Archived: Dr Manohar Singh Also known as Birkby Health Centre

Updated 28 January 2016

The practice was established in December 1986 on Norwood Road and then relocated into purpose built premises in December 1997. The premises have a waiting room and full facilities for disabled patients with wide entrance doors. These include purpose built treatment and minor surgery rooms, consulting rooms and an interview room. The Medical Centre also has onsite car parking facilities with a designated disabled parking space. Services are provided under a General Medical Services (GMS) contract with NHS England.

The practice is in a relatively disadvantaged area with high levels of deprivation. The community is predominantly of South Asian ethnicity, followed by White British and a small number of Black Afro-Caribbean British. It has experienced a growing number of Eastern European migrant families on its list. The practice has increased from 2500 to 3170 patients in the last two years.

There are two full time GP partners, one male and one female, a non-clinical partner who is also the practice manager, two part-time locum GPs, a Practice Nurse and a Medical Secretary/Health Care Assistant. Several receptionists support the administrative running of the practice.

The surgery is open Monday to Friday from 8.30am until 6.00pm, apart from Monday where it closes at 8.00pm. Wednesday is half day and the surgery closes at 1pm.

Appointments are from 9.30am to 11.30am and 2pm to 5.30pm Monday, 9.30am to 11.30am and 2pm to 5.30pm Tuesday, 9.30am to 11.30am Wednesday, 9.30am to 11.30am and 3.30pm to 5.30pm Thursday, 9.30am to 11.30am and 3.30pm to 5.30pm Friday.

Extended hours surgeries are offered at 6.30pm to 7.30pm on Mondays, the practice does not open at weekends.

When the practice is closed out of hours cover is provided by Local Care Direct.

The practice is registered with Dr Manohar Singh as a single handed GP.  However, we were informed that Dr Khaliq has been a partner since 2012 and the practice manager is also a non-clinical partner. The partnership is not registered with CQC and as such is providing services without being registered.  Urgent action is required on the part of the part of the practice to ensure they are correctly registered to carry out regulated activities under the Health and Social Care Act 2008. 

Updated 28 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Manohar Singh on 7 October 2015. 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, necessary recruitment checks on staff had not been undertaken prior to their employment; there was incomplete evidence of staff undertaking mandatory training or nursing staff receiving any clinical supervision.

• The indemnity insurance the practice had in place did not cover all relevant clinical staff.

• Temperature checks for the refrigerator that stored vaccines and other medicines had not been undertaken in excess of one year.

• The clinician identified as the safeguarding lead for children and vulnerable adults was unable to demonstrate adequate awareness of how such matters should be managed with other local agencies.

• Staff did not consistently record, report, analyse or share learning from significant events, incidents, near misses and concerns and there was no evidence of formal communication with staff.

• Meetings held with other health professionals were inadequately recorded, with no evidence of appropriate minutes, attendance or actions agreed.

• There was insufficient assurance to demonstrate people received effective care, such as the recording of consent and treatment and there was a failure to undertake any full clinical audits.

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

• Complaints made to the practice were not adequately recorded and there was no evidence there had been any learning from them. None of the complaints registered against the practice at the NHS Choices website had been responded to by the practice.

• Urgent appointments were usually available on the day they were requested. It was common practice to be asked to wait for up to two hours for an urgent same day appointment as part of the ‘sit and wait’ policy used at the practice.

• The practice had no clear leadership structure, insufficient leadership capacity and formal governance arrangements.

The areas where the provider must make improvements are:

• Take action to address identified concerns with the management of medicines at the practice.

• Ensure recruitment arrangements include all necessary employment checks for all staff.

• Put systems in place to ensure all clinicians are kept up to date with national guidance and guidelines.

• Ensure the safeguarding lead has appropriate understanding of their responsibilities in this role.

• Ensure clinical audits are undertaken in the practice, including completed clinical audit or quality improvement cycles.

• Ensure there are formal governance arrangements in place including systems for assessing and monitoring risks and the quality of the service provision.

• Ensure staff have appropriate policies and guidance to carry out their roles in a safe and effective manner which are reflective of the requirements of the practice.

• Clarify the leadership structure and ensure there is leadership capacity to deliver all improvements

The areas where the provider should make improvement are:

• Improve processes for making appointments, to prevent patients who require urgent care waiting in the surgery for long periods of time.

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 such that there remains a rating of inadequate 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. Since the inspection the named provider has cancelled his registration and a new provider is now in place delivering the service. 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 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

Updated 28 January 2016

The practice is rated as inadequate for the care of patients with long term conditions. The practice is rated as inadequate for providing safe, effective and well-led services. The concerns which led to these ratings apply to everyone using the practice, including this population. The practice was developing ways to improve care of patients with long term conditions, in particular diabetes and atrial fibrillation. Some initial audit work had begun. The health care assistant worked under clinical direction to recall patients for review and maintain checks on patients with long term conditions. We were told by staff that the practice nurse undertook chronic disease management and the health care assistant carried out opportunistic monitoring of patients; for example checking the pulse of patients who attended for a flu vaccination.

Updated 28 January 2016

The practice is rated as inadequate for the care of families, children and young people. The practice is rated as inadequate for providing safe, effective and well-led services. The concerns which led to these ratings apply to everyone using the practice, including this population group. Uptake rates were relatively high for all standard childhood immunisations, in comparison to local practices. However, the fridge where vaccines were stored had not been monitored which meant that no reassurance could be shown they had been stored at the required temperature for them to be effective. We spoke to clinical staff about their awareness of Gillick competence. (This is legal principle that helps clinicians decide if a child under the age of 16 years is able to consent to their own medical treatment.) There was a limited understanding among clinicians we spoke to and one informed us it was not relevant to their patient community. Cervical screening uptake was similar to the local average and 3.9% higher than the national average.

Updated 28 January 2016

The practice is rated as inadequate for the care of older people. The practice is rated as inadequate for providing safe, effective and well-led services. The concerns which led to these ratings apply to everyone using the practice, including this population group. The inspection found the safeguarding lead had a lack of awareness about the risks of abuse for older people. Vaccines (including the flu vaccine) were not stored in a safe way to provide reassurance that they were effective upon administration.

Updated 28 January 2016

The practice is rated as inadequate for the care of working age people (including those recently retired and students). The practice is rated as inadequate for providing safe, effective and well-led services. The concerns which led to these ratings apply to everyone using the practice, including this population group. However, the practice did encourage the use of online services and ran an extended hours clinic between 6.30 to 7.30pm on a Monday evening to improve access for working age patients. Health checks were offered by the practice nurse for patients aged 40 to 74 years.

Updated 28 January 2016

The practice is rated as inadequate for the care of patients experiencing poor mental health (including people with dementia). The practice is rated as inadequate for providing safe, effective and well-led services. The concerns which led to these ratings apply to everyone using the practice, including this population group. However, clinical data relating to the treatment and monitoring of patients with poor mental health was higher than the local and national average. The practice held a register of these patients and performed highly in terms of developing a comprehensive care plan. Patients with dementia who had had a review in the last twelve months was also higher than the local and national average measuring 5.5% higher locally and 6.9% higher nationally.

Updated 28 January 2016

The practice is rated as inadequate for the care of people whose circumstances may make them vulnerable. The practice is rated as inadequate for providing safe, effective and well-led services. The concerns which led to these ratings apply to everyone using the practice, including this population group. The practice did record patients who had a learning disability on their system, but did not routinely offer longer appointments or were able to confirm how many annual reviews had taken place. The ethos of the practice was to allow as much time as needed for each consultation which often increased waiting times. Safeguarding protocols were generally known by staff and a policy was in place, however, the designated safeguarding lead demonstrated inadequate awareness of the subject and their responsibilities in this area.