Archived: Dr Sidhu's Medical Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Sidhu’s Medical Practice on 20 October 2016. Overall the practice is rated as inadequate.

The practice had been previously inspected on 13 January 2016. Following this inspection the practice was rated inadequate with the following domain ratings:

Safe – Inadequate

Effective – Inadequate

Caring – Inadequate

Responsive – Inadequate

Well-led – Inadequate

The practice was placed in special measures.

Warning notices were issued on 24 March 2016 in relation to regulation 12 (Safe care and treatment) and regulation 17 (Good governance). An inspection was carried out on 17 June 2016 to check the warning notices had been complied with. It was found that the necessary improvements had taken place.

Our key findings across all the areas we inspected on 20 October 2016 were as follows:

• Data showed patient outcomes were usually low compared to the national average.
• Some patients reported that it was difficult to access appointments, and that it was difficult to get through to the practice by telephone.
• Not all clinicians understood issues relating to consent.
• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Reviews and investigations were thorough.
• Risks to patients were assessed and well managed, with the exception of those relating to recruitment checks
• Audits had been carried out and there was evidence that audits were driving improvements to patient outcomes.
• 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 management.
• The practice proactively sought feedback from staff and patients, which it acted on.

The areas where the provider must make improvements are:

• The provider must ensure appropriate action is taken when alerts are received from the Medicines and Healthcare Products Regulatory Agency (MHRA).

• The provider must ensure patients are appropriately diagnosed and read coded so that clinical prevalence rates are accurate and appropriate care and treatment can be offered.

• The provider must ensure all clinical staff have the required understanding of the Mental Capacity Act 2005 so consent is correctly sought.

• The provider must ensure all relevant information is obtained for staff prior to them being employed.

This service was placed in special measures following the inspection in January 2016. Insufficient improvements have been made and there remains a rating of inadequate for the safe, effective and well-led domains. Due to the improvements that have been made since the initial rating of inadequate we have not yet started the process of preventing the provider from operating the service. Other enforcement action will be taken. They will remain in special measures. Another inspection will be conducted within 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

Letter from the Chief Inspector of General Practice

On 13 January 2016 we carried out a full comprehensive inspection of Dr Sidhu’s Medical Centre (the registered under the name Dr Sukhdev Singh Sidhu). This resulted in two Warning Notices being issued against the provider on 24 March 2016. The Notices advised the provider that the practice was failing to meet the required standards relating to Regulation 12 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014, Safe care and treatment, and Regulation 17 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014, Good governance.

On 17 June 2016 we undertook a focused inspection to check that the practice had met the requirements of the Warning Notices. At this inspection we found that the practice had satisfied the requirements of the Notice.

Specifically we found that:

• The GP had a good understanding of the Mental Capacity Act 2005 and was able to give examples of when they had used it.

• There was a process in place to ensure the practice assessed needs and delivered care in line with relevant and current evidence based guidance and standards, including the National Institute for Health and Care Excellence (NICE). Guidance from the National Patient Safety Agency (NPSA) and the Medicines and Healthcare Regulatory Products Agency(MHRA) were followed.

• Training for staff of all levels was monitored and the practice ensure all staff had received appropriate training and supervision.

• There was a system in place to ensure the safe storage of medicines. Blank prescriptions were monitored and stored safely.

• There was a system in place to check the temperature of fridges used to store medicines. Appropriate staff were aware of the procedure to follow if the temperature went outside the recommended range.

• The recording of information in patients’ records had significantly improved and read coding was extensively used. (Read codes are the standard clinical terminology system used in General Practice)

• There was a system in place to monitor and assess the quality of the service. This included clinical audit cycles being carried out.

• Staff were aware of the process to follow if a complaint was received, and complaints were investigated and responded to appropriately.

The rating awarded to the practice following our full comprehensive inspection on 13 January 2016 remains unchanged. The practice will be re-inspected in relation to their rating in the future.

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 Sukhdev Singh Sidhu (also known as Dr Sidhu's Medical Centre) on 13 January 2016. 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 staff were not aware of safeguarding responsibilities, and GPs did not understand the principles of the Mental Capacity Act 2006 or the Gillick Competence.

• Staff were not clear about reporting incidents, near misses and concerns and there was no consistency in reporting.

• Patient outcomes were hard to identify as no reference was made to audits or quality improvement and there was no evidence that the practice was comparing its performance to others, either locally or nationally.

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

• Appointment systems were not working well so patients did not receive timely care when they needed it.

• There was very little evidence of staff training, and this included the training of clinical staff.

The areas where the provider must make improvements are:

• The provider must ensure care plans in place for patients in a care home or with a higher risk of an unplanned hospital admission contain the level of information required to deliver clinical and holistic care.

• The provider must ensure they understand the principles of the Mental Capacity Act 2005 when assessing the capacity of a patient, and also understand the Gillick Competence.

• The provider must have a formal system in place to receive and respond to national patient safety alerts or medicine alerts.

• The provider must ensure they understand their performance and have a system in place to monitor and improve performance.

• The provider must ensure all staff who provide care and treatment to patients have received training and updated training, and had their competence assessed prior to them working unsupervised.

• The provider must ensure all medicines not required in the practice are disposed of in the appropriate way. Emergency medicines must be available at all times patients are on the premises. There must be a system in place for blank prescriptions to be held securely. The cold chain in the practice must be maintained and staff must be aware of the action to take when there is a problem with this. They must ensure only appropriate items are stored in medicine fridges.

• The provider must ensure staff have an understanding of infection prevention and control.

• The provider must ensure all staff have an insight into their responsibilities relating to safeguarding, and know who the safeguarding lead at the practice is. Safeguarding training must be provided. If any safeguarding concerns are brought to the attention of the provider appropriate action must be taken.

• The provider must ensure that chaperones understand their role when carrying out chaperone duties. Chaperones must have had a Disclosure and Barring Service (DBS) check carried out.

• The provider must ensure up to date and accurate information is available to patients regarding how to make a complaint. They must ensure all staff are aware of the complaints’ procedure.

• The provider must ensure a system is in place to monitor the availability of appointments.

• The provider must ensure all patients’ records are complete with history, medical examinations and diagnostic reasoning adequately recorded. This must include read coding of conditions and illnesses, patients who are carers and patients who are housebound.

• The provider must ensure clinical audit cycles take place as a way of identifying issues and making improvements to the service provided.

• The provider must ensure all new staff have an induction programme in place. Training must be provided for staff when they start work and be updated appropriately. Staff must have regular supervision or appraisals.

The areas where the provider should make improvement are:

• The provider should improve access to NHS Health Checks for patients.

• The provider should bring their mission statement to the attention of staff, including the GPs.

• The provider should bring practice meetings to the attention of staff so they are aware of their existence.

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 so a rating of inadequate remains 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.

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.

Special measures will give people who use the practice the reassurance that the care they get should improve.

In addition, two warning notices were issued to the provider under Section 29 of the Health and Social Care Act 2008. These related to breaches of Sections 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and they stated the provider must be compliant with the regulations by 27 May 2016.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice