This practice is rated as Good overall. (Previous rating January 2018 – Good overall with Requires Improvement for well led)

The key questions at this inspection are rated as:

Are services safe? – Not inspected

Are services effective? – Not inspected

Are services caring? – Not inspected

Are services responsive? – Not inspected

Are services well-led? - Good

We carried out an announced comprehensive inspection at Dr Vishwambhar Sinha (also known as Crane Park Surgery) on 9 January 2018. During that inspection we found a breach of regulation in respect of Regulation 17 (Good Governance) of the Health and Social Care Act 2014. Following that inspection the practice submitted an action plan, outlining how they intended to address the issues identified. We returned to the practice on 9 August 2018 to carry-out an announced focused inspection, looking at the Well Led key question, in order to check that the practice’s action plan had been implemented and that the issues identified at the previous inspection had been addressed.

At this inspection we found:

• Following the previous inspection in January 2018 the practice had begun to keep minutes of staff meetings, which were made available to all staff. However, the practice’s arrangements in respect of recording discussions about patient care in weekly meetings between the principal GP and long-term locum GPs had not changed. Notes of these discussions were still not comprehensive and were not made available to all participants of the meeting; details of these discussions were not routinely saved in the relevant patient’s records.
• The practice was able to demonstrate that they used available information to assess their performance against other practice’s locally, and clinical audits were completed as required by the CCG medicines team; however, there remained no culture of two-cycle clinical audit as a tool for quality improvement at the practice.
• The practice had up to date policies in place, which were available to all staff.
• Comprehensive records were maintained of activities such as the cleaning of clinical equipment, the monitoring of stocks of equipment and medicines, and the receipt and allocation of prescription stationery.
• The practice had identified 34 patients who had caring responsibilities (compared to 33 patients identified at the time of the previous inspection), this represented approximately 1% of the patients registered at the practice.
• The practice had stocks of all recommended emergency medicines, and there were processes in place to ensure that adequate stocks were maintained and all medicines were in date.
• During the previous inspection we reviewed examples of complaint responses from the practice and noted that these did not contain contact information for the Parliamentary and Health Service Ombudsman (PHSO). At the time of the re-inspection the practice had not received any further complaints; however, following a discussion during the follow-up inspection about the availability of information for patients on how to make a complaint, we saw evidence that the practice had produced a complaints leaflet, which contained contact details for PHSO.

The areas where the provider should make improvements are:

• Introduce a process for recording and sharing with all participants, details of informal discussions about patient care, and where appropriate, record these discussions directly into patient’s medical records.
• Introduce a formal programme of clinical quality improvement activity.

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

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

Letter from the Chief Inspector of General Practice

This practice is rated as Good overall. (Previous inspection in October 2014 rated the practice as Good in all domains and overall).

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires Improvement

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 Vishwambhar Sinha (also known as Crane Park Surgery) on 9 January 2018 as part of our inspection programme.

At this inspection we found:

• The practice had 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; however, they did not always ensure that a comprehensive record was kept of the investigation and the action taken.
• The practice ensured that care and treatment was delivered according to evidence- based guidelines. There were systems in place to ensure that patients with long-term conditions or who were vulnerable received the treatment and health checks they needed; however, there were limited arrangements in place to formally review the effectiveness and appropriateness of the care provided.
• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients found the appointment system easy to use and reported that they were able to access care when they needed it.
• There was a lack of governance arrangements to ensure that comprehensive records were kept relating to the running of the practice and that quality assurance processes were in place which led to improvements in patient outcomes.

The areas where the provider must make improvements are:

• The practice must ensure systems and processes are established and operated effectively to demonstrate good governance.

In addition, they should:

• Take action to increase the number of carers identified, in order that they can provide support to these patients.
• Make available all required emergency medicines and put processes in place to monitor the stocks of these medicines.
• Complete a risk assessment of the practice and put in place arrangements to mitigate any risks identified.
• Introduce a programme of clinical audit, to include action plans to address identified areas of improvement.
• Include contact details for the Parliamentary and Health Service Ombudsman in responses to complaints.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

The Crane Park Surgery, located in Twickenham in the London Borough of Richmond upon Thames in south-west London, provides a general practice service to around 3,000 patients.

We carried out an announced comprehensive inspection on 29 October 2014. The inspection took place over one day and was undertaken by a lead inspector, along with a GP advisor. We looked at care records; spoke with patients, and staff including the management team.

Overall the practice is rated as Good.

Our key findings were as follows:

• The service is safe. There were systems in place for reporting, recording and monitoring significant events to help provide improved care. Staff were clear of their roles in regards to monitoring and reporting of incidents, safeguarding vulnerable people and children, and following infection prevention and control guidelines.

• The service is effective. Staff shared best practice through internal arrangements and meetings and also by sharing knowledge and expertise with external consultants and other GP practices. There was a strong multidisciplinary input in the service delivery to improve patient outcomes.

• The practice is caring. Feedback from patients about their care and treatment was positive. Patient feedback seen from the national GP survey 2014 was mostly positive. Patients were treated with kindness and respect and felt involved in their care decisions. Almost all of the 46 comment cards completed by patients who used the service in the two weeks prior to our inspection visit had very positive comments about the care and service provided by the surgery.

• The practice is responsive. The practice was responsive to the needs of vulnerable patients and there was a strong focus on caring and on the provision of patient-centred care. Information on health promotion and prevention, on the services provided by the practice and on the support existing in the community was available for patients. However the practice had no place for patients to make comments or suggestions within the practice. The practice did not have a Patient Participation Group (PPG).

• The practice is well-led. The practice has a clear vision and strategic direction. Staff were suitably supported, and patient care and safety were a high priority.

All the population groups including older people; people with long term conditions; mothers, babies, children and young people; the working age populations and those recently retired; people in vulnerable circumstances and people experiencing poor mental health received care that was safe, effective, caring, responsive and well-led.

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

Importantly the provider must:

• The practice must regularly gather the views of service users, persons acting on their behalf and persons who are employed for the purposes of carrying out the regulated activity. Such as the views and comments of a Patient Participation group (PPG).

In addition the provider should:

• Consider having an Automated External Defibrillator (AED) to maximise emergency care provision available within the practice and to ensure the welfare and safety of service users.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice