Archived: Dr Krishna Singh Also known as Bath Road Surgery

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