Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Amanullah Shamsher Khan surgery also known as Khan Medical Practice on 21 June 2016. The overall rating for the practice was good. The full comprehensive report on the June 2016 inspection can be found by selecting the ‘all reports’ link for Dr Amanullah Shamsher Khan surgery on our website at www.cqc.org.uk.

This inspection was an announced desk based inspection carried out on 28 March 2017 to confirm that the practice had carried out their plan to meet the required improvements in relation to the breaches in regulations that we identified in our previous inspection on 21 June 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall, the practice continues to be rated as good.

Our key findings were as follows:

• Since our comprehensive inspection, which took place in June 2016 the practice management team reviewed their policies to ensure all staff had received a Disclosure and barring service check (DBS). As a result DBS checks had been carried out non-clinical staff members.

• Previously staff we spoke with were unable to provide documentation to evidence that fire safety checks had been carried out. During the follow up inspection, we were provided with documents which showed that fire safety checks were taking place.

• When we carried out the comprehensive inspection we saw that the practice did not have access to medicines which could be used to respond to suspected opioid overdose or carry out a risk assessment to mitigate identified risks. During the follow up inspection staff explained that they have access to appropriate medicines within the practice, staff had received training and guidelines which staff were required to follow were in place.

• Data from the January 2016 national GP patient survey showed that the practice were below local and national averages for its scores on consultations with GPs. As a result staff we spoke with as part of the follow up inspection explained that during team meetings they discussed how to effectively greet patients. GPs were advised to obtain an overview of patient’s conditions before calling them into consultation rooms and were advised to place less focus on the computer monitors and actively engage in patient conversation. As a result data from the 7 July 2016 national GP patient survey showed improvements in all areas.

• Previous data from the National Cancer Intelligence network published March 2015 showed that the practice were performing below local and national averages for the uptake of breast and bowel cancer screenings.

• During the desk based follow up inspection members of the management team explained that the practice were taking part in a CCG programme which involved carrying out a search to identify eligible patients. Letters were sent to all identified patients, those who had not contacted the practice were followed up by the practice nurse and health care assistant to encourage them to book appointments. Data provided by the practice showed that further improvements had been made to engage patients with national screening programmes.

• March 2015 data showed that exception reporting for cancer related indicators was above local and national average (Exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects).

• Staff we spoke with as part of the March 2017 follow up inspection explained that there has been a reduction in the use of exception reporting as GPs were advised to make further attempts to encourage patients to attend for reviews and national screenings.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

The Care Quality Commission previously inspected Dr Amanullah Shamsher Khan surgery on 15 October 2014. Overall the practice was rated as requires improvement. During the inspection we found that the provider did not operate effective recruitment procedures. We found that the provider did not operate effective systems to assess risks associated with infection control and did not operate effective systems such as clinical audits to assess and monitor the quality of services provided. As a result, requirement notices for breach of regulation 19 fit and proper persons employed, regulation 12 safe care and treatment and regulation 17 Good governance were served on the registered person.

We carried out a second announced comprehensive inspection at Dr Amanullah Shamsher Khan surgery on 21 June 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were not always assessed and well managed. For example the practice did not carry out risk assessments in the absence of a DBS check for non-clinical staff and did not conduct a risk assessment to mitigate risks in the absence of some emergency medicines. Following the inspection the practice provided evidence where appropriate actions had been taken to mitigate identified risks.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.

• The practice had carried out two clinical audits in the last two years however these were not practice driven and the process for continual clinical audit cycles was not evident.

• The practice had a well-established shared care service which they managed in conjunction with community outreach workers. This allowed the practice to effectively manage physical and psychological health issues that may coexist with substance misuse.

• Patients we spoke to on the day of the inspection felt the practice offered an excellent service and staff were helpful, caring and treated them with dignity and respect. However results from the national GP patient survey showed that patients did not always feel treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• 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. However some members of the patient participation group PPG felt that the group would be more successful if it was better organised.
• The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• Continue to seek assurance that sufficient stocks of appropriate medicines are available in case of emergencies and continue doing all that is reasonably practicable to mitigate identified risks.

• Gain assurance from the property landlords that fire checks are undertaken and actions arising addressed.

• Consider ways of improving the coordination, management and maximising the skills of the patient participation group.

• Continue to explore ways to improve the national GP patient survey results.

• Consider methods to increase the uptake of national screening programs.

• Carry out risk assessments on non-clinical staff in the absence of a disclosure and barring service check.

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 Amanullah Shamsher Khan surgery also known as Khan Medical Practice on 21 June 2016. The overall rating for the practice was good. The full comprehensive report on the June 2016 inspection can be found by selecting the ‘all reports’ link for Dr Amanullah Shamsher Khan surgery on our website at www.cqc.org.uk.

This inspection was an announced desk based inspection carried out on 28 March 2017 to confirm that the practice had carried out their plan to meet the required improvements in relation to the breaches in regulations that we identified in our previous inspection on 21 June 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall, the practice continues to be rated as good.

Our key findings were as follows:

• Since our comprehensive inspection, which took place in June 2016 the practice management team reviewed their policies to ensure all staff had received a Disclosure and barring service check (DBS). As a result DBS checks had been carried out non-clinical staff members.

• Previously staff we spoke with were unable to provide documentation to evidence that fire safety checks had been carried out. During the follow up inspection, we were provided with documents which showed that fire safety checks were taking place.

• When we carried out the comprehensive inspection we saw that the practice did not have access to medicines which could be used to respond to suspected opioid overdose or carry out a risk assessment to mitigate identified risks. During the follow up inspection staff explained that they have access to appropriate medicines within the practice, staff had received training and guidelines which staff were required to follow were in place.

• Data from the January 2016 national GP patient survey showed that the practice were below local and national averages for its scores on consultations with GPs. As a result staff we spoke with as part of the follow up inspection explained that during team meetings they discussed how to effectively greet patients. GPs were advised to obtain an overview of patient’s conditions before calling them into consultation rooms and were advised to place less focus on the computer monitors and actively engage in patient conversation. As a result data from the 7 July 2016 national GP patient survey showed improvements in all areas.

• Previous data from the National Cancer Intelligence network published March 2015 showed that the practice were performing below local and national averages for the uptake of breast and bowel cancer screenings.

• During the desk based follow up inspection members of the management team explained that the practice were taking part in a CCG programme which involved carrying out a search to identify eligible patients. Letters were sent to all identified patients, those who had not contacted the practice were followed up by the practice nurse and health care assistant to encourage them to book appointments. Data provided by the practice showed that further improvements had been made to engage patients with national screening programmes.

• March 2015 data showed that exception reporting for cancer related indicators was above local and national average (Exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects).

• Staff we spoke with as part of the March 2017 follow up inspection explained that there has been a reduction in the use of exception reporting as GPs were advised to make further attempts to encourage patients to attend for reviews and national screenings.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice