Archived: Dr Manohar Singh Also known as Birkby Health Centre

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Manohar Singh on 7 October 2015. Overall the practice is rated as inadequate.

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

• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example, necessary recruitment checks on staff had not been undertaken prior to their employment; there was incomplete evidence of staff undertaking mandatory training or nursing staff receiving any clinical supervision.

• The indemnity insurance the practice had in place did not cover all relevant clinical staff.

• Temperature checks for the refrigerator that stored vaccines and other medicines had not been undertaken in excess of one year.

• The clinician identified as the safeguarding lead for children and vulnerable adults was unable to demonstrate adequate awareness of how such matters should be managed with other local agencies.

• Staff did not consistently record, report, analyse or share learning from significant events, incidents, near misses and concerns and there was no evidence of formal communication with staff.

• Meetings held with other health professionals were inadequately recorded, with no evidence of appropriate minutes, attendance or actions agreed.

• There was insufficient assurance to demonstrate people received effective care, such as the recording of consent and treatment and there was a failure to undertake any full clinical audits.

• Patients were generally positive about their interactions with staff and said they were treated with compassion and dignity.

• Complaints made to the practice were not adequately recorded and there was no evidence there had been any learning from them. None of the complaints registered against the practice at the NHS Choices website had been responded to by the practice.

• Urgent appointments were usually available on the day they were requested. It was common practice to be asked to wait for up to two hours for an urgent same day appointment as part of the ‘sit and wait’ policy used at the practice.

• The practice had no clear leadership structure, insufficient leadership capacity and formal governance arrangements.

The areas where the provider must make improvements are:

• Take action to address identified concerns with the management of medicines at the practice.

• Ensure recruitment arrangements include all necessary employment checks for all staff.

• Put systems in place to ensure all clinicians are kept up to date with national guidance and guidelines.

• Ensure the safeguarding lead has appropriate understanding of their responsibilities in this role.

• Ensure clinical audits are undertaken in the practice, including completed clinical audit or quality improvement cycles.

• Ensure there are formal governance arrangements in place including systems for assessing and monitoring risks and the quality of the service provision.

• Ensure staff have appropriate policies and guidance to carry out their roles in a safe and effective manner which are reflective of the requirements of the practice.

• Clarify the leadership structure and ensure there is leadership capacity to deliver all improvements

The areas where the provider should make improvement are:

• Improve processes for making appointments, to prevent patients who require urgent care waiting in the surgery for long periods of time.

I am placing this practice in special measures. Practices placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. Since the inspection the named provider has cancelled his registration and a new provider is now in place delivering the service. The practice will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice