Archived: Dr Junaid Syed Also known as Kingsdowne Surgery

Updated 6 October 2016

Dr Junaid Syed provides primary medical services from Kingsdowne Surgery in Surbiton to approximately 3800 patients and is one of 26 practices in Kingston Clinical Commissioning Group (CCG).

The practice population is in the second least deprived decile in England. The proportion of children registered at the practice who live in income deprived households is 12%, which is the same as the CCG average, and for older people the practice value is 13%, which is also the same as the CCG average. The practice has a larger proportion of patients aged 30-34 than the CCG average. Of patients registered with the practice, the largest group by ethnicity are white (76%), followed by asian (16%), mixed (4%), black (2%) and other non-white ethnic groups (2%).

The practice operates from a 2-storey converted residential premises which has been extended to incorporate the neighbouring property. The reception desk, waiting area, one GP consultation room and two nurse consultation rooms are situated on the ground floor. Three further GP consultations rooms and an administrative area are on the first floor, which is accessible by a flight of stairs.

The practice team at the surgery is run by one principal GP who does four clinical sessions per week and spends the remainder of his time undertaking management activities both for the practice and the CCG. There are two part time male salaried GPs and one part time female salaried GP; in total 19 GP sessions are available per week. In addition, the practice also has two part time female nurses, and one part time female healthcare assistant. The practice team also consists of a practice manager, eight reception/administrative staff, two secretaries, and an IT lead.

The practice operates under a Personal Medical Services (PMS) contract, and is signed up to a number of local and national enhanced services (enhanced services require an enhanced level of service provision above what is normally required under the core GP contract).

The practice is open between 8.30am and 6.30pm Monday to Friday apart from Wednesday afternoons when the practice is closed (patients can access a GP during this time by telephoning the mobile phone number provided via the recorded message on the practice’s answerphone). Appointments are from 9.00am to 1.00pm every morning, and 2.00pm to 6.30pm every afternoon. Extended hours surgeries are offered between 6.30pm and 8.00pm on Tuesdays.

When the practice is closed patients are directed to contact the local out of hours service.

The practice is registered as an individual provider with the Care Quality Commission to provide the regulated activities of diagnostic and screening services; maternity and midwifery services; treatment of disease, disorder or injury; surgical procedures; and family planning.

Updated 6 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Kingsdown Surgery (Dr Junaid Syed) on 14 July 2016. Overall the practice is rated as requires improvement.

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; staff were not up to date with mandatory training such as infection prevention and control and information governance; the process in place for updating changes to repeat prescriptions and reviewing letters relating to patients from external clinicians was unsafe.
• The processes in place for storing and administering medicines were not effective. For example, at the time of the inspection there was no arrangement in place for the temperature of the vaccine fridge to be monitored on days when there were no nursing staff present, the practice did not have systems in place to ensure that the legal documentation required for the administering of medicines was up to date. There was no process in place for monitoring the use of blank prescription sheets, and sheets were left in printer trays in unlocked consultation rooms overnight.
• Staff were not clear about reporting incidents, near misses and concerns and there was limited evidence of learning and communication with staff when these incidents occurred.
• We saw evidence that patient safety alerts were being sent to appropriate staff members; however, there was no evidence that these were being acted on. Following the inspection the practice put a process in place to ensure that action is taken on all relevant alerts.
• Care plans for vulnerable patients had been completed and were sufficiently detailed; however, these had not been saved to the patient records system, and therefore, these were not accessible to staff who were reviewing these patients, nor could they be updated when a patient’s condition changed.
• At the time of the inspection the practice did not have a working fire alarm in place (they were in the process of procuring a new system) and had not completed a risk assessment or mitigation plan in relation to this. There was no evidence that the practice carried out regular fire drills or that staff had received training in fire safety.
• Data showed patient outcomes were comparable to the national average with the exception of those relating to patients with diabetes; however, the practice had a high exception reporting rate.
• The practice had completed two complete audit cycles which showed quality improvement; however, there was limited evidence that the improvements made as a result of the initial audits had been embedded.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available; however, at the time of the inspection it was not clearly displayed in the waiting area. Complaints were responded to promptly and in appropriate detail; however, there was limited evidence that improvements were made to the quality of care as a result of complaints and concerns, and learning from complaints was not routinely shared with staff.
• 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.
• The practice had a number of policies and procedures to govern activity, but some were overdue a review.
• There was a leadership structure in place, and overall, staff felt supported; however, there was some ambiguity around the roles and responsibilities of some staff members.

