Recipient

Brinnington Surgery

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First report 14 Nov 2024•Latest report 14 Nov 2024

Recipient record

Reports, concerns and published responses

Health and care · Healthcare site. This page brings together reports naming this recipient and response statements clearly connected to concerns raised in those reports.

Reports
1

Naming this recipient

Published responses
0%

Found for named reports

Concerns addressed
0

Across all linked responses

Stated actions
0

Described in responses

Reports over time

Reports over time

Reports naming this recipient by issue year.

Evidence profile

Report topics

Share of this recipient’s reports compared with all other recipients.

0%published responses found
0stated actions described

Topic comparisons are not available in the current evidence snapshot.

Concerns and recipient responses

Statements from Brinnington Surgery linked to the concerns in each report. Select any concern, action or position to view the source wording.

  1. Manchester South

    AI-generated summary

    Mr. Kurnathy · Prevention of Future Deaths report

    This summary was generated using AI from the published report. Please read the original report for the complete account.

    Report summary

    Mr. Kurnathy was found unresponsive at home on 9 May 2024 and was pronounced dead; autopsy confirmed acute left ventricular failure, with fentanyl and morphine toxicity contributing to the death. Four fentanyl patches were found on his back, exceeding the prescribed amount. The principal concern was that correspondence reporting excessive fentanyl use was not identified by the surgery and did not trigger a medication review, and that the surgery had no specific procedures for flagging or reviewing concerns about fentanyl abuse.

    Read the report on judiciary.uk

    Source evidence

    How this individual concern was interpreted

    PFD Monitor created a concise, searchable interpretation from the report wording shown below. The report was sent to Brinnington Surgery; that does not assign responsibility.

    PFD Monitor interpretation

    Failure of correspondence triage to identify excessive use of controlled drugs

    Wider context from the report

    “This report of excessive fentanyl use outside of the prescribed regime was not identified by the Surgery upon receipt of the letter and did not trigger a medication review for Mr Chetty. I am concerned that the correspondence triage did not identify this excessive use of a controlled drug which is known to cause fatalities if abused. I am further concerned that there are no specific policies or procedures within the Surgery to flag up or review concerns around fentanyl abuse. As a known recipient of this and other strong opiate medication, all correspondence received by the surgery relating to Mr. Chetty’s treatment and care had the potential to reveal important information about his ability to self-manage his medication. ”
    Open source report

    Source evidence

    How this individual concern was interpreted

    PFD Monitor created a concise, searchable interpretation from the report wording shown below. The report was sent to Brinnington Surgery; that does not assign responsibility.

    PFD Monitor interpretation

    Lack of specific policies or procedures to flag or review fentanyl abuse

    Wider context from the report

    “This report of excessive fentanyl use outside of the prescribed regime was not identified by the Surgery upon receipt of the letter and did not trigger a medication review for Mr Chetty. I am concerned that the correspondence triage did not identify this excessive use of a controlled drug which is known to cause fatalities if abused. I am further concerned that there are no specific policies or procedures within the Surgery to flag up or review concerns around fentanyl abuse. As a known recipient of this and other strong opiate medication, all correspondence received by the surgery relating to Mr. Chetty’s treatment and care had the potential to reveal important information about his ability to self-manage his medication. ”
    Open source report
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Published response patterns

Compared with other recipients in reports included in PFD Monitor

Describes published response evidence, not performance.

Published responses found

0%
0%All other recipients 58%
0%100%

How actions were described at the time

This respondent
All other recipients
47%25%27%<1%<1%
  • Completed
  • In progress
  • Planned
  • Unclear
  • Partially completed

Statuses reflect what recipients said at the time. PFD Monitor does not verify whether actions happened.

Types of action described in responses

Percentages use all actions described by each group. An action may have more than one type, so percentages do not total 100%.

Information checked against published PFD reports and official responses · Data reviewed 7 Sep 2026 · About data quality and limitations

Data last updated 7 September 2026