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

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

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Taj Khattak Surgery on 18 May 2016. Overall the practice is rated as inadequate.

Dr Taj Khattak surgery has been through a period of change due to the departure of their practice nurse and practice manager. Two weeks prior to the inspection the practice recruited a locum nurse, locum practice manager and a permanent manager. During the inspection the practice recruited a GP partner and is now receiving support from Walsall Clinical Commissioning Group.

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

• Staff understood their responsibilities to raise concerns, and to report incidents and near misses. However, the systems in place to review and investigate incidents were not thorough enough. Patients did not always receive an apology.
• The practice did not have a system for shared learning, they did not hold regular practice or clinical meetings and they were not attending external meetings with other healthcare professionals
• Risks to patients were not always assessed and well managed, for example there were no care plans for vulnerable people at risk of acute admission and the practice did not establish a clear system for receiving medicines and healthcare products regulatory (MHRA) alerts. There were gaps in the practice recruitment checks.
• Although some audits had been carried out, we saw no evidence that audits were driving improvements to patient outcomes.
• The majority of patients said they were treated with compassion, dignity and respect. However, data from the GP patient survey identified that, of those responding not all felt cared for, supported and listened to.

• There was limited information available about services; the practice did not have a practice leaflet or a web site for online access.

• Although the practice had a suggestion box for patients to provide feedback they did not provide information on how to make a complaint.

• The practice had a number of recently implemented policies and procedures to govern activity; however they were not fully embedded.

The areas where the provider must make improvements are:

• Ensure they are signed up to receive medicines and healthcare products regulatory (MHRA) alerts and establish a system to manage and disseminate these alerts.

• Actively seek and act on feedback on the services provided for the purposes of continually evaluating and improving service delivery.

• Implement a system for shared learning through internal and external meetings with other health care professionals.

• The practice must do all that is reasonably practicable to mitigate risks, for example follow good practice guidance and adopt control measures to ensure risks such as legionella is reduced and fire risk assessments are in place. The practice must also carry out and record fire drills.

• Ensure policies and procedures are maintained, within date and embedded into the practice. Ensure an effective audit system is in place to drive service improvement

• Ensure staff receive appropriate support such as training, professional development and appraisals as is necessary to enable them to carry out the duties they are employed to perform. For example chaperoning, safeguarding and infection control training.

• Ensure systems and processes are in place and established to ensure safeguarding concerns are acted on immediately.

• Create clear care and/or treatment plans where appropriate, which are available to all staff involved in providing the care.

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

• Ensure systems are in place to monitor and renew clinical staff’s medical indemnity.
• Ensure equipment to deal with medical emergencies is fit for purpose.
• Establish and operate effectively an accessible system for identifying, receiving, recording, handling and responding to complaints. The practice should ensure information on how to make a complaint is available for patients.
• Have a completed comprehensive business continuity.

In addition the provider should:

• Consider how they ensure patients have the necessary information available to them in the absence of a practice website and patient leaflet.

• Explore ways how they can proactively identify and support carers.

• In the absence of a Patient Participation Group consider how to gather the views of people who use their service and support actions needed to respond to feedback.

I am placing this service in special measures. Where a service is rated as inadequate for one of the five key questions or one of the six population groups or overall, we place it into special measures.

Services placed in special measures will be inspected again within six months. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as 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 varying the terms of their registration within six months if they do not improve.

The service 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.

Special measures will give people who use the service the reassurance that the care they get should improve. We are currently carrying out enforcement actions against the provider and will report on the outcomes at a later date.  

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice