The Care Quality Commission
  • Doctor
  • GP practice

Archived: Dr Mujib ul Haq Khan Also known as Granville Road Surgery

Overall: Inadequate read more about inspection ratings

78 Granville Road, Southfields, London, SW18 5SG (020) 8874 2471

Provided and run by:
Dr Mujib ul Haq Khan

All Inspections

7 May 2015

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced inspection of Granville Road Surgery on 6 January 2015. Breaches of legal requirements were found in relation to: staff recruitment; safeguarding of vulnerable adults and children; dealing with medical emergencies; lack of induction for locum GPs and training for all staff and equipment was not checked at the required intervals. After the comprehensive inspection the provider failed to write to us to say what they would do to meet legal requirements in relation to the breaches. The CQC sent two letters reminding the provider of his responsibility to send an action plan to show how he intended to become compliant with the Regulations. The provider did not respond to these letters. 

Granville Road Surgery was not providing a GP service because the CQC suspended the providers registration to provide regulated activities for a four month period from 9 January 2015 until 8 May 2015, to protect people who use the service from avoidable harm and to give the provider the opportunity to make the necessary improvements. Overall the practice was rated inadequate at an inspection carried out on 6 January 2015, in particular it was inadequate for providing safe and effective services and for being well led. It was also inadequate for providing services to all population groups. Improvements were required to ensure the service was responsive and caring.

We undertook this focussed inspection on 7 May 2015 to check that the provider had made the required improvements and now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Granville Road Surgery on our website at www.cqc.org.uk

There is one GP who has conditions imposed on his GMC registration which restrict his ability to practice and who, after the inspection terminated his contract with NHS England. The provider attended the inspection for one and a half hours and had to leave, this meant we did not receive information to confirm the required improvements had been made. The CQC sent the provider a letter requesting information to confirm suitable arrangements were in place should the practice open after the suspension ended on 9 May 2015. A second letter was sent which gave the provider further opportunity to show how they were meeting or planning to meet all the Regulations. The provider did not respond to these letters.

While we found some improvements had been made, there were also areas that still required improvement and there were some things we were not able to check.

Improvements included:

  • a new medical bag had been purchased and emergency medicines were accessible and within their use by date;
  • the carpet had been replaced with linoleum flooring in the entrance, waiting room and consultation room;
  • toilet roll was in place;
  • a disaster plan had been developed;
  • a fire plan was in place and the fire risk assessment had been updated; 
  • a number of policies and been updated and were accessible and an induction programme had been developed for new staff;

However there were a number of issues which had not been addressed, in particular:

  • the provider was not able to tell us if he planned to open the practice;
  • if the practice was to open there was no clarity about how reception staff would deal with patients who walked in requiring urgent medical assistance;
  • there were no arrangements in place for patients to see a female clinician;
  • no progress had been made with developing a Patient Participation Group;
  • the provider had not completed training in child protection since August 2012; reception staff had not completed updated child protection training since 2010; the practice manager had not completed updated child protection training;
  • portable electrical appliances had not been tested;
  • there was no system to check or calibrate equipment
  • a risk assessment had not been completed regarding whether the practice needed a defibrillator;
  • there was no risk assessment or evidence of consideration taken regarding whether reception and practice management staff needed a DBS check;
  • there was no evidence that the cleaner had completed training in infection control, or any other training;
  • there was only one reference for a new member of staff.

We were not able to check:

  •  that the recruitment process for locum GPs was safe and in line with requirements;
  • that the provider was aware of the induction programme the practice manager had developed for new staff;
  • that the provider had information to confirm the training locum GPs had completed in particular regarding basic life support and child protection and any other training;
  • the arrangements to ensure locum GPs were able to provide the cover required;
  • how important messages would be communicated between the provider and any locum GPs;
  • the arrangements for sharing best practice;
  • what if any clinical audits had been completed;
  • the arrangements to review significant events and ensure any learning was shared amongst staff and locum GPs;
  • if there were arrangements to review referrals;
  • how the practice was going to work with other health and social care providers;
  • how the practice planned to engage with the CCG and NHS England regarding the needs of the local population;
  • the strategy and values for the practice;
  • governance arrangements.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

6 January 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

Granville Road Surgery provides a GP service to just under 790 patients in the Southfields area of Wandsworth. There is one GP who has conditions imposed on his GMC registration which restrict his ability to practice. As a result he is currently not practising but employing locum GPs.

We carried out a short notice announced comprehensive inspection on 6 January 2015. The inspection took place over one day and was carried out by a lead inspector, an inspection manager and a GP specialist advisor. We spoke with patients and staff including the GP, a locum GP, reception staff and the practice manager.

Overall the practice is rated as inadequate.

Specifically, we found the practice inadequate for providing safe and effective services and being well led. It was also inadequate for providing services for all population groups. Improvements were required to ensure the service was responsive and caring.

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

  • Patients were at risk of harm because systems and processes were not in place to keep them safe. For example appropriate recruitment checks on staff had not been undertaken prior to their employment; arrangements for emergency medicines were not safe; staff were not trained in safeguarding and child protection and not clear who to report concerns to;
  • Staff were not clear about reporting incidents, near misses and concerns and there was no evidence of learning and communication with staff.
  • There was insufficient assurance to demonstrate people received effective care and treatment. For example there were no systems to share patient safety alerts and information from the Clinical Commissioning Group, clinical audits were not completed and the provider did not participate in peer reviews.
  • Patients made positive comments about their experience of making an appointment. They said staff were kind, helpful and caring and felt their privacy and dignity were maintained; the doctor gave them time and explained treatments to them in ways they understood. They said the practice was clean. Patients were aware of how to make a complaint.
  • Urgent appointments were usually available on the day they were requested.
  • The practice had no clear leadership structure, insufficient leadership capacity and limited formal governance arrangements.

As a result of these findings, we suspended the provider's registration with CQC for a period of four months in order to protect people using the service from avoidable harm and to give the provider an opportunity to make the necessary improvements. The provider's registration was suspended from 9 January until 8 May 2015 in relation to the regulated activities of diagnostic and screening and treatment of disease, disorder or injury.

The areas where the provider must make improvements are:

  • Ensure staff and locum recruitment includes documentation showing all the required checks were carried out before staff start work;
  • The provider must keep an up to date record of clinical staff who provide care and treatment to patients (staff rota to show staff due to attend the surgery and the hours they worked);
  • Provide a detailed induction for locums to ensure they are familiar with policies and procedures so they can report child protection, adult safeguarding and serious untoward incidents to the required agencies;
  • Ensure staff have completed child protection training to the required Level (Level 3 for clinical staff and Level 1 for non- clinical staff) and are aware of their responsibilities to report concerns and incidents;
  • Put in place suitable arrangements which ensures clinical staff deal with clinical correspondence, results of blood tests and other investigations in a timely manner
  • Ensure clinical staff have access to emergency medicines at all times;
  • Ensure suitable systems are in place for responding to risk, including an accurate fire risk assessment and staff to be clear about how to respond in the event of a fire.

In addition the provider should:

  • Ensure policies are in place, up to date, accessible and understood by staff;
  • Continue to work through the action plan to meet all the requirements from the infection control audit carried out by NHS England;
  • Carry out a risk assessment regarding the need for an automated external defibrillator (AED);
  • Review availability of appointments.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

14 August 2014

During an inspection looking at part of the service

Our inspections of 16 December 2013 and 7 January 2014 found there were inadequate arrangements in place to deal with medical emergencies, patients were not protected from the risk of infection because appropriate guidance had not been followed, storage and recording of medicines were not sufficient, staff did not have supervision or an annual appraisal and the provider did not have an effective system or programme of audit to monitor the quality of service provided. The provider sent an action plan stating they would be compliant by March 2014. A further inspection on 10 June 2014 found the emergency medicines had been replaced although the provider had failed to make the necessary changes to ensure the service provided was safe. We served a warning notice requiring the provider to become compliant with the Health and Social Care Act 2008 Regulations 2008 by 1 August 2014.

During our inspection 14 August 2014 we found that whilst some improvements had been made, the warning notice had not been fully met. The oxygen cylinder had been refilled to enable the practice to deal with medical emergencies, but the doctor had not completed recent training in basic life support. A cleaning schedule was in place but it failed to identify all areas of the practice that required cleaning, in particular telephones and keyboards and the patient toilet. In addition, it did not include the frequency of cleaning for all areas. Records indicated cleanliness checks were carried out, but they had not identified the areas of the practice that were not clean. While a number of boxes had been cleared from the practice manager's room, it remained extremely cluttered as was the doctor's consultation room. The volume of clutter would make keeping these areas clean difficult. Medicine and vaccine storage and recording were suitable and medicines were in date, but there was a supply of medicines in the doctor's bag that were not in their original containers. They had hand written labels that were clearly old and there was no record of use by dates. Staff had received an appraisal. Whilst a patient survey had been completed recently, issues patients raised about waiting times had not been addressed. In addition, there was a lack of audits and analysis of significant events. Records were checked in respect of the recording of vaccinations given and the accuracy of records for patients with long term conditions. The review of these records strongly suggested a poor level of record keeping because of the lack of detail, no medical history and no record of examinations.

10 June 2014

During an inspection looking at part of the service

Our inspection of 16 December 2013 and 7 January 2014 found that there were insufficient arrangements in place to ensure patients' safety and welfare as emergency medications and oxygen had expired. People were not protected from the risk of infection or the risks associated with medicines as no infection control audits had been completed and medications were not appropriately stored. People were not cared for by staff who were appropriately supported to carry out their roles as there was no programme of appraisal or supervision. The provider did not have effective systems or programme of audit to monitor the quality of service provided. The provider wrote to us and told us that they would make the required improvements by March 2014.

Our inspection of 10 June 2014 found that the expired emergency medications had been replaced, but no other improvements had been made to meet the requirements of the compliance actions issued. The oxygen cylinder had not been checked or replaced, we found out of date medicines, there were no cleaning schedules or audits, staff had not been appraised and there were no mechanisms to monitor the quality of service provided. The provider had failed to make the necessary changes to ensure the service provided was safe.

16 December 2013 and 7 January 2014

During a routine inspection

During our visit we were unable to speak with people who used the service. We spoke to the GP, practice manager and receptionist.

We observed staff communicating respectfully with patients' both-face-to-face and by telephone. There was a wide range of information material and leaflets available to patients in the waiting room. This included information about national screening and immunisation programs, as well as leaflets about specific medical conditions and support groups.

The practice provided urgent 'on the day' appointments and daily telephone consultations with the GP to ensure that people who required an urgent appointment could be seen the same day. Medical emergency drugs and equipment were in place at the practice. However at the time of our visit we observed that some of the emergency drugs retained were not in date.

Staff had received training in safeguarding children and vulnerable adults from abuse. Effective systems were not in place to reduce the risk and spread of infection. Medicines were not kept safely as storage practices followed were not in line with national pharmaceutical guidelines. There was no formal system of supervision and appraisals in place for staff. The practice participated in the NHS quality and outcomes framework (QOF).