Background to this inspection
Updated
26 October 2016
Dr Nabila Khan (London Road Medical Centre) is located at Cavendish House, 515 London Road, Croydon, CR7 6AR and operates from a converted detached house with access to four consulting rooms on the ground floor. The first floor is for staff only and is accessed by stairs.
The practice provides NHS primary care services to approximately 5,800 patients living in the Croydon area through a Personal Medical Services (PMS) contract (an alternative to the standard GMS contract used when services are agreed locally with a practice which may include additional services beyond the standard contract).
The practice is part of Croydon Clinical Commissioning Group (CCG) which consists of 61 GP practices.
The practice population is in the third most deprived decile in England (one being most deprived and 10 being least deprived). People living in more deprived areas tend to have a greater need for health services.
The practice is registered as a partnership with the Care Quality Commission to provide the regulated activities of diagnostic and screening procedures; treatment of disease; disorder or injury; maternity and midwifery services; family planning and minor surgery.
The practice staff comprises of one principal female GP, one male salaried GP and two long-term locum GPs (totally 27 sessions per week), two part-time practice nurses (equal to one whole time equivalent), one part-time healthcare assistant, a full-time practice manager, two administrators and six receptionists.
The practice is open 8am to 6.30pm Monday to Friday. Extended hours are provided on Wednesday from 6.30pm to 8pm.
The practice provides a range of services including childhood immunisations, chronic disease management, sexual health, cervical smears and travel advice and immunisation.
When the surgery is closed, out-of-hours services are accessed through the local out of hours service or NHS 111.
Updated
26 October 2016
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Dr Nabila Khan (London Road Medical Centre) on 5 September 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.
- Risks to patients were assessed and well managed.
- 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.
- Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
- 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 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. The practice proactively sought feedback from staff and patients, which it acted on.
- The provider was aware of and complied with the requirements of the duty of candour.
The areas where the provider should make improvement are:
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Ensure the recently acquired automated external defibrillator (AED) is included in a schedule for electrical and medical equipment checks in line with guidance.
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Ensure there is an effective system to track blank prescriptions through the practice in line with national guidance.
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Ensure recommendations from the fire risk assessment are carried out.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
People with long term conditions
Updated
26 October 2016
The practice is rated as good for the care of people with long-term conditions.
- Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
- Performance for diabetes related indicators was comparable to the national average. For example, the percentage of patients with diabetes, on the register, in whom the last HbA1c was 64 mmol/mol or less in the preceding 12 months was 75% (national average 78%) and the percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/80 mmHg or less was 79% (national average 78%).
- Longer appointments and home visits were available when needed.
- All these patients had a named GP and 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.
Families, children and young people
Updated
26 October 2016
The practice is rated as good for the care of families, children and young people.
- There were systems in place 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 A&E attendances.
- Immunisation rates for all standard childhood immunisations were comparable with CCG and national averages. The practice had a system in place to follow-up on any children not attending for immunisations.
- The percentage of patients with asthma, on the register, who had an asthma review in the preceding 12 months was above the national average (practice 89%, national 75%).
- The practice’s uptake for the cervical screening programme was 81%, which was comparable to the national average of 82%.
- Appointments were available outside of school hours and the premises were suitable for children and babies. Appointments for under five-year-olds were available on the day.
- We saw positive examples of joint working with midwives, health visitors and school nurses.
Updated
26 October 2016
The practice is rated as good for the care of older people.
- The practice offered proactive, personalised care to meet the needs of the older people in its population.
- The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. Those on the ‘at risk of admission’ registrar were offered appointments on the same day.
Working age people (including those recently retired and students)
Updated
26 October 2016
The practice is rated as good for the care of working-age people (including those recently retired and students).
- The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
- 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.
- The practice offered extended hours clinics on Wednesday from 6.30pm to 8pm for working patients who could not attend during normal opening hours. The practice also offered appointments between 1.30pm and 3pm following feedback from a patient survey regarding access mid-day.
People experiencing poor mental health (including people with dementia)
Updated
26 October 2016
The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).
- Performance for mental health related indicators was comparable to the national average. For example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 89% (national average 88%).
- The percentage of patients diagnosed with dementia whose care has been reviewed in a face-to-face review in the preceding 12 months was 84% (national average 84%).
- Staff had a good understanding of how to support patients with mental health needs and dementia. The practice had allocated each patient on its dementia registrar with a named ‘buddy’ from the administration team to help make appointments, arrange transport and enabled patients to have familiarity and consistency.
- The practice had a dedicated GP who undertook a weekly ward round at a nursing home which provided dementia care. The practice shared with us an audit that showed proactive and regular case management and support of the nursing home team had resulted in a reduction in hospital admission for its residents.
- The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
- The practice carried out advance care planning for patients with dementia.
People whose circumstances may make them vulnerable
Updated
26 October 2016
The practice is rated as good for the care of people whose circumstances may make them vulnerable.
- The practice held a register of patients living in vulnerable circumstances including those with a learning disability.
- The practice offered longer appointments for patients with a learning disability and health checks were carried out by a GP with a learning disability special interest.
- There was an alert on the clinical system for all patients with enhanced needs such as a disability, impairment or sensory loss to enable staff to appropriately manage their care.
- There were systems in place to follow up on A&E attendances, ambulance call outs and 111 reports of high risk, vulnerable patients and those who may have been experiencing poor mental health.
- The practice regularly worked with other health care professionals in the case management of vulnerable patients and informed patients about how to access various support groups and voluntary organisations.
- Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff 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.