The areas where the provider must make improvements are:

• Ensure improved arrangements for safety to include: safe storage, prescribing and administering of medicines and storage of prescription sheets; completion of pre employment staff recruitment checks, in adherence with the practice’s recruitment policy; correspondence relating to patient care being reviewed by a clinician; suitable fire safety systems being in place; all staff being familiar with new guidance for reporting and recording significant events and for the learning to be shared with relevant staff; and the new process for dealing with patient safety alerts being followed.
• Take action to ensure that patients receive the necessary reviews of their clinical conditions and complete and contemporaneous electronic patient records are kept, including patient care plans and records of meetings where individual patients’ care is discussed.
• Ensure that all staff are up to date with training.
• Ensure that all policies and procedures are up to date.
• Ensure that learning from complaints is shared with all relevant staff.
• Ensure that audit is being used to drive quality improvement.

In addition the provider should:

• Review arrangements to identify carers so their needs can be identified and met.
• Review how they inform patients of the availability of language translation services.

Where a service is rated as inadequate for one of the five key questions or one of the six population groups or overall, it will be re-inspected within six months after the report is published. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group or overall, we will place the service into special measures. Being placed into special measures represents a decision by CQC that a service has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 6 October 2016

The provider was rated as inadequate for safety and requires improvement for effective and well-led. The issues identified as requiring improvement overall affected all patients including this population group.

• Performance for diabetes related indicators were below the CCG and national average. Overall the practice achieved 90% of the total QOF points available, compared with an average of 92% locally and 89% nationally. The practice had a large exception reporting rate for diabetes related indicators (20% compared to a Clinical Commissioning Group (CCG) average of 13% and national average of 11%). The proportion of diabetic patients with a record of a foot examination and risk classification in the preceding 12 months was 32% (CCG and national average 88%).

• Longer appointments and home visits were available when needed.
• Patients at risk of hospital admission received personalised care plans; however, these were not saved to their patient record, and we saw no evidence that these plans were updated throughout the year as the patient’s condition changed.

Updated 6 October 2016

The provider was rated as inadequate for safety and requires improvement for effective and well-led. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• 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.
• Immunisation rates were relatively high for all standard childhood immunisations.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• Cervical screening had been carried-out for 82% of women registered at the practice aged 25-64, which was comparable to the CCG average of 83% and national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We were told that staff at the practice met regularly with midwives and health visitors; however, no record was kept of these meetings.

Updated 6 October 2016

The provider was rated as inadequate for safety and requires improvement for effective and well-led. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice was concerned to ensure that the social needs of its elderly patients were met; for example, they had sent leaflets produced by Age Concern about fuel poverty and the importance of keeping warm in winter to all their patients aged 85 years and over.

Updated 6 October 2016

The provider was rated as inadequate for safety and requires improvement for effective and well-led. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• 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; for example, they offered evening appointments one day per week for people unable to attend the surgery during the day.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.
• The practice’s uptake for cancer screening was comparable to local and national averages with the exception of screening for breast cancer, where their uptake was below average. The practice had discussed their rate of uptake for cancer screening with their patient participation group, and had developed actions for promoting this service to patients to encourage them to attend, for example, they included questions about cancer screening uptake in their annual patient survey in order to raise awareness of this service.

Updated 6 October 2016

The provider was rated as inadequate for safety and requires improvement for effective and well-led. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• The practice had 19 patients diagnosed with dementia and the practice had recorded that 100% of these patients had had their care reviewed in a face to face meeting in the last 12 months, which was better than the Clinical Commissioning Group (CCG) and national average of 84%; however, the practice had a 16% exception rate for this indicator, which was approximately double that of the CCG and national average.
• The practice had 22 patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses, and had recorded a comprehensive care plan for 100% of these patients, compared to a CCG average of 92% and national average of 88%; however, they had a higher than average exception reporting rate at 18%, compared to a CCG average of 10% and national average of 13%.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 6 October 2016

The provider was rated as inadequate for safety and requires improvement for effective and well-led. The issues identified as requiring improvement overall affected all patients including this population group. There were, however, examples of good practice.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
• 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.
• 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.