Archived: Dr Nowsherwan Khan

Updated 27 October 2016

Dr Nowsherwan Khan also known as Darlaston Health Centre is located in Walsall, West Midlands situated in a multipurpose modern built NHS building, providing NHS services to the local community. Based on data available from Public Health England, the levels of deprivation (Deprivation covers a broad range of issues and refers to unmet needs caused by a lack of resources of all kinds, not just financial) in the area served by Dr Nowsherwan Khan are below the national average, ranked at two out of 10, with 10 being the least deprived. The practice serves a higher than average patient population aged between zero to 35 and 70 to 74.

The patient list is approximately 2,750 of various ages registered and cared for at the practice. Services to patients are provided under a General Medical Services (GMS) contract with the Clinical Commissioning Group (CCG). GMS is a contract between general practices and the CCG for delivering primary care services to local communities.

The surgery has expanded its contracted obligations to provide enhanced services to patients. An enhanced service is above the contractual requirement of the practice and is commissioned to improve the range of services available to patients.

The surgery is situated on the ground floor of a multipurpose building shared with other health care providers. Parking is available for cyclists and patients who display a disabled blue badge. The surgery has automatic entrance doors and is accessible to patients using a wheelchair.

The practice staffing comprises of two male GP partners, three practice nurses, one practice manager, one secretary and four receptionists.

The practice is open between 7.15am and 6:30pm Mondays and Tuesdays, 8am and 6:30pm Wednesdays and Fridays; 8am and 12:30pm on Thursdays.

GP consulting hours are from 7:30am to 12:30pm and 3pm to 7pm on Mondays, 7:30am to 12:30pm and 3pm to 6:30pm on Tuesdays. Wednesdays and Friday consulting times are 8am to 12:30pm and 3pm to 6:30pm; and 8am to 12:30pm on Thursdays. Extended consulting hours are offered on Mondays and Tuesdays from 7:30am and Nurses worked until 7pm on Mondays. The practice has opted out of providing cover to patients in their out of hours period. During this time services are provided by Primecare.

Updated 27 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Nowsherwan Khan on 2 August 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.
• 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.
• Risks to patients were assessed and well managed with the exception of emergency medicines. The practice did not have access to some emergency medicines while GPs were carrying out home visits. Since the inspection the practice reviewed this and added the required medicine to treatment rooms.
• On the day of the inspection the premises was observed to be clean and tidy; however the latest infection control audit identified gaps in the thoroughness’ of their general cleaning. Staff we spoke to told us that the issue had been brought to the attention of the property owners and cleaning contractors.
• There was a programme of continuous clinical audits, which demonstrated quality improvement. Staff were actively engaged to monitor and improve patient outcomes; the practice employed additional clinical staff in response to audit findings.

• On the day of the inspection patients said they were treated with compassion, dignity and respect and they felt involved in their care and decisions about their treatment. The national GP patient survey showed patients responded positively to nurse related questions however less favourably to questions relating to the GP.

• 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 with a named GP 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. Although the practice proactively sought internal feedback from staff and patients, which it acted on they did not demonstrate an understanding of the national GP patient survey results.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw two areas of outstanding practice where the practice used their knowledge of the local community and patient population as levers to deliver high quality, person centred care. The practice expanded the clinical team in order to respond to population needs. For example:

• Following an audit regarding support for the frail and vulnerable patients the practice employed a part time independent nurse prescriber who provided domiciliary support for patients who were vulnerable, frail, elderly and recently discharged from hospital. Support included things such as, safety in the home, fire hazards, social welfare, falls, nutrition, care packages and sign posting to other services.
• The practice employed a second part time nurse with a health visitor and dental care background to run a family health drop in clinic. The nurse took a holistic approach in order to support parents to address issues such as everyday ailments, childhood obesity, dental care, information on children’s activities during the six week holiday and sign posted families to services to support parents to access education and employment. The practice reveived positive feedback from patients regarding this service. For example opportunistic testing provided early identification of long term conditions and petients whoi accessed the service felt that the drop in service provided support when they needed without having to wait for a set appointment.

