Archived: Dr Jamil Khan Also known as The Coulsdon Medical Practice

Updated 22 August 2018

Dr Jamil Khan / The Coulsdon Medical Practice provides primary medical services in 66 Brighton Road, Croydon CR5 2BB to approximately 3,700 patients and is one of 52 practices in Croydon Clinical Commissioning Group (CCG). The practice has no website.

The clinical team at the surgery is made up of one full-time male lead GP, one part-time long-term female locum GP and two part-time female practice nurses. The non-clinical practice team consists of two practice managers and four administrative or reception staff members.

The practice population is in the third least deprived decile in England. The practice population of children and working age people are below the CCG and national averages and the practice population of older people is above the CCG and national averages.

The provider is registered as an individual with the Care Quality Commission to provide the regulated activities of diagnostic and screening procedures, family planning, maternity and midwifery services and treatment of disease, disorder or injury.

Updated 22 August 2018

This practice is not rated in this inspection. (Previous rating April 2018 – Inadequate)

The key questions are rated as:

Are services safe? – not rated.

Are services effective? – not rated

Are services well-led? – not rated

We carried out an unannounced focused inspection at Dr Jamil Khan on 14 June 2018 to follow up on breaches of regulations on safe, effective and well-led key questions. The practice remains rated overall as inadequate. 

At this inspection we found:

• The practice had put some systems in place to monitor patients on high risk medicines; however, we found that the systems in place were inconsistent.
• The practice had put a system in place to monitor the temperature of medicines refrigerators daily; however, we found a number of instances since the last inspection in February 2018 where the refrigerator temperatures had not been monitored.
• The practice had put a clear system in place to monitor uncollected prescriptions and to follow-up on patients who do not attend their appointments to review their non-urgent abnormal test results.
• Unverified data from the Quality and Outcomes framework for 2017/18 indicated that patient outcomes were significantly below when compared to the 2016/17 results.
• The practice did not have a clinical audit program and had not undertaken any recent clinical audits.

The areas where the provider must make improvements as they are in breach of regulations are:

• Ensure care and treatment is provided in a safe way for service users including a clear, embedded system in place to monitor patients on high risk medicines.
• Ensure that all patients’ needs are identified and care and treatment meet their needs including improving outcomes for patients with long-term conditions.

The provider has been rated as inadequate in June 2016, requires improvement in June 2017 and as inadequate again on February 2018. We found this had not been improved at this inspection. We are therefore taking action in line with our enforcement procedures to begin the process of preventing the provider from operating the service.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Updated 8 August 2017

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

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• The national Quality and Outcomes Framework (QOF) data showed that 78% of patients had well-controlled diabetes, indicated by specific blood test results, compared to the Clinical Commissioning Group (CCG) average of 70% and the national average of 78%. 97% of patients with diabetes had received a foot examination in the preceding 12 months which was above the CCG average of 87% and national average of 89%. However the practice had higher than average exception reporting for patients with diabetes.
• The national QOF data showed that 84% of patients with asthma in the register had an annual review, compared to the CCG average of 74% and the national average of 76%; however the practice had an higher than average exception reporting for patients with asthma.
• 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 8 August 2017

The practice is rated as requires improvement 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. The practice was one of the lowest in the local Clinical Commissioning Group (CCG) for paediatric emergency admissions.
• Immunisation rates were relatively high 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.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.
• The patients had access to GP led antenatal clinics and nurse or GP led family planning clinics. One of the practice GPs was a consultant gynaecologist.

Updated 8 August 2017

The practice is rated as requires improvement 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 lead GP offered daily walk-in surgery where older people are prioritised as required.
• 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.
• Where older patients had complex needs, the practice shared summary care records with local care services. The practice was in the process of adding care plans for all the required patients.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible; however the practice had only identified 0.4% (14 patients) of the practice list as carers.
• The practice GP undertook weekly visits for three local nursing and residential homes supporting the needs of 36 residents.

Updated 8 August 2017

The practice is rated as requires improvement 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; however the practice did not have a website.
• The practice had a dedicated health awareness notice board and had a range of health promotion information available for patients in the waiting area.

Updated 8 August 2017

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

• 65% of 29 patients with severe mental health conditions had a comprehensive agreed care plan in the last 12 months which was below the CCG average of 86% and national average of 89%.
• The practice carried out advance care planning for patients living with dementia.
• 46% of patients with dementia had received an annual review which was below the Clinical Commissioning Group (CCG) average of 83% and national average of 84%.
• 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 8 August 2017

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

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers, carers and those with a learning disability.
• The practice offered longer appointments and extended annual reviews for patients with a learning disability. Only 33% (4 patients) out of 12 patients with a learning disability had received a health check in the last year.
• 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 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.