Dr Sukhdeep Singh Gujral

Updated 23 March 2016

Marsh Surgery (Dr S Gujral) is situated in Marsh, a suburb of Huddersfield.

The practice building was formerly a terraced house. It is two storeys high and presents limitations for disabled access. The practice has 2566 patents on their list. Approximately 50% of their patients are white British, whilst 30-40% are of South Asian ethnicity, with approximately 10% of Eastern European or Afro-Caribbean origin. The practice provides General Medical Services (GMS) under a contract with NHS England. The practice offers a range of enhanced services such as extended hours access to appointments and childhood immunisations.

The practice is run by a single handed male GP. It also makes use of two regular locums, one male and one female. Clinical staff also include one nurse practitioner, one practice nurse and two health care assistants, all of whom are female. The clinical team is supported by a business manager, a senior practice administrator and a range of administrative and clerical staff.

The practice is classed as being in one of the more deprived areas in England. The age profile of the practice is commensurate with average practice profiles in England.

The practice is open from 8.30am until 6pm Tuesday, Thursday and Friday. On Wednesday the practice has an early closing time at 12.30pm with emergency telephone cover only provided until 6.30pm. On Monday is it open from 8.30am with extended hours until 8pm.

Child surveillance, asthma, diabetes and coronary heart disease are some of the clinics which run every week. Patients are able to access smoking cessation and weight management support in-house at the surgery. Patients can be signposted to local agencies for support with drug and alcohol problems or mental health support services.

One of the upstairs consultation rooms is used by an aesthetic skin care provider. This is a separate organisation and sees patients privately.

Marsh Surgery is registered with the Care Quality Commission to provide diagnostic and screening procedures, treatment of disease, disorder or injury, family planning and surgical procedures.

Updated 23 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Marsh Surgery (Dr Sukhdeep Singh Gujral) on 25 January 2016. Overall the practice is rated as good for all the population groups it serves.

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

• Staff understood and fulfilled their responsibilities to raise concerns and to report incidents and near misses.
• Some risks to patients were assessed and managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had 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.
• Patients said they were able to make an appointment with the GP and that urgent appointments were available the same day when required, although access to the surgery by telephone was difficult at busy periods.
• The practice was constrained by their premises, in particular in relation to disabled access and fire safety arrangements.
• The practice had a number of policies and procedures to govern activity.
• The practice had recently established a patient participation group (PPG) and was responsive to their suggestions.

However there are areas where the provider needs to make improvements.

The provider should:

• Risk assess the emergency medicine arrangements. Consider range of medicines in use, and storage arrangements.

• Evidence cleaning schedules for medical equipment by developing a log of actions completed.

• Review the risk assessment in relation to an on-site defibrillator

• Improve patient experience of accessing the practice by telephone

• Enhance patients’ dignity and privacy by ensuring curtains are fitted in examination rooms.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 March 2016

The practice is rated as good for the care of people with long term conditions.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• 95% of patients on the diabetes register had a recorded foot examination completed within the preceding 12 months which was higher than the national average of 88%.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review as a minimum to check their health and medicines needs were being met. For those patients with the most complex needsthe GP worked with relevant health and social care professionals to deliver a multidisciplinary package of care.

Updated 23 March 2016

The practice is rated as good for the care of families, children and young people.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of accident and emergency(A&E) attendances. Immunisation rates were relatively high for all standard childhood immunisations.

• 76% of patients with asthma, on the register had received a review in the preceding 12 months compared to the national average fo 75%.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• Appointments were available outside of school hours.

• The constraints of the building meant that baby changing and breast feeding facilities were not available; however children were given priority access to same day appointments.

• Staff told us they had regular liaison with the health visitor and we saw minutes to evidence these meetings.

Updated 23 March 2016

The practice is rated as good for the care of older people.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• The practice provided access to ground floor consulting rooms for those patients with mobility difficulties.

• Data showed that 84% of eligible patients had received an over 75 year check in the preceding year.

• The practice participated in the Kirklees Dementia Action Alliance which aimed at increasing awareness of dementia in the community.

Updated 23 March 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

• 79% of eligible women had a recorded cervical smear completed within the preceding five years compared to the national average of 82%.

• Data showed that 59% of eligible patients had received the NHS cardiovascular health check in the preceding year.

Updated 23 March 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• 80% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is lower than the national average of 84%.

• 96% of patients with schizophrenia or other psychoses had a comprehensive care plan documented in the preceding 12 months which is higher than the national average of 88%.

• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

• The practice carried out advance care planning for patients with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Dementia screening tools were routinely used and staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 23 March 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours. Staff were able to give examples of when safeguarding processes had been appropriately implemented.