The areas where the provider should make improvement are:

• Should ensure arrangements implemented since the inspection for responding to a medical emergency is well established and embedded.
• Review the satisfaction rates from the national GP patient survey in addition to the practice survey, when responding to patient feedback and taking action in response to the findings.
• Ensure that the property owners carry out the required actions relating to gaps in the general cleaning as identified in the infection control audit.
• Proactively use a variety of methods to identify carers and encourage self identification.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 27 October 2016

• 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 similar to the national average. For example, 77% had a specific blood glucose reading of 64 mmol/mol or less in the preceding 12 months (01/04/2014 to 31/03/2015) compared to the CCG and national average of 78%.

• The percentage of patients with diabetes on the register who had had influenza immunisation in the preceding 1 August to 31 March (01/04/2014 to 31/03/2015) was 99%, compared to the CCG average of 96% and national average of 94%.

• Longer appointments and home visits were available when needed.

• The practice referred into services such as the Desmond Diabetic Programme, Chronic Obstructive Pulmonary Disease Team, Expert Patient and Heart Rehabilitation Programme. Written management plans were in place for patients with long term conditions and those at risk of hospital admissions.

• All  patients with a long term condition 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.

Updated 27 October 2016

• 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. We saw positive examples of joint working with health visitors and safeguarding teams.

• The practice held nurse-led baby immunisation clinics and vaccination rates were relatively high for all standard childhood immunisations.

• Staff we spoke with were able to demonstrate how they would ensure children and young people were treated in an age-appropriate way and that they would recognise them as individuals.

• The practice’s uptake for the cervical screening programme for patients aged 25-64 in the preceding five years was 85%, which was comparable to the CCG average of 81% and the national average of 82%.

• Appointments were available outside of school hours and the premises were suitable for children and babies. New mothers were offered post-natal and baby development checks; same day appointments for emergency contraception.

• The practice ran a nurse led family health drop in clinic where the nurse took a holistic approach in order to support parents to address issues such as everyday ailments, childhood obesity, dental care, information on children’s activities during the school holiday and signposted families to services to support parents to access education and employment.

Updated 27 October 2016

• 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, for example the practice nurse reviewed patients in their own homes offering domiciliary support looking at things such as, safety in the home, fire hazards, social welfare, falls, nutrition, care packages and sign posting to other services.

• Data provided by the practice showed that their uptake of flu immunisations for over 65s in the last 12 months was 87% and 96% had received a Pneumococcal vaccine (protection against a form of bacterial meningitis). Health assessments for over 75’s in the past two years was 86%.

• Patient over the age of 75 years had a named GP, offered longer appointments if required and at a time to suit patients needs.

Updated 27 October 2016

• 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, they used social media to promote seasonal immunisation programmes as well as a full range of health promotion and screening that reflects the needs for this age group.

• Health checks are offered by the nursing team to patients aged 40-75 years old, data provided by the practice showed that 22% received a health check in the past 12 months.

• The practice provided Chlamydia screening.

• The practice offered extended clinic hours on Mondays and Tuesdays from 7.30am to 7pm.  

Updated 27 October 2016

• 89% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was above the national average of 84%.

• Performance for patients with a mental health related disorder who had a comprehensive, agreed care plan documented in their record, in the preceding 12 months was below the national average. However data provided by the practice on the day showed that 96% had a care plan in place.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. For example the Primary Care Mental Health Nurse held a weekly clinic at the practice, patients who failed to attend were contacted to assess whether there were any concerns.

• The practice had told patients experiencing poor mental health how to access various support groups and voluntary organisations. There were systems in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• The practice carried out advance care planning for patients with dementia. The practice offer opportunistic dementia screening.

• Staff we spoke with had a good understanding of how to support patients with mental health needs and dementia.

Updated 27 October 2016

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability (LD). The practice provided data which showed that 100% of patients with a LD have had a care plan, medication and face to face review in the last 12 months.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients. For example the practice worked with the local addiction service to manage the general health care of patients receiving interventions for substance and alcohol dependency.

• The practice informed vulnerable 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.

• Carers of patients registered with the practice had access to a range of services, for example annual health checks, flu vaccinations and a review of their stress levels. The practice also provided carers with a detailed carers pack.