Archived: Dr A Khan and K Muneer

Updated 16 August 2016

Dr Khan and Dr Muneer have been in partnership at the practice since 2007. Their practice is a member of the Leeds South and East Clinical Commissioning Group (CCG). Personal Medical Services (PMS) are provided under a contract with NHS England. The practice is registered with the Care Quality Commission (CQC) to provide the following regulated activities: diagnostic and screening procedures, treatment of disease, disorder or injury and maternity and midwifery. They also offer a range of enhanced services, which include:

• extended hours access
• delivering childhood, influenza and pneumococcal vaccinations
• facilitating timely diagnosis and support for people with dementia
• identification of patients with a learning disability and the offer of annual health checks

The practice is located in the Hunslet area, on the outskirts of Leeds city cente. It is based within a purpose built health centre, which also houses another GP practice and several community based services. There is a large reception area where the chairs are colour coded to enable patients to know where to sit and wait to be called for each service. The reception staff for those services share the same office. A notice above each area identifies where patients need to go to access a receptionist for the practice. All consulting rooms are on the same floor. There is disabled access and a large car park with some designated disabled parking spaces.

The practice currently has a patient list size of 2,254, which is predominantly white British. They have a higher than CCG and national average number of patients aged 25 to 35 years. The percentage of patients who are in paid work or full time education is 63%; compared to 59% locally and 61% nationally. Sixty eight percent of patients have a long standing health condition, compared to 56% locally and 54% nationally. We were informed that the practice had seen an increase of approximately 400 patients over the preceding two years. Reasons for the increase included an increasing birth rate, an influx of European migrants into the area and the closure of a local practice. We were assured the practice was coping with the extra patients and the additional workload.

There are two male GP partners who work at the practice. Nursing staff consist of a practice nurse and a health care assistant; both of whom are female. There is a practice manager, an assistant practice manager (who also acts in the capacity of a phlebotomist when needed) and a team of administration and reception staff who oversee the day to day running of the practice.

The practice is open Monday to Friday 8am to 6pm. Extended hours are available from 7.30am on Thursday. GP appointments are available:

Monday, Tuesday 8.30am to 10.30am and 3.30pm to 5.30pm

Wednesday, Friday 8.50am to 11am and 4.45pm to 5.45pm

Thursday 7.30am to 10.30am and 3.30pm to 5.30pm

When the practice is closed out-of-hours services are provided by Local Care Direct, which can be accessed via the surgery telephone number or by calling the NHS 111 service.

The practice has good working relationships with local health, social and third sector services to support provision of care for its patients. (The third sector includes a very diverse range of organisations including voluntary, community, tenants’ and residents’ groups.)

Updated 16 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr A Khan and Dr K Muneer’s practice on 26 July 2016. Overall the practice is rated as good for providing safe, effective, caring, responsive and well-led care for all of the population groups it serves.

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

• There was a clear leadership structure, staff were aware of their roles and responsibilities and told us the GPs were accessible and supportive. There was evidence of an inclusive team approach to providing services and care for patients.
• Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Patients’ needs were assessed and care was planned and delivered following local and national care pathways and National Institute for Health and Care Excellence (NICE) guidance.
• There was good access to clinicians and patients said they found it generally easy to make an appointment. There was continuity of care and if urgent care was needed patients were seen on the same day as requested.
• Information regarding the services provided by the practice and how to make a complaint was readily available for patients.
• The practice sought views on how improvements could be made to the service, through the use of patient surveys, the NHS Friends and Family Test and engagement with patients and their local community.
• Risks to patients were assessed and well managed.
• The practice had a very organised approach to working systems and processes, which was evidenced in their policies, staff personnel files and locum recruitment.
• There was a system in place whereby after all policies had been updated, they were reviewed and signed off by one of the GP partners. We saw evidence of the signed and dated signatory sheet for all policies. Policies were available to all staff via the computer or as a paper copy.
• There were safeguarding systems in place to protect patients and staff from abuse.
• The practice promoted a culture of openness and honesty. There was a nominated lead who had a very organised approach for dealing with significant events. All staff were encouraged and supported to record any incidents using the electronic reporting system. There was evidence of good investigation, learning and sharing mechanisms in place.
• The practice complied with the requirements of the duty of candour. (The duty of candour is a set of specific legal requirements that providers of services must follow when things go wrong with care and treatment.)

We saw an area of outstanding practice:

• Patient comments we received were overwhelmingly positive about the practice. The last two national patient surveys regarding the practice, had shown that patient averages for positive experiences were consistently higher than local and national averages. For example:
• 96% of respondents said they could easily get through to the practice by telephone, compared to 68% locally and 73% nationally.
• 99% of respondents said the last appointment they got was convenient, compared to 91% locally and 92% nationally.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 16 August 2016

The practice is rated as good for the care of people with long term conditions.

• The practice maintained a register of patients who were a high risk of an unplanned hospital admission. Care plans and support were in place for these patients.
• The practice had a same day access policy for those patients who experienced a deterioration in their condition. Longer appointments were also available as needed.

• The practice delivered care and support for some patients using the Year of Care model. This approach enabled patients to have a more active part in determining their own needs in partnership with clinicians. It was currently used with patients who had chronic obstructive pulmonary disease (COPD), diabetes, pre-diabetes or coronary heart disease (CHD).
• In line with best practice, six monthly or annual reviews were undertaken to check patients’ health care and treatment needs were being met. For example:

• 79% of patients diagnosed with COPD had received a review in the last 12 months (CCG average 88%, national average 90%)
• 100% of newly diagnosed diabetic patients had been referred to a structured education programme in the preceding 12 months (CCG average 87%, national average 90%)
• 76% of patients diagnosed with asthma had received a review in the last 12 months (CCG and national average 75%)

Updated 16 August 2016

The practice is rated as good for the care of families, children and young people.

• The practice worked with midwives, health visitors and school nurses to support the needs of this population group. For example, the provision of ante-natal, post-natal and child health surveillance clinics.
• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk.
• There was a paediatric trained GP who held quarterly meetings with the health visitor to discuss any concerns regarding children aged five years and under.
• Patients and staff told us 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. Same day access was available for all children under the age of five.
• The practice had a dedicated individual who dealt with the recall of children requiring vaccinations. Uptake rates for all standard childhood immunisations were between 97% and 100%.
• Sexual health, contraceptive and cervical screening services were provided at the practice.
• 87% of eligible patients had received cervical screening in the preceding five years (CCG and national average 82%).

Updated 16 August 2016

The practice is rated as good for the care of older people.

• Proactive, responsive care was provided to meet the needs of the older people in its population.
• Registers of patients who were aged 75 and above and also the frail elderly were in place. to ensure timely care and support were provided. Health checks were offered for all these patients and all had a named GP.
• The practice worked closely with other health and social care professionals, such as the district nursing team, to ensure housebound patients received the care and support they needed.
• Influenza vaccinations were offered and the practice could evidence an 82% uptake between October 2015 and March 2016.

Updated 16 August 2016

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of these patients 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 provided appointments from 7.30am one morning a week, telephone consultations, online booking of appointments and ordering of prescriptions.
• The practice offered a range of health promotion and screening that reflected the needs of this age group. This included screening for early detection of COPD (a disease of the lungs) for patients aged 35 and above who were known to be smokers or ex-smokers.
• NHS health checks were offered to patients aged between 40 and 74 who did not have a pre-existing condition.
• Travel health advice and vaccinations were available.

Updated 16 August 2016

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

• The practice regularly worked with multidisciplinary teams in the case management of people in this population group, for example the local mental health team.
• Patients and/or their carer were given information on how to access various support groups and voluntary organisations.
• 83% of patients diagnosed with dementia and 80% of patients who had a complex mental health problem, such as schizophrenia, bipolar affective disorder and other psychoses, had received a review of their care in the preceding 12 months. These were both lower than the CCG and national averages of 88%.
• Staff had a good understanding of how to support patients with mental health needs or dementia.
• Screening blood tests were undertaken for patients who were prescribed lithium and were under the care of psychiatric services. The results were forwarded onto the psychiatric team for information to support continuity of care.

Updated 16 August 2016

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

• Staff 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.
• We saw there was information available on how patients could access various local support groups and voluntary organisations.
• Patients were signposted to other agencies for additional care and support as needed.