We carried out an announced comprehensive inspection at Dr Manjit Singh’s practice also known as Cambridge Street surgery on 20 January 2017. The overall rating for the practice was Good, however, it was rated requires improvement for providing safe services. The full comprehensive report on the January 2017 inspection can be found by selecting the ‘all reports’ link for Dr Manjit Singh on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 15 March 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 20 January 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice continues to be rated as Good, however the practice also continues to be rated as requires improvement for providing safe services.

Our key findings were as follows:

• The practice had reviewed and developed some systems to ensure that risks in some areas were monitored and managed appropriately, for example in relation to the management of patient safety alerts, legionella assessment and the management of significant events.
• The practice did not demonstrate effective systems were in place in relation to recruitment and prescription safety.

• The practice had completed some medicine audits in line with local guidelines; however they were unable to demonstrate quality improvement through these audits.
• The practice had assessed patients ‘needs and delivered care in line with current evidence based guidance. Since the previous inspection the practice had introduced a systematic approach for the implementation of clinical guidelines.
• The practice had considered future planning and since the last inspection had implemented a formal written business plan.
• The practice had ensured that a female locum was available on a regular basis for female patients.
• The practice had reviewed the number of carers on their practice list and had seen an increase in the number of carers to 2%.
• Since the previous inspection patient feedback on nursing staff, telephone access and availability of pre-bookable appointments was below the national average. At this inspection we found the practice had seen an improvement in patient satisfaction in the July 2017 GP patient survey results.

However there were areas of practice where the provider must make improvements:

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

In addition the provider should:

• Strengthen the current process to demonstrate the action taken on receipt of safety alerts.

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 Manjit Singh’s Practice on 20 January 2016. Overall, the practice is rated as good.

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

• There was a system in place for reporting and recording significant events. Learning outcomes were seen to have been shared but records of these were not readily available to the wider practice team.
• 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.
• Practice staff reviewed the needs of its local population to secure improvements to services where these were identified.
• Information about services and how to complain was available and easy to understand.
• Patient feedback on making an appointment was below local and national averages although they spoke positively about the continuity of care and availability of same day urgent appointments.
• 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 the 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 areas where the provider must make improvement are:

• Introduce a formal system to log, review, discuss and act on alerts received to minimise risk to the safety of patients and staff.
• Ensure appropriate pre-employment checks are carried out on staff employed and implement processes to demonstrate that the physical and mental health of newly appointed staff have been considered to ensure they are suitable to carry out the requirements of the role.

The areas where the provider should make improvement are:

• Review the process for sharing learning outcomes from significant event with the wider practice team.
• Revise the adult safeguarding policy to include updated definitions of abuse such as modern day slavery.
• Refer to nationally recognised guidelines for infection prevention control.
• Minimise the risk of legionella by carrying out the control measures as outlined in the risk assessment.
• Introduce a system to monitor and track the use of prescription pads and forms.
• Consider the inclusion of pulse oximeters as part of the equipment held to deal with a medical emergency.
• Introduce a systematic approach for the implementation of clinical guidelines.
• Implement a programme of audits to monitor performance and drive improvement.
• Consider how patient feedback on the nursing staff could be improved.
• Explore how the number of carers identified can be increased.
• Formalise communication for female patients advising on how a female GP could be provided if requested.
• Look at how to improve the patient feedback on access by telephone and availability of pre-bookable appointments.
• Consider the introduction of a written business plan for the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

At our previous inspection in September 2013 we saw that the recruitment processes in place were not robust. We also identified that improvements were needed to the systems used at the practice for assessing and monitoring the quality of the service provided to patients. Following the inspection the provider had sent us an action plan giving details of action taken to ensure robust systems were in place.

This visit to the surgery was announced to ensure that we had the opportunity to speak to the registered manager and review the actions identified in the action plan.

We found that the required documentation was in place in relation to recruitment. A fire risk assessment had been completed and staff had received fire safety training.

We visited the surgery to check that the needs of patients were being met. On the day of the inspection we spoke with two staff members, the principal GP and the practice manager. We also spoke with six patients about their experience. One patient said: “Brilliant doctor, the other doctor is fantastic as well, I couldn’t ask for a better surgery”. All the patients we spoke with were positive about the staff at the practice. One patient said: “Staff are good”.

Patients we spoke with told us they were happy with the level of care they had received. We found that care and treatment was planned and delivered in a way that met patients’ needs. However, improvements were needed in their arrangements for medical emergencies.

We saw evidence of local authority guidance in place to protect vulnerable adults and children.

The provider did not have a robust system to ensure staff were registered with their relevant professional body and were subject to the necessary checks to ensure that they were fit to work.

The provider did not have a robust system in place for monitoring the quality of service provision. The provider did not demonstrate learning from accidents and incidents.

We carried out an announced focused inspection on 15 November 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations we identified in our previous inspection in March 2018 where breaches of the Health and Social Care Act 2008 were identified. You can read the report from our last comprehensive inspection on 18 October 2017; by selecting the ‘all reports’ link for Dr Manjit Singh on our website at www.cqc.org.uk. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Our judgement of the quality of care at this service is based 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.

I have rated this practice as good overall.

This means that:

• People were protected from avoidable harm and abuse and that legal requirements were met.
• The provider had implemented a system to ensure the safety of blank prescription pads on the premises.
• The provider had processes in place to gain assurances through relevant checks that staff were competent for their role prior to employment.
• Patients had good outcomes because they received effective care and treatment that met their needs.
• The provider had reviewed all non clinical staff immunisation status to mitigate risk to both patients and staff.
• Patients were supported, treated with dignity and respect and were involved as partners in their care.
• People’s needs were met by the way in which services were organised and delivered.
• The leadership, governance and culture of the practice promoted the delivery of high quality person-centred care.

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

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice