Dr Tuljaram Patalay Also known as Rainbow Practice

Updated 17 January 2017

The Dr Tuljaram Patalay practice is located in Evergreen Primary Care Centre in Enfield, North London within the NHS Enfield Clinical Commissioning Group. The practice holds a Primary Medical Services contract (an agreement between NHS England and general practices for delivering personal medical services). The practice provides a full range of enhanced services including alcohol support, childhood immunisation and vaccination, extended hours, dementia support, online access, influenza and pneumococcal immunisations, learning disabilities, minor surgery, rotavirus and shingles immunisation and unplanned admissions.

The practice is registered with the Care Quality Commission to carry on the regulated activities of diagnostic and screening procedures, maternity and midwifery services, surgical procedures, family planning, and treatment of disease, disorder or injury.

The practice had a patient list size of approximately 4,500 at the time of our inspection.

The staff team at the practice included one principle GP (male), one salaried GP (female), three GP locums (one male, two female), one practice manager and two locum practice nurses (females). The practice had six administrative staff. There were 16 GP sessions and 10 nurse sessions available per week.

The practices opening hours are:

• Monday to Friday 8:00am to 6:30pm

Appointments are available at the following times:

• Monday to Thursday 9:00am to 12:00pm and 4:00pm to 6:30pm (3:30pm to 6:30pm on Thursday)

• Extended hours are offered Monday evening from 6:30pm to 7:30pm

Outside of these times cover is provided the local out of hours service which can be contacted via the NHS 111 service.

To assist patients in accessing the service there is an online booking system, and a text message reminder service for scheduled appointments. Urgent appointments are available daily and GPs also complete telephone consultations for patients.

Updated 17 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Tuljaram Patalay on 18 May 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• 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 and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• 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.
• 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 and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

• To review the scheduling of clinical meetings to allow maximum attendance from all relevant staff members, ensure all clinicains receive detailed minutes of discussions and any agreed actions

• To review the audit systems to monitor the serial number of prescription pads.

• To review and improve outcomes for patients with dementia.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 17 January 2017

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• The percentage of patients on the diabetes register, with a record of a foot examination

  and risk classification within the preceding 12 months was 91% compared to the CCG average of 86% and the national average of 88%.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 17 January 2017

The practice is rated as good for the care of families, children and young people.

• 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.

• The percentage of women aged 25-64 whose notes record that a cervical screening

  test has been performed in the preceding 5 years was 82% compared to the CCG average of 81% and the national average of 82%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 17 January 2017

The practice is rated as good for the care of older people.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• The practice carried out NHS health checks for patients aged 40–74.

Updated 17 January 2017

The practice is rated as good for the care of working-age people (including those recently retired and students).

• 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.

• 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 offered extended hours appointments to meet the needs of working age people.

Updated 17 January 2017

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• The percentage of patients with schizophrenia, bipolar affective disorder and other

  psychoses whose alcohol consumption has been recorded in the preceding 12 months was 97% compared to the CCG and national average of 90%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice carried out advance care planning for patients with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 17 January 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• 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.