We carried out an announced comprehensive inspection at Dr Gian Singh on 12 March 2019 as part of our inspection programme.

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 with requires improvement for providing well lead services. We rated the practice good for all population groups.

We rated the practice as requires improvement for providing well led services because:

• The practice did not make full use of information available through the identification of significant events or complaints to assess, monitor and develop the service through shared learning.
• The arrangements in place for identifying, managing and mitigating risks were not always effective.

We rated the practice as good for providing safe, effective, caring and responsive services because:

• 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.
• Patients spoke highly about the care and support they received from the practice, and commented on the friendly nature of the practice. They told us they could access appointments when they needed them.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• The patient participation group supported the practice through educational events, patient satisfaction surveys and feedback and suggestions from patients.
• The way the practice was led and managed promoted the delivery of high-quality, person-centre care.

The areas where the provider must make improvements are:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards.

(Please see the specific details on action required at the end of this report).

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

• Review and update policies and procedures as required.
• Continue to focus on improving the uptake of cervical, breast and bowel screening.

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

Letter from the Chief Inspector of General Practice

GOOD

We carried out an announced comprehensive inspection at Dr Gian Singh surgery on 4 May 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 an effective system in place for reporting and recording significant events.
• Risks to patients were assessed, well managed and records maintained by the practice. Patient safety alerts were managed by the community pharmacist.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments and home visits available the same day.
• Although the practice had good facilities and was well equipped to treat patients and meet their needs, we were not provided with evidence that a general health and safety risk assessment had been carried out.
• 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 and complied with the requirements of the duty of candour.

• The practice carried out clinical audits to help drive continuous improvements.

We saw two areas of outstanding practice:

The practice organised an annual health fair in the local church hall to promote and increase access to a range of healthcare services. The practice nurse carried out blood tests and there were stalls offering information on money matters, Macmillan palliative care, dementia and weight management. The Local Mayer attended to open the event and the local newspaper wrote a positive article on its success.

The practice engaged with the local church who were running a fortnightly dementia café, they actively identified and referred patients. Staff were registered as dementia friends and the practice manager had completed a NVQ in dementia care in order to continually improve their ability to identify, diagnose and support patient with dementia . As a result between April 2014 and March 2015 the practice increased their diagnosis rate from 70% to 93%.

The areas where the provider should make improvement are:

• Provide notices in the reception area advising patients that chaperones were available
• Consider developing a contingency plan in the absence of the practice nurse.
• Continue to seek a completed risk assessment from NHS Property Services Ltd who were the landlords of the building.
• Consider how they could proactively identify and support carers.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice