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

Updated 27 August 2015

The provider operates from a single location in Southfields in the London Borough of Wandsworth and has a list size of just under 400 patients, although no patients had been seen since 9 January 2015. While the conditions imposed on the provider by the GMC in December 2015 remain in place, he is not able to practice. A part time receptionist and part time practice manager had remained at the practice during the last four months to ensure patients were directed to other practices for their primary medical needs to be met. We were told that blood test results, hospital letters and other correspondence was referred to a locum GP who visited when such correspondence arrived at the practice.

The provider had a General Medical Services contract with NHS England, although the provider resigned from this contract after this inspection. (I need to check this)

The CQC have inspected the practice four times in the last eighteen months and found issues relating to patient safety, medication management, infection control, staff recruitment, risk management, equipment not being checked at the required intervals, staff supervision and appraisal and quality assurance with new issues found at every inspection. Compliance actions, warning notices and suspension of the providers registration were all used to require the provider to improve and while some improvements were made, they were not sufficient to reduce or eliminate the risk of harm to patients and new issues were found at each inspection.

Updated 27 August 2015

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

Updated 12 March 2015

The practice is rated inadequate for safety, effective and well-led and requires improvement for responsive and caring. The concerns which led to these ratings apply to everyone using the practice, including this population group.

There was no evidence of joint working with other health and social care services to ensure patients received multidisciplinary care. While the electronic patient records identified when a medication review was required when they attended for an appointment, there was no system to ensure patients were invited for reviews. There was no system to confirm medication reviews were taking place when required. There was no auditing of patients with long term conditions and no other form of reviewing their health outcomes. Safeguarding policies were in place but no safeguarding lead was identified and the locum GP was not aware who to report safeguarding concerns to.

Updated 12 March 2015

The practice is rated inadequate for safety, effective and well-led and requires improvement for responsive and caring. The concerns which led to these ratings apply to everyone using the practice, including this population group.

Appointments were provided outside of school hours. While there were child protection and adult safeguarding policies in place, there was no safeguarding lead and the locum GP we spoke with had not completed child protection training to the required Level and was not clear about who to report safeguarding concerns to.

There was only one male GP which, reception staff told us could be an issue for female patients. There had not been a nurse at the practice for over two years.

There were low numbers of children who required childhood immunisations. Data showed higher than the CCG average for most immunisations.

Updated 12 March 2015

The practice is rated inadequate for safety, effective and well-led and requires improvement for responsive and caring. The concerns which led to these ratings apply to everyone using the practice, including this population group.

The safety of care for older people was not a priority and care and treatment of older people did not always reflect current evidence based practice. Arrangements were in place for locum GPs to cover the practice; however we were told that patients over the age of 75 had not been informed of the change to their named GP. Arrangements were in place for a locum GP to carry out home visits should they be required. Although there were no prescription pads, which meant the locum GP would need to return to the practice to write a prescription. It was not clear if the locum would use the provider’s doctor’s bag or supply their own.

While safeguarding policies were in place, there was no safeguarding lead. The locum GP we spoke with was clear about what constituted a vulnerable adult, but was not aware who to report safeguarding concerns to.

Updated 12 March 2015

The practice is rated inadequate for safety, effective and well-led and requires improvement for responsive and caring. The concerns which led to these ratings apply to everyone using the practice, including this population group.

Appointments could only be booked by telephone and there were no extended hours, early morning or after hours appointments for working people or students. The locum GP gave an example of a recent telephone consultation with a patient. Data showed the practice had higher numbers of working people than the national average. Patients did not have the choice of receiving treatment from a female clinician. The practice did not offer cervical smears; notices in the waiting room gave details of local clinics where patients could attend for a smear test.

Updated 12 March 2015

The practice is rated inadequate for safety, effective and well-led and requires improvement for responsive and caring. The concerns which led to these ratings apply to everyone using the practice, including this population group.

There was no evidence of multi-disciplinary work with other health and social care services to ensure patients received joined up care.

Updated 12 March 2015

The practice is rated inadequate for safety, effective and well-led and requires improvement for responsive and caring. The concerns which led to these ratings apply to everyone using the practice, including this population group.

Arrangements for safeguarding were not sufficient, there was no designated lead and the locum GP was not clear about who to report concerns to. There were five patients with learning disabilities and records showed all had received an annual health check in February or March 2014.