The Care Quality Commission
  • Doctor
  • GP practice

Dr Nalliah Sivananthan Also known as The Alexandra Surgery

Overall: Good read more about inspection ratings

125 Alexandra Park Road, Wood Green, London, N22 7UN (020) 8888 2518

Provided and run by:
Dr Nalliah Sivananthan

All Inspections

6 July 2023

During a monthly review of our data

We carried out a review of the data available to us about Dr Nalliah Sivananthan on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.

This could change at any time if we receive new information. We will continue to monitor data about this service.

If you have concerns about Dr Nalliah Sivananthan, you can give feedback on this service.

4 July 2022

During an inspection looking at part of the service

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

18 October 2021

During an inspection looking at part of the service

We carried out an announced focussed inspection at Alexandra Surgery on 18 October 2021. Overall, the practice is rated as Good.

Set out the ratings for each key question

Safe - Requires Improvement

Effective - Good

Well-led - Good

Following our previous inspection on 23 November 2016, the practice was rated Good overall and for all key questions.

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

This inspection was a focused inspection to follow up on information of concern we hold about the location, regarding the practice’s child immunisation and cervical screening uptake rates.

How we carried out the inspection

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 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:

  • Systems, processes and practices were not always reliable or appropriate to keep people safe. For example, systems for locum GP pre-employment checks and locum GP induction; and arrangements for monitoring patients prescribed a high risk medicine called Lithium, placed patients at risk.
  • The practice was not meeting its cervical screening uptake target but we saw evidence of actions being undertaken to improve performance.
  • Although the practice kept a significant incidents log, it was unclear how reflection and learning from these incidents took place.
  • Appropriate standards of cleanliness and hygiene were met.
  • Risk assessments had been undertaken regarding fire safety; and health and safety.
  • The practice adjusted how it delivered services to meet the needs of patients during the COVID-19 pandemic. Patients could access care and treatment in a timely way.
  • There was compassionate, inclusive and effective leadership at all levels.
  • We saw evidence of systems for learning and continuous improvement.

The areas where the provider must make improvements are:

  • Ensure that care and treatment is provided in a safe way.

The areas where the provider should make improvements are:

  • Continue to improve systems for patient recall and patient monitoring.
  • Take action to improve how learning from significant events is shared.

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

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care

23 November 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Nalliah Sivananthan on 23 November 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.
  • The practice had a Health Officer who helped patients whose first language is not English have access to healthcare.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • This practice offered its older patients extended access to the practice via an emergency hotline number.
  • 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 able 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 practice had three different Patient Participation Groups (PPG) which reflected the diverse patient list. One group caters for Turkish speaking patients, the second group for Tamil speaking patients and the third for all other patients. The three groups met regularly as individual groups and together as a whole group to discuss relevant issues.

The areas where the provider should make improvements are:

  • Ensure that all members of staff receive fire training.
  • Review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is available to them.
  • Ensure there are written policies in place to provide guidance on the monitoring of patients on high-risk medicines who are under the care of both the practice and hospital.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice