Archived: Dr Nowsherwan Khan

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Nowsherwan Khan on 2 August 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.
• 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.
• Risks to patients were assessed and well managed with the exception of emergency medicines. The practice did not have access to some emergency medicines while GPs were carrying out home visits. Since the inspection the practice reviewed this and added the required medicine to treatment rooms.
• On the day of the inspection the premises was observed to be clean and tidy; however the latest infection control audit identified gaps in the thoroughness’ of their general cleaning. Staff we spoke to told us that the issue had been brought to the attention of the property owners and cleaning contractors.
• There was a programme of continuous clinical audits, which demonstrated quality improvement. Staff were actively engaged to monitor and improve patient outcomes; the practice employed additional clinical staff in response to audit findings.

• On the day of the inspection patients said they were treated with compassion, dignity and respect and they felt involved in their care and decisions about their treatment. The national GP patient survey showed patients responded positively to nurse related questions however less favourably to questions relating to the GP.

• 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. Although the practice proactively sought internal feedback from staff and patients, which it acted on they did not demonstrate an understanding of the national GP patient survey results.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw two areas of outstanding practice where the practice used their knowledge of the local community and patient population as levers to deliver high quality, person centred care. The practice expanded the clinical team in order to respond to population needs. For example:

• Following an audit regarding support for the frail and vulnerable patients the practice employed a part time independent nurse prescriber who provided domiciliary support for patients who were vulnerable, frail, elderly and recently discharged from hospital. Support included things such as, safety in the home, fire hazards, social welfare, falls, nutrition, care packages and sign posting to other services.
• The practice employed a second part time nurse with a health visitor and dental care background to run a family health drop in clinic. The nurse took a holistic approach in order to support parents to address issues such as everyday ailments, childhood obesity, dental care, information on children’s activities during the six week holiday and sign posted families to services to support parents to access education and employment. The practice reveived positive feedback from patients regarding this service. For example opportunistic testing provided early identification of long term conditions and petients whoi accessed the service felt that the drop in service provided support when they needed without having to wait for a set appointment.

The areas where the provider should make improvement are:

• Should ensure arrangements implemented since the inspection for responding to a medical emergency is well established and embedded.
• Review the satisfaction rates from the national GP patient survey in addition to the practice survey, when responding to patient feedback and taking action in response to the findings.
• Ensure that the property owners carry out the required actions relating to gaps in the general cleaning as identified in the infection control audit.
• Proactively use a variety of methods to identify carers and encourage self identification.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice