Archived: Dr Krishna Singh Also known as Bath Road Surgery

Updated 6 October 2016

Dr Krishna Singh provides NHS primary medical services to around 2100 patients in Hounslow through a general medical services contract. The service is provided from one site.

The current practice staff team comprises the principal GP (male), a locum GP (female), and a practice nurse. The practice also employed a practice manager and receptionists and administrators.

The practice is open from 8.00am and closes at 6.30pm every weekday except Wednesday when the practice is closed from 2.30pm. Appointments can be booked between 9.30am and 1.00pm daily and between 4.30pm and 6.30pm on Monday, Tuesday, Thursday and Friday.

The practice offers online appointment booking and an electronic prescription service. The principal GP makes home visits to see patients who are housebound or are too ill to visit the practice.

When the practice is closed, patients are advised to use a contracted out-of-hours primary care service if they need urgent primary medical care. The practice provides information about its opening times and how to access urgent and out-of-hours services in the practice leaflet and on a recorded telephone message.

The practice has lower proportions of patients aged over 85 and babies and young children compared to the English average, with a high proportion of male patients aged between 25-59 years. The local population is ethnically diverse and the majority of patients registered with the practice are black or Asian by ethnicity. The practice staff speak English and Sinhala. Income deprivation levels in the area are similar to the English national average but the prevalence of some chronic diseases, notably diabetes, is very high locally.

The practice is registered with the Care Quality Commission (CQC) to provide the regulated activities of diagnostic and screening procedures; family planning; maternity and midwifery services; and treatment of disease, disorder and injury.

Updated 6 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at 303 Bath Road Surgery on 15 March 2016. Overall the practice is rated as requires improvement.

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. Reviews were adequately recorded. The practice was aware of the duty of candour and patients received an explanation and apology if they had been affected by an incident.
• The practice assessed most risks to patients but we found some gaps in relation to its recruitment practice, infection control, medicines management and readiness for emergencies.
• Data showed patient outcomes were in line with national and local performance. Clinical staff maintained their knowledge and skills. The practice carried out audits and could demonstrate these had driven improvement to patient outcomes.
• The service was principally provided by one male GP. The practice offered limited appointments with a female locum GP and also offered a practice nurse session one afternoon a week.
• The practice provided a range of services, including onsite phlebotomy, which was valued by patients.
• Patients told us they were treated with compassion, they received personalised care and they had high confidence in their GP.
• Patients said they usually found it easy to make an appointment with the principal GP with urgent appointments available the same day. However, demand for appointments with the female GP was high and patients sometimes had to wait two or three weeks for a non-urgent appointment. 
• We found that clinical sessions seemed to regularly run with delays.
• Written information about services was available in the form of leaflets and various posters in the waiting room. The practice did not have its own website.
• There was a clear leadership structure and staff felt supported both by the principal GP and the practice manager.  
• The practice sought feedback from staff and patients, with an active patient participation group.

The areas where the provider must make improvements are:

• The practice must ensure recruitment arrangements include the completion of necessary employment checks prior to staff starting work at the practice.
• The practice must improve its systems for ensuring that vaccines are stored at the correct temperature, and that all medicines, including vaccines, are stored securely.
• The practice must carry out audits of infection prevention and control in line with national guidance.
• The practice must have a defibrillator on site or carry out a documented risk assessment showing why this is unnecessary.
• The practice must regularly check its stock of emergency medicines and immediately replace any out of date items.
• The practice must ensure that it has an accessible complaints system which includes clear information for patients about how to make a complaint.

In addition the provider should:

• Reduce the incidence of late-running surgeries.
• Implement a system to review non-clinical safety alerts for relevance to the practice. For example, the practice had not risk assessed or secured looped blind cords in areas of the practice used by patients.
• Continue to review ways to improve the management of diabetes and in particular the control of blood sugar levels of patients diagnosed with the condition.
• Continue to review patient feedback and identify ways to improve its performance in comparative patient surveys.
• Consider developing a practice website with information for patients about the service.  
• Continue to evaluate its staffing needs and if necessary expand the number of appointments with a female doctor.
• Assess the feasibility of providing baby changing facilities on the premises.
• Improve the identification of patients who have significant caring responsibilities so that these patients have access to appropriate and available support to meet their needs.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 October 2016

The practice is rated as requires improvement for the care of people with long-term conditions.

The practice was rated as requires improvement for safe and responsive. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• Patients with long-term conditions had a structured regular review to check their health and medicines needs were being met. Patients with long term conditions told us they received good advice on how to manage their condition and live healthily.
• Longer appointments and home visits were available when needed.
• The practice carried out care planning with patients with complex needs and at risk of unplanned hospital admission. The practice did not hold multidisciplinary meetings at the practice but we saw evidence of good coordination and communication with other health and social services professionals to deliver coordinated care.
• The practice monitored its performance in managing long term conditions and tended to perform close to the national for most indicators. For example, 80% of patients diagnosed with hypertension had a recent blood pressure reading in the normal range compared to the national average of 84%.

Updated 6 October 2016

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

The practice was rated as requires improvement for safe and responsive. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• 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 A&E attendances.
• The practice was achieving child immunisation targets.
• 81% of patients diagnosed with asthma had an asthma review in the last 12 months which was close to the national average of 84%.
• Appointments were available outside of school hours and the premises were suitable for children although there were no baby changing facilities.
• Some appointments were available with a female GP.

Updated 6 October 2016

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

The practice was rated as requires improvement for safe and responsive. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• The practice patient list included around 130 patients aged over 75. The practice team spoke Hindi, Sinhala and Nepali in addition to English and this was valued by some older patients. 
• We spoke with a number of older patients who told us they had developed a trusted relationship with their GP over many years and experienced good continuity of care.
• The practice was responsive to the needs of older people, and offered longer appointments, home visits and urgent appointments for those with complex needs.

• The practice carried out care planning with patients who had more complex needs and had good links with local community services.

Updated 6 October 2016

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

The practice was rated as requires improvement for safe and responsive. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• The practice offered appointments until 6.30pm in the evening. Most patients were satisfied with the opening hours.
• The practice also offered online appointment booking and an electronic prescription service.
• The practice provided health promotion and screening services reflecting the needs for this age group.
• The practice’s cervical screening coverage was 77% compared to the national average of 82%.

Updated 6 October 2016

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

The practice was rated as requires improvement for safe and responsive. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• All of the patients on the practice mental health register had a documented care plan. The practice also offered these patients an annual face-to-face review.
• The practice liaised with specialist mental health teams to support patients experiencing poor mental health and was aware of the local mental health crisis pathway.
• The practice referred patients with mental health and substance misuse problems to specialist services in the area
• The practice signposted patients experiencing poor mental health to various support groups and voluntary organisations.

Updated 6 October 2016

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

The practice was rated as requires improvement for safe and responsive. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• The practice held a register of patients living in vulnerable circumstances including people with a learning disability and carers. Vulnerable patients were supported to register at the practice.
• The practice offered longer appointments for patients with a learning disability or other complex needs. All patients on the learning disability register had had a face-to-face review with the GP within the last 12 months.
• The practice liaised with other health and social services professionals to coordinate the care of vulnerable patients.
• The practice informed vulnerable patients about how to access support groups and voluntary organisations, for example the local carers centre.
• 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.