to access the practice by telephone in the mornings. Urgent appointments were available the same day but may not be with a GP of the patient’s choice.
• 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 sought feedback from patients, staff and the patient participation group (PPG), which it acted on.

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

Importantly, the provider should:

• Ensure all staff receive training in the safeguarding of vulnerable adults.
• Carry out a comprehensive risk assessment to identify, assess and mitigate the risks associated with fire.
• Ensure reference checks for all staff are consistent with the practice’s recruitment policy.
• Ensure staff are familiar with the practice’s vision and values.
• Ensure information on whistleblowing is available to staff should they have any concerns.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice