Dr Nalliah Sivananthan Also known as The Alexandra Surgery

Updated 22 August 2022

Alexandra Surgery is located at 125 Alexandra Park Road, London, N22, 7UN. The practice is in a converted house within a busy residential and commercial area of Bounds Green, North London. The practice has a disabled parking bay at the front of the surgery. The nearest bus stops are approximately three minutes’ walk from the practice. The practice is part of a primary care network of four other local practices.

The practice operates under a Personal Medical Services (PMS) contact (a locally agreed alternative to the standard GMS contract used when services are agreed locally with a practice which may include additional services beyond the standard contract). The practice provides NHS services through a Personal Medical Services (PMS) contract to approximately 5,700 patients. The practice is part of NHS Haringey Clinical Commissioning Group (CCG) and has a deprivation score of 6 out 10 (1 being the most deprived). Alexandra Surgery cares for a diverse population (with approximately 27% of its patients from Black and minority ethnic backgrounds).

The practice’s clinical team is led by a female lead GP (working ten sessions per week), supported by six locum GPs (three male, three female working a combined 17 sessions per week). A further female locum GP works one session per month.

A female practice nurse works at the practice (6 sessions per week) and a female clinical pharmacist works the equivalent of a 0.64 full time role. The clinical team are supported by a practice manager, an IT manager and a team of reception/administration staff.

The practice is registered with the Care Quality Commission to provide the following regulated activities:

• Diagnostic and screening procedures
• Family planning
• Maternity and midwifery services
• Surgical procedures
• Treatment of disease, disorder or injury

The practice’s opening hours are 8:00am to 6:30pm on weekdays. Patients can also book appointments to be seen at local hub centres between 6:30pm and 8:30pm on weekdays and 8:00am to 8:00pm at weekends.

Updated 22 August 2022

We carried out an announced focussed inspection at Dr Nalliah Sivananthan (also known as Alexandra Surgery) on 28 June 2022 and 4 July 2022. Overall, the practice is rated as Good.

Safe - Good

Effective - Good

Caring - Good

Responsive - Good

Well-led - Good

Following our previous inspection on 18 October 2021, the practice was rated Good overall and for all key questions other than Safe which was rated as requires improvement.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Dr Nalliah Sivananthan on our website at www.cqc.org.uk

Why we carried out this inspection

We had previously inspected the practice on 18 October 2021, when we rated it Good in respect of the Effective, Caring, Responsive and Well Led questions but rated it as Requires Improvement in respect of providing Safe services. We served a Requirement Notice for breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, due to concerns regarding the monitoring of high-risk medicines. This inspection took place to confirm that the necessary actions had been taken to address the breach of regulation.

How we carried out the inspection/review

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

• Conducting staff interviews using video conferencing
• Completing clinical searches on the practice’s patient records system and discussing findings with the provider
• Reviewing patient records to identify issues and clarify actions taken by the provider
• Requesting evidence from the provider
• A short site visit

Our findings

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as Good overall

We found that:

• Action had been taken since our last inspection such that processes for monitoring high risk medicines and recruiting locum GPs were now reliable and appropriate to keep people safe.
• Although the practice was not meeting its cervical screening uptake target, performance had slightly improved since our last inspection.
• We identified some instances of lapsed patient monitoring which we considered presented a low risk of patient harm.
• We saw evidence of systems for learning and continuous improvement including where findings from our last inspection had been acted upon and used to drive improvement.
• There was compassionate, inclusive and effective leadership at all levels.

Whilst we found no breaches of regulations, the provider should:

• Continue to improve patient recall systems regarding cervical screening and child immunisations uptake.

• Continue to use CQC searches to support its clinical governance systems and oversight of safe practice.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services