Dr Muhammad Akbar Khan Also known as Horn Lane Surgery

Updated 4 October 2017

Dr Mohammad Akbar Khan is a single-handed GP based at 156 Horn Lane, Ealing, W3 6PH. The practice provides primary care services through a General Medical Services contract (GMS) to approximately 5,100 patients living in the London borough of Ealing. The practice is part of the NHS Ealing Clinical Commissioning Group (CCG).

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

The ethnicity of the practice population is of mixed origin with a significantly higher than national average number of patients 20-44 years old. There is also a slightly higher than average number of children 0-4 years old. Life expectancy is 80 years for males and 86 years for females which is above CCG/national averages.

The practice serves a multi-lingual community including English, Arabic, Somali, Gujarati and Punjabi speakers. The local area is the fourth more deprived in the London Borough of Ealing (people living in more deprived areas tend to have greater need for health services).

The practice team consists of a principal male GP (one whole time equivalent), three sessional GPs (1.48 whole time equivalent), a part time practice nurse, and a management team who are supported by a team of non-clinical staff.

Services provided by the practice include substance misuse clinics, minor surgery, smoking cessation, maternity services, NHS health checks, cervical screening and immunisations. The practice provide the following out of hospital services; ambulatory blood pressure monitoring,

electrocardiogram, spirometry and wound care. The practice is a yellow fever centre. The principal GP is a GP with Special Interests in substance misuse, minor surgery and cardiovascular disease.

Updated 4 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Muhammad Akbar Khan on 23 August 2016. The practice was rated as requires improvement for providing safe, effective and well-led services and good for providing caring and responsive services. The overall rating for the practice was requires improvement. The full comprehensive report on the August 2016 inspection can be found by selecting the ‘all reports’ link for Dr Muhammad Akbar Khan on our website at www.cqc.org.uk.

This inspection was an announced comprehensive follow up inspection on 12 September 2017 to check for improvements since our previous inspection. Overall the practice is now rated as good.

Our key findings were as follows:

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.

• The practice had clearly defined and embedded systems to minimise risks to patient safety.

• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.

• Results from the national GP patient survey were generally below average. However, the provider had an action plan in place to improve patient satisfaction.

• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.

• Patients we spoke with and comment cards received reported that appointments could be made with a named GP in a reasonable timeframe and urgent appointments were available the same day.

• The practice had poor facilities to treat patients and meet their needs. However, the provider had secured funding to improve the practice.

• 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.

• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

  However, there were also areas of practice where the provider needs to make improvements.

The provider should:

• Take action to improve childhood immunisation rates and bowel/breast cancer screening rates.

• Continue to identify and support more patients who are carers.

• Improve the documentation of meeting minutes.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 4 October 2017

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

• Nursing staff supported the GPs in long-term disease management and patients at risk of hospital admission were identified as a priority.

• Performance for diabetes related indicators was similar to the CCG and national averages. For example, the percentage of patients with diabetes, on the register, in whom the last blood glucose reading is 64 mmol/mol or less in the preceding 12 months was 73% compared to the CCG and national average of 78%. The exception rate was 4% significantly below the CCG average of 17% and the national average of 13%.

• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

• All these patients had a named GP and there was a system to recall patients for a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 4 October 2017

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

• From the sample of documented examples we reviewed we found there were systems 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 accident and emergency (A&E) attendances.

• Immunisation rates were below average for all standard childhood immunisations.

• Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.

• The practice provided support for premature babies and their families following discharge from hospital.

  Appointments were available outside of school hours and the premises were suitable for children and babies.

• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Updated 4 October 2017

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

• The practice offered proactive, personalised care to meet the needs of the older patients in its population.

• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.

• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

Updated 4 October 2017

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

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours.

• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

Updated 4 October 2017

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

• The practice carried out advance care planning for patients living with dementia.

• The practice specifically considered the physical health needs of patients with poor mental health and dementia.

• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.

• Patients at risk of dementia were identified and offered an assessment.

• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 4 October 2017

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

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability.

• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.

• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.