Archived: Dr Kumara Srikrishnamurthy

Updated 10 November 2017

Dr Kumara Srikrishnamurthy operates from 574 Harrow Road, London, W10 4NJ. The practice has access to three consulting rooms located on the ground floor and the first floor. The first floor is accessible by stairs.

The practice provides NHS primary care services to 2,200 patients and operates under a General Medical Services (GMS) contract (a contract between NHS England and general practices for delivering general medical services and is the commonest form of GP contract). The practice is part of NHS West London Clinical Commissioning Group (CCG).

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

The practice staff comprises of a male principal GP totalling nine sessions per week, an advanced nurse practitioner (28 hours per week), a practice nurse (30 hours per week). The clinical team are supported by a full-time practice manager and a full-time receptionist and administrator.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments are available Monday to Friday between 9am and 2pm and 4pm to 6.30pm. Extended hours appointments are available on Monday, Tuesday and Friday from 6.30pm to 7pm and on Wednesday from 6.30pm to 8pm. The practice refers patients to the London Central & West Unscheduled Care Collaborative Out of Hours and NHS 111 service for healthcare advice during out-of-hours.

The Information published by Public Health England rates the level of deprivation within the practice population group as two on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest. Patients registered with the practice are predominantly from ethnic minority backgrounds, predominantly Bangladeshis.

Updated 10 November 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Kumara Srikrishnamurthy on 22 September 2015. The overall rating for the practice was good with requires improvement for providing safe services. The full comprehensive report on the 22 September 2015 inspection can be found by selecting the ‘all reports’ link for Dr Kumara Srikrishnamurthy on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 10 October 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 22 September 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 good.

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

• The practice had addressed the findings of our previous inspection in respect of risk assessments relating to the health, safety and welfare of people using the service.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• 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.
• Results from the national GP patient survey showed patients rated the practice above others for aspects of caring. Patients told us they 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. Improvements were made to the quality of care as a result of complaints and concerns.
• 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. Examples we reviewed showed the practice complied with these requirements.

The areas where the provider should make improvement are:

• Consider the infection control lead undertaking enhanced training to support them in this extended role.
• Provide guidance to all staff on how to respond to an activation of the newly installed emergency call cord in the accessible toilet.
• Review how carers are identified and recorded on the clinical system to ensure information, advice and support is made available to them.
• Develop a written strategy or supporting business plan that details the short and long-term development objectives.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 10 November 2017

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

• The nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• The practice had a high clinical prevalence of diabetes with 12.5% of its practice population on its diabetes register which was 8% above the CCG average and 6% above the national average.
• Performance for diabetes related indicators was statistically comparable to the CCG and national averages. For example, the percentage of patients with diabetes, on the register, in whom the last HbA1c was 64 mmol/mol or less in the preceding 12 months was 65% (CCG average 74%; national average 78%).
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
• There was a system to recall patients for 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 10 November 2017

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

• From the sample of documented examples we reviewed we found there were systems 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 accident and emergency (A&E) attendances.
• Immunisation rates were met national targets for standard childhood immunisations.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.
• The percentage of patients with asthma, on the register, who have had an asthma review in the preceding 12 months that includes an assessment of asthma control was 80% (CCG average 77%; national average 76%).
• The practice’s uptake for the cervical screening programme was 84%, which was comparable with the CCG average of 75% and the national average of 81%.

Updated 10 November 2017

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population. The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible. In addition, patients requiring additional support could be referred to a primary care navigator who helped signpost patients to health, social care and voluntary sector services.
• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
• The practice utilised Coordinate My Care (a system which allows healthcare professionals to electronically record patient's wishes and ensures their personalised urgent care plan is available 24/7 to all those who care for them).
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• Where older patients had complex needs, the practice shared summary care records with local care services.

Updated 10 November 2017

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

• The needs of these populations 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, extended hours appointments were available on Monday, Tuesday and Friday from 6.30pm to 7pm and on Wednesday from 6.30pm to 8pm.
• 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.

Updated 10 November 2017

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

• The practice carried out advance care planning for patients living with dementia.
• Patients at risk of dementia were identified and offered an assessment.
• The percentage of patients diagnosed with dementia who had had their care reviewed in a face-to-face meeting in the last 12 months was 90% (CCG average 85%; national average 84%).
• The practice specifically considered the physical health needs of patients with poor mental health and dementia. For example, the practice had accessed the Alzheimer Society's resources for developing dementia friendly general practice and identified changes in the practice to better support people with dementia.
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 68% (CCG average 91%; national average of 89%) and the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption has been recorded in the preceding 12 months was 77% (CCG average 89%; national average 89%).
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 10 November 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 and those with a learning disability.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• 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 had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.