Archived: Dr Nadarajah Sivananthan Also known as Quedgeley Medical Centre

Updated 1 September 2016

The practice is more commonly known as Quedgeley Medical Centre and was established in 1995. The provider relocated to a purpose built surgery in 2000 which is located in Olympus Business Park, Quedgeley. The practice list has significantly increased within the past year seeing an increase of 1600 additional patients registering with the practice. The practice is situated in a two storey building which was designed by the provider to ensure room for growth. The practice is wheelchair accessible with consultation and treatment rooms available on the ground floor.

The practice provides general medical services to approximately 5,800 patients. Services to patients are provided under a General Medical Services (GMS) contract with NHS England. (A GMS contract is a contract between NHS England and general practices for delivering general medical services and is the commonest form of GP contract).

The practice has three GP partners (one female and two male) which is equivalent to approximately three full time equivalent GPs. The clinical team includes a practice nurse and a health care assistant. The practice manager is supported by a team of four receptionists.

The practice population has significantly increased over the past three years and has a lower proportion of patients aged 65 years and over compared to local and national averages. For example, 9% of practice patients are over 65 years of age compared to the clinical commissioning group (CCG) average of 20% and the national average of 17%. The practice has relatively low numbers of patients from different cultural backgrounds with approximately 93.5% of patients being white British.

The practice is located in an area with low social deprivation and is placed in the third least deprived decile by Public Health England. The prevalence of patients with a long standing health condition is 46% compared to the local CCG average of 55% and the national average of 54%. People living in more deprived areas and with long-standing health conditions tend to have greater need for health services.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments are available between 9am and 6.30pm. Extended surgery hours are also offered on Monday evenings from 6.30pm to 8.15pm and Wednesday mornings from 7.30am to 8.30am.

Out of hours cover is provided by South Western Ambulance Service NHS Foundation Trust and can be accessed via NHS 111.

The practice provided its services from the following address:

Quedgeley Medical Centre

Olympus Park

Gloucester

Gloucestershire

GL2 4NF

This was the first inspection of Dr Nadarajah Sivananthan.

Updated 1 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Dr Nadarajah Sivananthan on 26 July 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.
• 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.

• Patients said they found it easy to make an appointment with a named GP and there was good continuity of care. The practice provided excellent patient access, all urgent appointments were scheduled for the same day and routine appointment could be scheduled within two days. This was reflected by patient access scores and also confirmed by patients and the patient participation group we spoke with on the day of our inspection. The practice had a philosophy to see patients on the day and to educate patients to empower them by ensuring their whole care plan is identified and agreed at one appointment where appropriate.

• The practice used ‘Vision clinical system’ and its’ link to NICE guidelines for day to day management of patients. In addition it used ‘Vision anywhere’ which was linked to the clinical system and available on tablets and mobile phones. This could be used during home visits and allowed the practice to record visit information using built-in dictaphone functionality and also generated prescriptions using the software. This information was automatically uploaded to the practice's clinical system and prescription sent to the chemist via the electronic prescription service.

The areas where the provider should make improvement are:

• Review how the practice identifies carers in order to increase the numbers of patients who may require carer support.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 1 September 2016

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

• The practice nurse had additional training in diabetes and provided both chronic and acute management of these patients. Support from a GP was available if needed, and patients at risk of hospital admission were identified as a priority. The nurse personally contacted patients if they failed to attend review appointments.

• Performance for overall diabetes related indicators in 2014/15 was 91% which was below the clinical commissioning group average of 95% and above the national average of 89%.

• 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.

• The practice used an electronic ‘day book’ message, to notify the reception team when to inform patients about follow-up advice. This led to a reduction in the need for patients needing to re-attend to discuss results or any changes in management of their condition. This also encouraged and empowered patients to reschedule an appointment when required for follow up.

Updated 1 September 2016

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

• 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 patients who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations. A midwife held clinics at the practice twice a week.

• Patients told us that children and young patients were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• The practice’s uptake for women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding five years in 2014/15 was 87% which was above both the clinical commissioning group average of 84% 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.

• The practice grouped all family members together on their clinical system to ensure that they could access relative’s notes quickly if one family member had an appointment but wished to discuss a child’s health at the same time.

• The practice held weekly multidisciplinary meetings with midwife representation.

Updated 1 September 2016

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

• The practice offered proactive, personalised care to meet the needs of the older patients in its population and had a range of enhanced services, for example dementia, influenza, shingles and pneumococcal immunisations.

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

• High risk patients’ clinical information was available online using Summary Care Records Version-2. This ensured visibility for doctors with appropriate credentials on their smart card to aide patient emergency management even if they are outside the locality.

Updated 1 September 2016

The practice is rated as good for the care of working-age patients (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.

• Extended surgery hours were offered on Monday evenings and Wednesday mornings for patients who could not attend during normal opening hours. Bookable telephone appointments were also available.

• The practice reduced repeat visits to the surgery by agreeing a plan of action at the initial consultation which was entered onto the clinical system so that results of investigations and any change in the management of the patients’ condition was communicated to them by the GP via telephone consultation. This enabled good patient access at the practice.

Updated 1 September 2016

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

• 82% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months (04/2014 to 03/2015), which was comparable to both the clinical commissioning group average (CCG) of 86% and the national average of 84%.

• Performance for mental health related indicators was 100% which was above both the CCG average of 97% and national average of 82%.

• 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.

• A community psychiatric nurse held clinics at the practice every two weeks.

• 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 1 September 2016

The practice is rated as good for the care of patients 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.

• All vulnerable patients were coded and flagged on the practice clinical system to highlight to all staff members that they were on the vulnerable patient list.

• The practice displayed information for carers in the waiting room, on their website, on the health education screen and offered carers health checks.