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

Overall: Requires improvement read more about inspection ratings

66 Brighton Road, Coulsdon, Surrey, CR5 2BB (020) 8660 2700

Provided and run by:
Dr Jamil Khan

All Inspections

14 June 2018

During an inspection looking at part of the service

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

7 February 2018

During a routine inspection

This practice is rated as Inadequate overall. (Previous inspection 7 June 2017 rated overall as Requires Improvement)

The key questions are rated as:

Are services safe? – Inadequate

Are services effective? – Inadequate

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Inadequate

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Inadequate

People with long-term conditions – Inadequate

Families, children and young people – Inadequate

Working age people (including those recently retired and students – Inadequate

People whose circumstances may make them vulnerable – Inadequate

People experiencing poor mental health (including people with dementia) - Inadequate

During the inspection carried out on 16 June 2016 the practice was rated overall as inadequate and was placed in special measures. Following the period of special measures we undertook an announced inspection on 7 June 2017 to follow-up on breaches of regulations and the practice was rated overall as requires improvement.

We carried out an announced comprehensive inspection at Dr Jamil Khan on 7 February 2018 to follow up on breaches of regulations.

At this inspection we found:

  • The governance arrangements did not ensure safe care for patients as there was a lack of oversight. During the inspection on 7 June 2017 we found that the practice had made significant improvements in relation to the issues found on the inspection in 16 June 2016; however during this inspection we found that some of these improvements had not been sustained.
  • The practice did not have a clear system in place to monitor patients on high risk medicines, monitoring of refrigerator temperatures on a daily basis and uncollected prescriptions. Some of the medicines and safety alerts were not received, implemented and monitored by the practice.
  • The practice did not have a system in place to follow-up patients who do not attend their appointments to review non-urgent test results.
  • The data from the Quality and Outcomes framework for 2016/17 indicated that patient outcomes were significantly below when compared to the local and national averages.
  • The practice did not adequately review the effectiveness and appropriateness of the care it provided; the practice did not have a program of regular audits and some of the audits and re-audits they had completed had not been written up.
  • The practice ensured that care and treatment was delivered according to evidence- based guidelines.
  • Staff involved and treated patients with compassion, kindness, dignity and respect.
  • Patients had access to a walk-in service Monday to Friday where they could attend the surgery without an appointment; the patients we spoke to and the CQC comment cards we received indicated that they found this system very helpful and reported that they were able to access care when they needed it. The practice also offered pre-bookable appointments with a long-term locum female GP.

The areas where the practice must make improvements are:

  • Ensure care and treatment is provided in a safe way for service users including a clear system in place to monitor patients on high risk medicines, monitoring of refrigerator temperatures and uncollected prescriptions.
  • Ensure that all patients’ needs are identified and care and treatment meet their needs including improving outcomes of patients with long-term conditions especially for patients with mental health and dementia.
  • Ensure there is a system in place to for patients who do not attend their follow-up appointments.

The areas where the provider should make improvements are:

  • Review procedures to ensure all the relevant historical medicines and safety alerts are received, implemented and monitored.
  • Review procedures in place to ensure there is a signed contract in place for employed staff.
  • Review processes in place to ensure there is a program of clinical audits and they are written-up for dissemination and learning.
  • Review processes in place to improve clinical coding and exception reporting for patients with long-term conditions.
  • Review how patients with caring responsibilities are identified to ensure information, advice and support can made available to them.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

7 June 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Jamil Khan / The Coulsdon Medical Practice on 16 June 2016. The overall rating for the practice was inadequate and the practice was placed in special measures. The full comprehensive report on the June 2016 inspection can be found by selecting the ‘all reports’ link for Dr Jamil Khan on our website at www.cqc.org.uk.

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 7 June 2017. Overall the practice is now rated as requires improvement.

Our key findings were as follows:

  • The practice had made significant improvements since the last inspection. The practice had hired an external consultant to help them address the issues identified in the previous inspection.
  • 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 the skills, knowledge and experience to deliver effective care and treatment. We reviewed a sample of patient records and found that the care was delivered in line with current evidence based guidance. However the data from the Quality and Outcomes Framework for 2015/16 showed patient outcomes were significantly below average when compared to the local and national averages. Recent unpublished data for 2016/17 provided by the practice indicated a slight improvement; however their exception reporting figures was significantly higher than average.  
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment; however the practice had only identified a low number of carers.
  • Information about services and how to complain was available and easy to understand.
  • The lead GP offered a daily walk-in surgery (mornings and afternoons) where patients could attend without an appointment and were seen on a first come first served basis; patients we spoke to said they liked this walk-in surgery. Pre-booked appointments were also available with the two part-time female regular locum GPs and patients we spoke with said they found it easy to make an appointment with these GPs and there was continuity of care.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There was a 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.

However, there were also areas of practice where the provider needs to make improvements.

Importantly, the provider must:

  • Ensure that all patients’ needs are identified and care and treatment met their needs.

In addition the provider should:

  • Review how patients with caring responsibilities are identified to ensure information, advice and support can be made available to them.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by the service.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

16 June 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Jamil Khan/The Coulsdon Medical Practice on 16 June 2016. Overall the practice is rated as Inadequate.

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

  • Patients were at risk of harm because systems the practice did not have suitable arrangements to respond to a range of medical emergencies. For example, the practice had no defibrillator or oxygen and did not have a full range of emergency medicines.
  • The practice had a system in place for reporting and recording significant events, although we found the analysis of significant event not always thorough.
  • Patient outcomes were hard to identify as little or no reference was made to audits or quality improvement and there was no evidence that the practice was comparing its performance to other practices; either locally or nationally. There was no system for staff to receive a regular appraisal and not all staff have completed mandatory training.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Patients said that there was continuity of care, with urgent appointments available the same day.
  • The practice had a leadership structure and staff felt supported by management; however the practice had limited governance arrangements.

There were areas of practice where the provider must make improvements:

  • Ensure the practice has suitable systems in place to deal with and monitor risks to patients to include: availability of equipment and medicines to respond to medical emergencies, including access to oxygen and a full range of emergency medicines and a defibrillator or to have completed a risk assessment identifying how they would deal with medical emergencies requiring one; a robust system in place for monitoring patients on high risk medicines; carrying out health and safety, fire, legionella and asbestos risk assessments and for any recommendations following these risk assessments to be actioned and that the recommendations from the infection control audit are actioned.
  • Ensure that the business continuity plan is up to date and contains information staff need to respond to a range of situations.
  • Ensure that all staff complete mandatory training including child protection and ensure all staff have a regular appraisal.
  • Ensure quality monitoring processes are in place that include: clinical audit being performed to identify and monitor improvements to patients and that requisite changes are made following the completion of audits and monitored through re-audits including the use of antibiotics and for the development of systems to seek and act on feedback from service users, including establishing a Patient Participation Group (PPG).

There were areas of practice where the provider should make improvements:

  • Review the practice procedures to ensure that accurate coding is used on the electronic record system so that patients are monitored effectively.
  • Review systems in place to ensure that patients with a learning disability are regularly reviewed.
  • Review practice procedures to ensure that patients who are eligible for NHS health checks are offered the opportunity to be screened.
  • Review the practice procedures to ensure all patients with unplanned admissions have care plans in place.
  • Review how they identify and record patients with caring responsibilities to ensure information, advice and support is made available to them.
  • Ensure that the practice policies and procedures are reviewed and regularly updated.
  • Ensure that patients are made aware of how to make a complaint.

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any population group, key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice