Archived: Dr Taj Khattak Also known as Lower Farm Health Centre

Updated 26 August 2016

Dr Khattak Surgery is located in Walsall, West Midlands situated in a purpose built single level building, providing NHS services to the local community. Based on data available from Public Health England, the levels of deprivation (Deprivation covers a broad range of issues and refers to unmet needs caused by a lack of resources of all kinds, not just financial) in the area served by Dr Khattak Surgery are comparable to the national average, ranked at five out of 10, with 10 being the least deprived.

The practice serves a higher than average population of patients aged between 40 to 85 plus. The patient list size is just below 2,000.

Dr Taj Khattak Surgery is a single handed GP practice however is in the process of taking on a second GP and registering with CQC as a partnership. Service[AB1] delivery is supported by a locum nurse, a practice manager and an administration team. Services to patients are provided under a General Medical Services (GMS) contract with the Clinical Commissioning Group (CCG). GMS is a contract between general practices and the CCG for delivering primary care services to local communities.

The surgery has expanded its contracted obligations to provide enhanced services to patients. An enhanced service is above the contractual requirement of the practice and is commissioned to improve the range of services available to patients.

The practice is open between 8:30am to 6pm. GP consulting hours are 9am to 11:30am and 5:30pm to 6:30pm on Monday, 9:30am to 11:30am and 4:30pm to 5:30pm on Tuesday, Wednesday and Friday. Thursday surgery times are from 9:30am to 11:30am. Extended consulting hours are offered on Monday between 6:30pm and 7:30pm.

The practice has opted out of providing cover to patients in their out of hours period. During this time services are provided by Waldoc from 8:00am to 8:30am and 1:00pm to 3:30pm; Primecare provides services from 6:30pm to 8:00am.

Updated 26 August 2016

Letter from the Chief Inspector of General Practice

We carried out an unannounced focused inspection on 6 July 2016 following information of concern. We were informed that the provider was on leave from the practice and a new GP partner was in day to day control of the practice. CQC received information of concern regarding the lack of GP clinical cover along with the absence of a contingency plan to manage periods of low staffing levels. During this inspection CQC only reviewed areas where concerns had been reported.

A full comprehensive inspection of Dr Taj Khattak Surgery at Lower Farm Health Centre was undertaken on 18 May 2016. The full report is available on CQC website.

Since the inspection on the 18 May 2016 Dr Taj Khattak has formed a partnership and is in the process of amending the current registration.

Our key findings across the area we inspected were as follows:

• We saw that urgent and routine appointments were not readily available on the day of the inspection.

• We were told that all patients must be triarged by a GP prior to appointments being given. Knowledge and understanding of the process differed amongst clinical and non-clinical staff.

• Some staff were not aware of roles and responsibilities of the wider team. For example, reception staff were not clear on how to triage appointments with the practice nurse, resulting in patients being booked inappropriately.

• The practice had not made appropriate arrangements for locum staff to issue prescriptions which complied with requirements. For example an independent nurse prescriber was not registered with the Clinical Commissioning Group as a prescriber at the practice and was not able to print prescriptions in their own name.

The areas where the provider must make improvements are:

• Ensure sufficient numbers of suitably qualified, competent, skilled and experienced staff must be deployed in order to meet the requirements and care needs of patients. For example suitable clinical staff must be employed to carry out medication reviews, chronic or long term condition (LTC) management.

• Ensure an appropriate appointment and triage system is in place which reception staff have the appropriate knowledge and skills to facilitate.

• Ensure arrangements are in place to respond appropriately and in good time to people’s changing needs. for example ensuring adequate and appropriate appointments are available to patients.

• The provider must follow guidance and adopt control measures to ensure practitioners are working within recognised guidance. For example, the practice must ensure that all prescribers who sign prescriptions are registered with the practice in order to carry out this role.

In addition the provider should:

• Ensure induction for all locum staff is documented and shared across the management team.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 25 August 2016

The practice is rated as inadequate for the care of people with long-term conditions. This is because the concerns identified in relation to how safe, effective, caring, responsive and well-led the practice was impacted on all population groups.

• Overall performance for diabetes related indicators was comparable to the national average. For example 95% compared to the national average of 89%.

• Longer appointments and home visits were available when needed. Patients with long term conditions had a named GP and there were systems in place for an annual recall to check that their health and care needs were being met, however patients did not have a personalised care plan.

• Although the practice held a list of patients with long term conditions (LTC) and there were a nominated lead for palliative care, the practice were not holding or attending multidisciplinary meetings to discuss and review care needs.

• There were systems in place via the CCG pharmacist to review patient’s medication.

Updated 25 August 2016

The practice is rated as inadequate for the care of families, children and young people. This is because the concerns identified in relation to how safe, effective, caring, responsive and well-led the practice was impacted on all population groups.

• Childhood immunisation rates for the vaccinations given were comparable to CCG/national averages. For example, childhood immunisation rates for the vaccinations given to under two year olds ranged from 89% to 100% and five year olds 100% for all vaccinations.

• Appointments were available outside of school hours. The premises were suitable for families, children and young people.

• The practice’s uptake for the cervical screening programme was 90%, which was above the CCG and national average of 81%.

• Although the practice held a list of patients with safeguarding concerns when asked we were told that the lead were not attending multi-disciplinary meetings. We saw that the safeguarding lead had not received relevant training to enable them to carry out this role.

• Confidentiality and privacy for children and young people was available, there was a poster in reception to make patients aware of  confidentiality and patients were being offered the opportunity to be seen without a parent or carer where appropriate.

Updated 25 August 2016

The practice is rated as inadequate for the care of older people. This is because the concerns identified in relation to how safe, effective, caring, responsive and well-led the practice was impacted on all population groups.

• Care and treatment of older people did not always reflect current evidence-based practice, and some older people did not have care plans where necessary.

• Structured annual health checks for patients aged 75 plus were not always being carried out, for example only 2% of patients aged 75 plus had received health checks.

• The practice was not involved in multidisciplinary discussions, when asked the practice were unable to demonstrate effective joint care to meet the needs of older people.

• Home visits and longer appointments were available where needed; the practice also offered same day telephone consultations where appropriate.

• There was no information available which sign posted patients to support services or volunteer services such as local community groups or charities such as age UK.

• Although the practice were providing follow up consultations following discharge form hospital there were no completed care plans which reflected any additional needs.

Updated 25 August 2016

The practice is rated as inadequate for the care of working-age people (including those recently retired and students). This is because the concerns identified in relation to how safe, effective, caring, responsive and well-led the practice was impacted on all population groups.

• The age profile of patients at the practice was above average for those aged 40 to 75; however the practice had a low uptake rate for NHS health checks for this population group. For example 4% had received a NHS health check, we were told that this were due to the absence of a practice nurse.

• The practice offered extended opening hours for appointments on Mondays, there were processes in place which allowed patients to order repeat prescriptions via the telephone.

• Health promotion advice was being offered during consultations however there were limited accessible health promotion material available throughout the practice.

• The practice offered support to enable patients to return to work, for example patients who were likely to be off work for four weeks were offered the option to be referred to the government fit for work scheme.

Updated 25 August 2016

The practice is rated as inadequate for the care of people experiencing poor mental health (including people with dementia). This is because the concerns identified in relation to how safe, effective, caring, responsive and well-led the practice was impacted on all population groups.

• 71% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is below the CCG average of 79% and below national average of 77%.
• The percentage of patients diagnosed with dementia whose care has been reviewed in a face-to-face review in the preceding 12 months (01/04/2014 to 31/03/2015) was below CCG and national average. For example 71% compared to CCG and national average of 84%.

• The practice had not worked with multi-disciplinary teams in the case management of people experiencing poor mental health. Although the practice held a register of these patients there were limited evidence of annual health checks being carried out and no evidence of completed personal care plans.

• Staff we spoke to had not received training on how to care for people with mental health needs and there were no dementia training available. However clinical staff we spoke to demonstrated awareness of the Mental Capacity Act and process for gaining consent.

• The practice were not attending or holding meetings with the community nursing team to discuss patient’s needs.

Updated 25 August 2016

The practice is rated as inadequate for the care of people whose circumstances may make them vulnerable. This is because the concerns identified in relation to how safe, effective, caring, responsive and well-led the practice was impacted on all population groups.

• Although the practice held a register of patients identified with a learning disability (LD) there were limited evidence of annual health checks being carried out. There was no evidence of completed personal care plans.

• There were no systems in place for sharing information about people at risk of abuse with other services.

• The practice was not proactive in engaging with families and carers of patients with learning disabilities. We were told that there was no support provided for carers.

• Not all staff we spoke with knew how to recognise signs of abuse in vulnerable adults and children.

• Not all staff were clear of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.

• We were told that the practice did not have any registered patients who were living in vulnerable circumstances; there were no registration processes in place for this patient group. For example when asked we were not provided with a policy of process for registering homeless patients.