Archived: Sinha Medical Teaching Practice

Updated 13 August 2015

The Sinha Medical Teaching Practice is a surgery located in the London Borough of Newham. The practice is part of the NHS Newham Clinical Commissioning Group (CCG) which is made up of 61 practices. It currently holds a PMS contract and provides NHS services to 6480 patients. despite the name of the practice, it was not an NHS England designated teaching practice.

The practice serves a diverse population with many patients attending where English is not their first language. The majority of the practice population is between the ages of 20 and 39. The practice is situated within a purpose built centre. Consulting rooms are available on two levels and there is a lift available for those with impaired mobility. There are currently two GP partners (both male); two part time practice nurses; administrative staff and a practice manager employed in the service. At the time of the inspection the senior partner had retired from practice (the CQC had not been informed of this) and the second partner was suspended by the General Medical Council (GMC). The practice manager was on sick leave. The practice was occupied by two locum doctors, a nurse and administrative staff.

The practice is open from 8.30am to 6.30pm on weekdays and 10am to 4pm on Saturdays. Appointments are available from 9am to 1:30pm and then from 2.30pm to 6pm on Monday to Thursday; between 11.am to 1.30pm and 2.30pm to 6pm on Friday; and between 12.30pm to 4pm on Saturday. The Saturday opening is extended hours for those patients who could not attend during the week as they worked. The practice did not provide out of hours treatment but referred patients to the local out of hour’s provider.

The practice had been inspected previously in August 2013 and was found to non-compliant in the areas of safeguarding people who use the service from abuse and supporting workers. The provider was found compliant at the follow up inspection in July 2014.

The service is registered with the Care Quality Commission to provide the regulated activities of diagnostic and screening procedures, family planning, maternity and midwifery services, surgical procedures and the treatment of disease, disorder or injury.

Updated 13 August 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Sinha Medical Teaching Practice on 27 May 2015. Overall the practice is rated as inadequate.

Specifically, we found the practice to be inadequate for providing well-led, effective, caring, safe and responsive services. It was also inadequate for providing services for the care provided to older people, people with long term conditions, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia).

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 there was a lack of staff safeguarding training, infection prevention and control was not being managed, there was no system to manage medicines within the practice, out of date emergency medicines, no emergency oxygen or defibrillator, no chaperone policy or procedures and no formal recruitment process.
• Staff were not clear about reporting incidents, near misses and concerns and there was no evidence of learning and communication with staff.
• There was insufficient assurance to demonstrate people received effective care and treatment as there was an absence of audit and performance data available.
• There was an absence of leadership and management oversight in the practice no clear formal governance arrangements.
• Patients said they were treated with compassion, dignity and respect and that they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available.
• The practice had good facilities and was well equipped to treat patients and meet their needs.

There were areas of practice where the provider needs to make improvements.

Importantly the provider must:

• Take action to address identified concerns with infection prevention and control practice. Including ensuring the practice is clean and an infection control audit is undertaken.
• Ensure recruitment arrangements include all necessary checks for all staff.
• Put systems in place to ensure all clinicians are kept up to date with national guidance and guidelines, including Gillick competency.
• Ensure staff have completed all mandatory training including basic life support, chaperoning and safeguarding.
• Ensure there are formal governance arrangements in place, including systems for assessing and monitoring risk.
• Ensure staff have appropriate policies and guidance to carry out their roles.
• Ensure all medicines are handled in accordance with current guidelines, and ensure all equipment for use in emergencies is available and maintained.
• Ensure that clinical systems are up to date and acted upon as per national guidelines. Including disease management registers, referrals and test results.

We found that the practice was in breach of regulation 12 (2)(a)(b)(h), regulation 17(b) and regulation 18 (2)(b) of the Health and Social Care Act (RA) Regulations 2014.

We believed that there was a serious risk to patients’ lives, health or wellbeing so we took immediate enforcement action. The registration of Dr Sinah to provide Diagnostic and Screening Procedures, family planning, maternity and midwifery services, surgical procedures and Treatment of Disease Disorder or Injury, at this location, was cancelled with immediate effect by an order of the Court on 29 May 2015.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 13 August 2015

Due to the issues identified within the practice the service is rated as inadequate for the care of people with long-term conditions.

Longer appointments and home visits were not always available when patients needed them. Very few of these patients had a named GP and personalised care plan. Structured annual reviews were not undertaken to check that patients’ health and care needs were being met. There was no up to date long-term conditions registers evident. Those with long-term conditions were not being managed effectively due to the staffing issues at the practice. Locum doctors did not manage patients with long-term conditions.

We were unable to find any performance data on the management of long-term conditions within the practice.

Updated 13 August 2015

Due to the issues identified within the practice the service is rated as inadequate for the care of families, children and young people.

There were no systems to identify and follow up patients in this group who were living in disadvantaged circumstances and who were at risk. Immunisation rates were also relatively low for a number of the standard childhood immunisations. For example in 2014, the practice vaccinated 72.8% for the MMR and the CCG average was 84.7%. There was no evidence of the practice working with health visitors or community midwives as part of a multi-disciplinary team.

The practice undertook a full childhood immunisation programme but was performing below the Clinical Commissioning Group average. For example, The practice offered sexual health advice to young people.

Updated 13 August 2015

Due to the issues identified within the practice the service is rated as inadequate for the care of older people.

The care of older people was not managed in a holistic way. Little attempt had been made to respond to older people’s needs and access for those with poor mobility or who were housebound was limited. The leadership of the practice have little understanding of the needs of older people and were not attempting to improve the service for them. Services for older people were therefore reactive, and there was a limited attempt to engage with this patient group to improve the service. However each person over the age of 75 had a named GP, however the regular GPs were not present in the practice and all patients had to see locum doctors. We found no evidence of an older persons’ register or of signposting older people to other organisations that could be of service.

Updated 13 August 2015

Due to the issues identified within the practice the service is rated as inadequate for the care of working age people (including those recently retired and students).

The age profile of patients at the practice is mainly those of working age, students and the recently retired but the services available did not reflect the needs of this group. Appointments could only be booked by telephone and extended opening hours were only available on Saturday’s for working people. There was a low uptake for both health checks and health screening.

Updated 13 August 2015

Due to the issues identified within the practice the service is rated as inadequate for the care of people experiencing poor mental health (including people with dementia).

The practice was unable to identify patients experiencing poor mental health or those with dementia. It had not worked with multi-disciplinary teams in the case management of people experiencing poor mental health. It did not carry out advance care planning for patients with dementia. The practice did not hold an up to date register of those patients experiencing poor mental health or living with dementia.

The practice had not told patients experiencing poor mental health about support groups or voluntary organisations. It did not have a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Some staff had received training on how to care for people with mental health needs but no dementia training was available.

Updated 13 August 2015

Due to the issues identified within the practice the service is rated as inadequate for the care of people whose circumstances make them vulnerable.

The practice did not hold an up to date register of patients living vulnerable circumstances. It was unable to identify the percentage of patients who had received an annual health checks.

The practice had not worked with multi-disciplinary teams in the case management of vulnerable people. Some staff knew how to recognise signs of abuse in vulnerable adults and children, but they were not aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies out of normal working hours.