This practice is rated as Good overall. (Previous rating April 2018 – Good overall, with a rating of requires improvement for providing safe services)

The key questions at this inspection are rated as:

Are services safe? – Good

We carried out an announced comprehensive inspection at Dr Deedar Singh Bhomra (also known as Aylesbury Surgery) in December 2016 where the provider was rated as requires improvement for providing safe services and breaches of regulations were identified. We undertook a follow up inspection in April 2018 the practice continued to be rated as requires improvement for providing safe services. As a result, we issued requirement notices as legal requirements were not being met and asked the provider to send us a report that says what actions they were going to take to meet legal requirements. The full comprehensive report of all previous inspections can be found by selecting the ‘all reports’ link for Dr Deedar Singh Bhomra on our website at

This inspection was an announced focused follow up inspection carried out on 3 December 2018 to check whether the provider had taken action to meet the legal requirement’s’ as set out in the requirement notices. The report covers our findings in relation to those requirements.

At this inspection we found:

• Staff demonstrated awareness of systems to manage risks so that safety incidents were less likely to happen. When incidents did happen, the practice demonstrated shared learning and the actions taken to improve processes.
• Since the inspection in April 2018, the practice had reviewed and improved the management of risks in areas such as health and safety.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Please refer to the detailed report and the evidence tables for further information.

This practice is rated as Good overall. Previous inspection December 2016 and rated overall good, except for providing safe services where the practice was rated as requires improvement. This was because action required to comply with findings from annual infection control audits had not been fully addressed. For example, provisions of a sluice hopper for the disposal of waste water and a hand wash basin in the area used to store cleaning equipment. Systems for monitoring prescription collection were not embedded.

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Outstanding

Are services well-led? – Good

We carried out an announced comprehensive inspection at Dr Deedar Singh Bhomra also known as Aylesbury Surgery on 11 April 2018 as part of our inspection programme.

• The practice had clear systems to respond to incidents and measures were taken to ensure incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
• The practice did not carry out some risk assessments. For example, a fire and health and safety risk to support the monitoring or mitigation of potential risks had not been carried out. However, staff explained that monthly walk arounds to check health and safety within the practice were carried out and, where required, actions had been taken.
• The practice had some arrangements in place to enable appropriate actions in the event of a medical emergency. However, not all potential medical emergency situations were considered and a risk assessment to mitigate potential risks had not been carried out. Following our inspection, the practice reviewed and updated their stock of emergency medicines.  
• 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. Results from the July 2017 national GP patient survey showed that the practice scored above local and national averages in a number of areas. Completed Care Quality Commission (CQC) comment cards were also positive about the services provided.
• Completed CQC comment cards showed that patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a strong focus on continuous learning, improvement and community engagement at all levels of the organisation. The leadership team maintained an inspiring shared purpose and strived to deliver the vision while motivating staff to succeed.

We saw areas of outstanding practice:

The practice used their knowledge of the local community and patient population as levers to deliver high quality, person centred care. Staff were well organised and made full use of their resources to respond to population needs. There was a strong focus on community involvement, for example:

• Children from local primary schools were invited to the practice where staff delivered short talks to provide an insight of visiting GPs. Staff with the help of teachers gave children demonstrations on how GPs carries out checks and children were able to see equipment used in the surgery. Discussions with the local church highlighted a concern that people within the area did not always have access to a hot meal. In response to this, the practice funded a monthly soup kitchen in the local Church Hall. Staff we spoke with explained that this was well attended. The practice actively worked with patients, residents and community organisations to encourage community spirit and involvement in various events. For example, the practice supported as well as arranged fund raising events, which collected donations to support local organisations.

The areas where the provider must make improvements are:

• Ensure care and treatment is provided in a safe way to patients

The areas where the provider should make improvements are:

• Ensure staff are aware of forms used by the practice to report incidents.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Aylesbury Surgery on 07 December 2016. 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 staff used an effective system to report significant events. The practice could demonstrate learning from investigations.
• Risks to patients were assessed and well managed with a particularly acute focus on risks associated with vulnerable children and patients with mental health needs.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. A system was in place to ensure clinical staff maintained an up to date knowledge of changes in national guidance, including from the National Institute of Health and Care Excellence.
• Patients feedback was consistely positive and the practice performed significantly better than local and national averages in the GP Patient Survey.
• Staff had established a clinical audit programme based on the performance of the practice and the needs of its patients and used results to improve services.
• 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 and the practice manager followed up each complaint personally.
• The practice offered a range of appointments to suit patients’ needs and to ensure continuity of care.
• The practice had good facilities and was well equipped to treat patients, with adaptations made based on patient feedback.
• The leadership structure meant staff felt supported and valued, which helped them to give their best. The practice proactively sought feedback from staff and patients, which it acted on.
• The provider complied with the requirements of the duty of candour.

We saw areas of outstanding practice:

• There was a consistent and proactive approach to engaging with the local community. This included the implementation of a community health forum to help drive health improvement and provide patients with links to multiprofessional services such as local authority safeguarding and the police. In addition, the service funded and facilitated a monthly communal hot meal for people in the local community.

The areas where the provider should make improvements are:

• The practice should ensure every member of staff has the knowledge and skills to access clinical policies and guidance on the electronic system, including how to flag and identify patients at risk. There should also be a system in place to ensure staff follow policies and ensure newly implemented guidance is embedded in the service.
• The practice should implement monitoring to ensure the chaperone policy implemented after our inspection was implemented consistently.
• The practice should implement a system to actively identify and support carers within their patient list, as this was at less than 1% at the time of our inspection.
• The practice should encourage patients to engage with national screening programmes for breast and bowel cancer

We found two areas in which the provider must make improvements:

• The provider must ensure the actions resulting from the 2016 infection control audit are fully implemented.

• The provider must ensure storage facilities used for infection control equipment are secured and fit for purpose, with documented evidence of regular reviews to establish effectiveness.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice