The Care Quality Commission
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  • GP practice

Archived: Dr Risiyur Nagarajan Also known as Dr R. K. Nagarajan

Overall: Requires improvement read more about inspection ratings

Queens Park Health Centre, Dart Street, London, W10 4LD (020) 8960 5252

Provided and run by:
Dr Risiyur Nagarajan

All Inspections

3 August 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Risiyur Nagarajan (Queens Park Health Centre) on 7 January 2015. The overall rating for the practice was requires improvement. The full comprehensive report on the 7 January 2015 inspection can be found by selecting the ‘all reports’ link for Dr Risiyur Nagarajan on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 3 August 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 7 January 2015. This report covers our findings in relation to those requirements and any improvements made since our last inspection.

Overall the practice remains rated as requires improvement.

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

  • Although risks to patients were assessed, the systems to address these risks were not implemented well enough to ensure patients were kept safe. For example, we found the processes and management of significant events, patient safety alerts and some aspects of prescription management required improvement.
  • Staff demonstrated that they understood their responsibilities with regards safeguarding and we saw that clinical staff had been trained to safeguarding level three. However, non-clinical staff and a phlebotomist had not received safeguarding children training relevant to their role.
  • Staff were aware of current evidence based guidance.
  • Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment. However, there were gaps in training which the practice had identified as mandatory, for example, fire safety awareness and information governance.
  • There was evidence of appraisals for all employed staff but the practice did not have a formal induction programme for newly appointed staff.
  • 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.
  • 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.
  • 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. 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. An example we reviewed showed the practice complied with these requirements.

The areas where the provider must make improvement are:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
  • Ensure persons employed in the provision of the regulated activity receive the appropriate support, training, professional development, supervision and appraisal necessary to enable them to carry out the duties.

The areas where the provider should make improvement are:

  • Consider the infection control lead undertaking enhanced training to support them in this extended role.
  • Review the fire evacuation procedure to ensure all staff understand, and continue to understand, the plan in the event of a fire.
  • Review the process to regularly check that the shared defibrillator is ready for use at all times.
  • Consider keeping a copy of the business continuity plan off site and include the names and contact details of all staff members.
  • Continue to monitor patient outcomes in relation to the childhood immunisation and the cervical screening programme.
  • Review the use of the urgent two-week referral pathway to ensure all patients within its criteria are being appropriately referred to improve early diagnosis and timely treatment.
  • Consider including the long-term sessional GP in the appraisal programme.
  • Continue to actively recruit a female GP and a practice nurse to enable patient preferences and outcomes to be met.
  • Review how carers are identified and recorded on the clinical system to ensure information, advice and support is made available to them.
  • Consider recording verbal complaints to capture all patient feedback in order to identify trends and enable learning.
  • Consider developing a practice website.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

7 January 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection on 7 January 2015. The practice is rated as requires improvement.

Specifically, we found the practice to require improvement for providing safe, effective and well led services. It was good for providing caring and responsive services. The practice also requires improvement for providing services to all of the population groups: older people; people with long-term conditions; families, children and young people; working age people (including those recently retired and students); people living in vulnerable circumstances; and people experiencing poor mental health (including people with dementia).

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

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
  • Risks to patients were assessed, with the exception of those relating to dealing with medical emergencies.
  • Information about services and how to complain was available and easy to understand.
  • 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 and that 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.
  • The practice sought feedback from staff and patients, and acted on it.
  • There was a leadership structure with staff happy to discuss concerns or issues with management.
  • There was insufficient assurance to demonstrate people received effective care and treatment. We did not see evidence of personalised care delivered following best practice guidance. Performance data showed that patient outcomes were below average for the locality.
  • Some clinical staff were unclear about obtaining and documenting patient consent.
  • Clinical staff training needs in infection prevention and control and the new computer system had not been met.

The areas where the provider must make improvements are:

  • Ensure staff have access to medical oxygen in the event of a medical emergency.
  • Ensure that suitable arrangements are in place for obtaining and documenting the consent of patients in relation to their care and treatment.
  • Ensure clinical staff receive support and training in infection prevention and control and accessing the electronic patient record system, to enable them to carry out their roles.
  • Ensure all patient test results and letters received by the practice relating to patient care are seen by a GP. In the event of abnormal test results discussions with the patient should be undertaken by a clinician.
  • Ensure all patient referrals are reviewed by the GP before being entered onto the system and the referral process is completed.
  • Ensure all patients identified as in need of an annual health check are offered one and actively arrange for patients to have a regular review of their medicines as appropriate.
  • Ensure vulnerable patients, such as those with mental illness or learning disabilities are offered an annual health check and that care plans are patient-centred and completed collaboratively with patients to reflect their preferences.
  • Introduce a system for the accurate recording and review of data from QOF to support learning and demonstrate what actions are taken to address poor clinical outcomes for patients.

In addition the provider should:

  • Ensure that staff responsible for medicine refrigerator temperature checks know what action to take should the thermometer read under or over the recommended temperature.
  • Ensure appraisals are undertaken for all staff.
  • Ensure repeat prescriptions are authorised by a GP.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

20 May 2014

During a routine inspection

Dr Risiyur Nagarajan, also known as Dr R. K. Nagarajan, provides primary medical services to people living in Westminster, Brent, Harrow, Ealing, Hammersmith, Hounslow and Barnet. Dr Nagarajan, the principal GP at the practice works with two GP associates. At the time of our inspection, there were 3,100 patients registered at the practice.

The practice is registered with the Care Quality Commission (CQC) to provide the following regulated activities: diagnostic and screening procedures; maternity and midwifery services; and treatment of disease, disorder or injury.

We carried out an announced inspection of the practice on the 20 May 2014. The team, led by a CQC Inspection Manager, included a GP, and an Expert by Experience. As part of the inspection, we spoke with five patients who use the practice, the GPs, practice manager and reception staff. All the patients we spoke with were happy with the treatment and care they received. We observed a good and friendly interaction between patients and the receptionists.

There were mechanisms in place to report and record safety incidents, concerns and allegations of abuse. However, the arrangements for learning from incidents were not effective.

There was some evidence of effective care being provided. However, communications with healthcare professionals that may be critical to patient care were not always recorded. This presents a risk to effective care, as vital information required for appropriate care may be missed.

All the patients were complimentary of the care they received. Receptionists knew most of the patients by name. Some patients reported occasional delays in answering phones and booking appointments.

The practice understood and responded to the needs of most of their patients. The practice was still in the process of establishing a Patient Participation Group (PPG), as a result of which essential patient feedback was limited.

There was a positive, open and caring culture within the practice. Staff were clear on their roles and responsibilities and had a good working relationship. However the practice did not have any documentary evidence of a practice-wide strategic objective to improve quality, and manage risk.