The Care Quality Commission
  • Doctor
  • GP practice

Archived: Dr Kiran Kunwar Also known as North Hyde Surgery

Overall: Inadequate read more about inspection ratings

North Hyde Surgery, 351 North Hyde Lane, Southall, Middlesex, UB2 5TH (020) 8574 3121

Provided and run by:
Dr Kiran Kunwar

All Inspections

4 February 2016

During an inspection looking at part of the service

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of this practice on 2 June 2015 and 2 July 2015. Breaches of legal requirements were found and we told the provider of our intention to take enforcement action.

We received representations from the provider informing us that they would remedy any breaches and enforcement action would be disproportionate. We undertook this focused inspection to check whether the practice was making progress in meeting legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Dr Kiran Kunwar on our website at www.cqc.org.uk

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

  • Practice patients were at serious risk of harm.

  • The safeguarding policy had been updated with local contacts and staff were familiar with this information.

  • The practice was able to demonstrate that staff were supported and there were opportunities for learning. However, some clinical staff  relied on outdated reference material to maintain their clinical practice.

  • The practice had secured external consultancy advice on practice management. We saw that policies and procedures were in the process of being reviewed, updated and tailored to the practice.

  • The incident reporting procedure had been reviewed. The practice kept notes of monthly meetings and incident reports were shared with the staff.

  • Infection control practice had improved. The practice was less cluttered, the cleaning schedule had been reviewed and the practice had conducted regular (six monthly) audits of infection control.

  • The practice now stocked emergency oxygen as well as a defibrillator and emergency medicines. Staff knew where the emergency equipment was located.

  • Patients were at significant risk of harm through poor record keeping. The practice ran parallel computerised and paper recording systems and saw no risk in doing so. We found that the computer records did not always match the paper records and the electronic records were not comprehensive.

  • The GP principal had increased their use of ‘read codes’ in the electronic records since our previous inspection but these were not being used systematically.

  • The GP principal’s ability to use the electronic record system remained very limited. They were unable to run automated searches, reports and audits and relied on an external contractor to carry out these sorts of tasks.

  • No new members of staff had been recruited since the last inspection and we did not verify the recruitment procedures. The relevant policies had been updated.

  • The practice had responded to a highly critical external report into the quality of their record keeping by increasing the level of detail used when recording consultations and using read codes. The practice had not undertaken any further investigaton into the underlying safety of care as a result.

Although the practice had made some improvements since our last inspection, we were not assured that the practice learned effectively from the evidence about the quality of its service. The practice did not demonstrate the capability to improve to the required standard to meet the regulations.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

2 June 2015 and 2 July 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Kiran Kunwar on 2 June 2015. Overall the practice is rated as inadequate.

Specifically, we rated the practice as inadequate for providing safe, effective, caring and for being well led. It is rated as inadequate for providing services for older people; people with long term conditions; families children and young people; working age people; people whose circumstances may make them vulnerable; and, people experiencing poor mental health. The practice is rated as requires improvement for providing responsive services.

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

  • Patients were at risk of harm because systems and processes were not in place to keep them safe. For example appropriate recruitment checks on staff had not been undertaken prior to their employment.
  • Incidents, near misses and concerns were reported but there was no evidence of wider learning and communication with staff.
  • There was insufficient assurance to demonstrate people received effective care and treatment. For example, apart from patients on the learning disability register, the practice had not developed care plans for patients with long-term needs.
  • Patients were positive about their interactions with staff and said they were treated with compassion and dignity although national GP patient survey scores for the practice were consistently lower than the Hounslow average for the quality of patient consultations
  • Urgent appointments were usually available on the day they were requested.
  • The practice had ineffective formal governance arrangements to monitor its performance, learn and improve.

The areas where the provider must make improvements are:

  • The practice must ensure that learning from incidents, complaints, audits and other sources of information about quality are systematically shared within the practice.
  • The practice must ensure that clinical staff are appropriately supervised and monitored.
  • The practice must put in place effective systems to ensure that any allegations of abuse are identified and acted on immediately
  • The practice must audit its infection control practice from time to time and ensure that a Legionella risk assessment has been carried out and any identified risks acted on.
  • The practice must ensure that emergency oxygen is available or carry out a risk assessment to show why this is not necessary
  • The practice must ensure that it can show that equipment in use is safe and reliable and maintained in line with the manufacturer’s instructions
  • The practice must ensure that recruitment procedures include and document all necessary pre-employment checks for all staff including DBS clinical records checks where appropriate.
  • The practice must ensure that there is an effective induction process for new and temporary members of staff
  • The practice must put systems in place to ensure all clinicians are kept up to date with national guidance and guidelines
  • The practice must ensure there are formal governance arrangements in place including systems for assessing and monitoring risks and the quality of the service provision.
  • The practice must ensure that staff have access to appropriate policies and guidance to carry out their roles in a safe and effective manner which are reflective of the requirements of the practice.
  • The practice must ensure that all staff are competent to use the electronic patient records system including running reports to monitor the quality of service where appropriate
  • The practice must ensure that the electronic patient records system includes accurate details of action and follow-up actions taken following diagnostic testing, health reviews or other changes to a patient’s health or treatment
  • The practice must not discourage patients from registering at the practice on non-clinical grounds, for example, their ability to speak English.
  • The practice must ensure that interpreting services are offered to patients when required so that patients understand their treatment and can give informed consent.
  • The practice must ensure it has a business continuity plan in place.

The areas where the provider should make improvement are:

  • The practice should review its workforce needs and ensure it can respond should a member of staff take leave at short notice
  • The practice should consider the introduction of effective care planning for those patients who would benefit from coordinated, multidisciplinary care
  • The practice should consider opportunities to engage more widely with health and social care professionals for the benefit of patients and staff development
  • The practice should embed clinical audit further into routine practice and complete the audit cycle to ensure that improvements are sustained
  • The practice should consider developing the information it provides to patients, for example by providing a website
  • The practice should consider some further investigation of the reasons for its patient satisfaction scores being lower than the local average.
  • The practice should keep records of mandatory staff training.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

12 May 2014

During an inspection looking at part of the service

At our last inspection in June 2013 we found that the provider was non-compliant with regulations relating to the quality of the premises including physical access to the building and aspects of infection control. We also found that the provider was not well prepared to manage foreseeable medical emergencies.

At this inspection we found that the provider had made some improvements to the service. The staff had been trained in basic life support and were confident about what to do in an emergency. The provider had also obtained a defibrillator although they were still familiarising themselves with how to operate this.

However, the provider had not improved the physical environment or made meaningful progress in relocating the practice to a new site. The quality of the environment remained poor. We also found at this visit that emergency medicines were out of date putting patients at risk. The premises were clean and the provider was following their infection control policy and procedures. However, the cleaner did not have a daily cleaning checklist which made it difficult to check that all tasks were completed. A sink in one treatment room presented a risk of cross infection. We found that despite some improvements, the practice remained non-compliant with the regulations.

14 June 2013

During a routine inspection

We spoke with six people who use the service, and the Chair of the Patient Participation Group. Overall people were satisfied with the service received, with one person saying "I am very happy with the doctor, she is very nice". Another told us "she is a very good doctor, really looks after the patient". A third person told us "overall 101% okay ' I've been here a long time. I'd change my doctor if I wasn't happy".

People told us they were able to get an appointment when they needed one, and that they would recommend the practice to family and friends. One person said "I have no problem getting an appointment ' any problems I see the doctor straight away". Another person told us "most of my family and friends are already here, but I would recommend the practice if they weren't".

We found that the service conducted appropriate assessments and ensured people made an informed choice about their care and treatment. However, the provider had not planned for foreseeable emergencies. We found that the provider had taken steps to safeguard people from the risk of abuse, and had conducted appropriate pre-employment checks to ensure staff were skilled, experienced and qualified.

We found the provider had not taken appropriate steps to ensure the premises were cleaned to a high standard, and that the premises did not meet government guidelines for the prevention of healthcare-associated infection. We found that the service had a system in place to monitor quality and safety.