Archived: Dr Padma Kanthan Also known as Dr P R Kanthan

Updated 22 January 2015

Dr Padma Kanthan is a small GP practice based in Hayes and Harlington in the Hillingdon area, providing primary care services to around 3000 patients.

Census data shows an increasing population and a higher than average proportion of black and minority ethnic residents in Hillingdon. Life expectancy is 6.6years lower for men and 4.7 years lower for women in the most deprived areas of Hillingdon than in the least deprived areas.

The practice operates from a converted house and has two consulting rooms used by the GPs and nurse. Surgeries are held every weekday from 8.30-18:30.The practice closes at 13:20 every Wednesday with the GP available for telephone emergencies. Late night surgeries are held on Fridays until 19:00. The practice has opted out of providing out of hours services to their own patients.

It is a single handed practice with one full time female  GP and a locum male GP who is employed to work once a week on Mondays from 17:00 until 19:00 .The practice employs one full time practice manager, four reception staff and an agency practice nurse who works 20 hours per week.

Updated 22 January 2015

Dr Padma Kanthan is a small GP practice based in Hayes and Harlington in the Hillingdon area, providing primary care services to around 3000 patients. The practice operates emergency appointments on the day and extended hours are offered once a week on Fridays from 18:00 until 19:00.

We spoke with eight patients during our inspection and received 25 completed comments cards. Patients reported being happy with the care and treatment they received. However 14 patients who had completed the comments cards were not happy with the current appointments system. Patients reported finding it difficult getting through via the telephone to obtain appointments. Some patients were also requesting an online booking appointment system which was currently not being offered by the practice. Data from the national patient survey published in July 2014 showed that patients rated the practice as good.

Patients did not receive safe care. They were no records of incidents that had occurred or any evidence that action had been followed to prevent similar incidents from recurring. The practice kept no log of incidents or alerts and had no systems to disseminate information. Patients were not protected from the risk of abuse, because the provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.   Patients were not protected against the risks associated with medicines because the provider had inappropriate arrangements to manage medicines. Patients were not protected from the risk of infection because they were no effective systems in place to reduce the risk and spread of infection.  Emergency equipment was not available and they were no risk assessments in place to deal with emergencies.

Patients did not receive care that was effective. The GP was not involved in the process of audits and could not demonstrate how they improved patient care. The GP did not demonstrate a clear understanding of the legislation relating to the Mental Capacity Act 2005 and could not demonstrate how they would deliver care in the best interests of patients. There was limited evidence to demonstrate that the practice worked with other services fully to provide care that was collaborated. There were no planned interventions to ensure patients were supported to make healthy choices.

Improvements were required to the care that was provided to patients. Although patients were complimentary about the care they received from the GP and felt they were respected and involved in decisions relating to their care, the practice had not taken steps to ensure privacy was maintained in the reception area. Patients were not offered support during bereavement.

The practice was not responsive to patients varying needs. Patients were not offered interpreting services and so their needs might not have always been met. Patients did not always have a choice of seeing a preferred gender GP because only a female GP was available most of the time. The practice did not employ a regular full time practice nurse and so the availability of services offered to patients was limited. There was no use of information technology and patients were limited in how they booked appointments or requested prescriptions. The practice did not respond appropriately to comments and complaints. They had not responded to suggestions made by the PPG regarding implementing online appointments.

There was inadequate leadership. There was no clinical governance policy in place and staff were not clear on their roles and responsibilities. The practice had not acted on valuable feedback from the PPG surveys. There were a lack of systems in place that enabled learning and improvement of performance and learning from incidents to avoid future occurrence.

The provider was in breach of Regulations 9, ,11, 12, 13, 15,19, 21, and 23 of the Health and Social Care Act (HSCA) (Regulated Activities) Regulations 2010 related to -

•           Care and welfare of people who use services

•           Safeguarding people who use services from abuse

•           Cleanliness and infection control

•           Safety and suitability of premises

•           Management of medicines

•           Requirements relating to workers

•           Supporting workers

•           Complaints

 Please note that when referring to information throughout this report, for example any reference to the Quality and Outcomes Framework data, this relates to the most recent information available to the CQC at that time.

We found that all population groups were receiving care that was not safe, effective, caring, responsive or well led.

Updated 22 January 2015

The practice had some arrangements to respond to this population group.

The practice provided some support to patients with long term conditions such as asthma, diabetes, dementia .We saw data collected for the Quality Outcomes Framework (QOF) and it was evident that these patients were being invited to attend yearly reviews as recommended. We saw evidence that the GP followed guidance used by the local Clinical Commissioning Group (CCG) in assessment, diagnosing and care planning for patients with asthma.  The care pathway provided guidance in diagnosing and managing   and clearly documented how referrals to secondary care were managed with the aim of improving care.

Updated 22 January 2015

The provider had limited arrangements to respond to this population group.

The practice offered six week post natal checks to mothers and development checks to babies at six weeks. The GP told us that they prioritised seeing sick babies for emergency appointments.

We were told that they had a baby immunisations session every Wednesday. However on the day of our inspection this clinic was not being held as the practice nurse was on holiday. We were told by the GP and reception staff that no patients had been booked for these sessions in the absence of the nurse. No other arrangements for cover were in place.

Surveillance data provided to us by the local NHS England team indicated the practice was scoring very low on the up take of childhood immunisations.

Updated 22 January 2015

 The provider had limited arrangements to respond to this population group.

Yearly health checks were offered to older patients. We were told that home visits were carried out for those patients that were too ill to attend the surgery. The GP operated same day telephone triage system and they prioritised this patient group. Flu and Shingles vaccines were offered at the surgery, though the practice used an agency nurse and they were no plans to cover absence and sickness.

Updated 22 January 2015

The provider had limited arrangements to respond to this population group.

The practice operated extended hours and so this gave an opportunity for working patients to book flexible appointments. Contraception services and smear checks were offered at the practice in line with local CCG arrangements. Telephone consultations were offered in emergencies.

Updated 22 January 2015

The provider had limited arrangements to respond to this population group.

 We were told the practice had few patients experiencing a mental health conditions no register was available .Patients experiencing poor mental were seen for a yearly check and this was indicated in the Quality Outcomes Framework (QOF) data we viewed.

Updated 22 January 2015

The provider had limited arrangements to respond to this population group.

The practice allowed patients living in hostels or those with temporary addresses to be registered. The practice stated they had three patients with learning disabilities and they were offered yearly checks in line with local Clinical Commissioning Group (CCG) requirements. However staff had not received training in adult safeguarding and so might not have identified people at risk of abuse. The practice did not have links into the Community Learning Disability team.