We carried out an announced comprehensive inspection at Dr Mohammad Khan on 12 December 2018 to check that the practice had maintained its improvements since coming out of special measures in August 2017.

We based our judgement of the quality of care at this service on a combination of:

• What we found when we inspected
• Information from our ongoing monitoring of data about services and
• Information from the provider, patients, the public and other organisations.

We have rated this practice as good overall and good for all population groups.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• The practice was well-led and managed the delivery of high-quality, person-centre care.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Professor Steve Field CBE FRCP FFPH FRCGP
Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Mohammad Khan on 3 November 2016. The overall rating for the practice was inadequate and the practice was placed in special measures. Warning notices were also issued to the practice because we were concerned about safety and governance. The full comprehensive report on 3 November 2016 inspection can be found by selecting the ‘all reports’ link for Dr Mohammad Khan on our website at www.cqc.org.uk. The practice was previously rated inadequate for safe and well-led, requires improvement for responsive and effective, and good for caring.

We then carried out an announced focussed follow up inspection on the 19 June 2017 which looked at the issues identified in the warning notices and we found that improvements had been made.

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 4 August 2017. We found that improvements had continued to be made. Overall the practice is now 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 a system in place for reporting and recording significant events.
• The practice now had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance and there were now systems in place to keep staff up to date. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with 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.
• There was now a clear leadership structure in place and staff felt supported by management. Improvements had been made to governance arrangements.
• The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of the requirements of the duty of candour.

The areas where the provider should make improvement are:

• The practice should continue to review best practice guidelines.
• All staff should be aware of the emergency call button within the clinical system.
• The practice should consider having a clinical lead for infection control within the practice.

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

Letter from the Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

On 3 November 2016 we carried out a full comprehensive inspection of Dr Mohammad Khan (Manchester Road East medical practice). This resulted in two Warning Notices being issued against the provider on 11 January 2016. The Notices advised the provider that the practice was failing to meet the required standards relating to Regulation 12 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014, Safe care and treatment, and Regulation 17 of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014, Good governance.

On 19 June 2017 we undertook a focused inspection to check that the practice had met the requirements of the Warning Notices. At this inspection we found that the practice had satisfied the requirements of the Notice. Specifically we found that:

• The practice now had a system in place to receive and disseminate patient safety and medicine alerts.
• Training for all staff was monitored and the practice ensured all staff had received appropriate training and supervision.
• There was a system in place to ensure the monitoring and secure storage of blank prescriptions. Medical records were also stored securely.
• Clinical staff were now aware of relevant clinical guidelines and were being discussed at team meetings.
• Patient Group Directives were correctly in place and signed by the relevant people.

The rating awarded to the practice following our full comprehensive inspection on 2 November 2016 remains unchanged. The practice will be re-inspected in relation to their rating in the future.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Mohammad Khan on 3 November 2016. Overall the practice is rated as inadequate.

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

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• 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.
• Data showed patient outcomes were low compared to the national average. Although some audits had been carried out, we saw no evidence that audits were driving improvements to patient outcomes.
• Patients were at risk of harm because systems and processes were not in place to keep them safe. For example, there was no system in place to monitor and act upon patient safety and medicine alerts.
• 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 others; either locally or nationally.
• Patients were positive about their interactions with staff and said they were treated with compassion and dignity.
• The practice had no clear leadership structure, insufficient leadership capacity and limited formal governance arrangements.

The areas where the provider must make improvements are:

• Put systems in place to ensure all clinicians are kept up to date with national guidance and safety alerts.
• Carry out clinical audits including re-audits to ensure improvements have been achieved.
• Implement formal governance arrangements including systems for assessing and monitoring risks such as legionella, monitoring training, and the quality of the service provision.
• Ensure that blank prescriptions, patient medical records and electronic data are stored securely.
• Care plans must be developed for patients requiring care and treatment and should be available to all staff involved in providing the care.
• Clinical staff administering medicines must do so under a valid prescription.
• All complaints must be recorded by the practice.

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