Archived: Dr Arulnathan Thurairatnam Also known as The Surgery, Tudor Lodge Health Centre

Updated 24 February 2017

Dr Arulnathan Thurairatnam provides primary medical services from Tudor Lodge Health Centre in Southfields to approximately 6800 patients and is one of 44 practices in Wandsworth Clinical Commissioning Group (CCG).

The practice population is in the fifth least deprived decile in England. The proportion of children registered at the practice who live in income deprived households is 28%, which is higher than the CCG average of 21%, and for older people the practice value is 26%, which is higher than the CCG average of 23%. The practice has a larger proportion of patients aged 0 to 44 years than the CCG average, and a much smaller proportion of patients aged 45 to 85+ years. Of patients registered with the practice, the largest group by ethnicity are white (66%), followed by Asian (15%), black (11%), mixed (5%) and other non-white ethnic groups (3%).

The practice operates from the ground floor of a two-storey purpose built premises (the first floor is used by local NHS community services). Car parking is available on site and in the surrounding streets. The practice has access to four doctors’ consultation rooms and one nurse consultation room.

The practice team at the surgery is made up of one full time male GP who is the practice principal; and three part time female salaried GPs. In total 32 GP sessions are available per week. In addition, the practice also has two part time female nurses (with one vacancy which is currently being recruited to), and one part time female healthcare assistant. The practice team also consists of a practice manager and six reception/administrative staff.

The practice operates under a Personal Medical Services (PMS) contract, and is signed up to a number of local and national enhanced services (enhanced services require an enhanced level of service provision above what is normally required under the core GP contract), including providing the violent patient scheme.

The practice is open between 8am and 6:30pm Monday to Friday. Appointments are from 8am to 1pm every morning, and 3pm to 6:30pm every afternoon. Patients can contact clinical staff by phone between 1pm and 3pm. Extended hours surgeries are offered between 6:30pm and 8:00pm Monday to Friday and from 8:30am to 11:00am on Saturdays.

When the practice is closed patients are directed to contact the local out of hours service.

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

Updated 24 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Tudor Lodge Health Centre (Dr Arulnathan Thurairatnam) on 2 June 2016. The practice was rated as good overall; however, breaches of legal requirements were found and therefore the practice was rated as requires improvement for the Safe domain. After the comprehensive inspection, the practice submitted an action plan, outlining what they would do to meet the legal requirements in relation to the breaches of regulation 12 (Safe care and treatment) and 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During the comprehensive inspection we found that the practice had failed to ensure that the risks to patients and staff had been considered and mitigated with regards to fire safety at the premises, and that they had failed to put in place a formal process for checking emergency equipment and for ensuring that medicines were safely stored. We also found that they had failed to ensure that all significant events were thoroughly documented, that they had failed to ensure that complete records were kept in relation to patient care and treatment and the management of the service, that they had failed to securely store confidential patient information, and that there was no system in place to monitor the use of prescriptions. We also identified areas where improvements should be made, which included ensuring that audit is being used to drive improvements in patient care, reviewing their recruitment process in relation to pre-employment checks, considering whether it would be beneficial for administrative staff to receive an individual appraisal and personal development plan, taking steps to identify as many carers as possible, and updating their business continuity plan.

We undertook this focussed inspection on 24 January 2017 to check that the practice had followed their action plan and to confirm that they now met the legal requirements. This report covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Dr Arulnathan Thurairatnam on our website at www.cqc.org.uk.

Following the focussed inspection, we found the practice to be good for providing safe services and good overall.

Our key findings were as follows:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• We saw evidence that records of staff meetings were kept.
• Risks to patients were assessed and well managed. We saw evidence of a recent fire risk assessment for the practice premises which identified actions which the practice were addressing.
• Processes were in place to ensure the security of equipment, resources and patient information. All staff were aware of their responsibility in relation to these.
• Process were in place to ensure that emergency equipment was in working order and that adequate supplies of emergency medicines were available.
• The practice had identified 122 patients as carers, which represented approximately 2% of their patient list; this was an increase of 16 patients since the previous inspection.
• The practice had plans in place to begin conducting annual one-to-one appraisals with staff in the new financial year, and preparations had been made in advance of this.
• Clinical audit was used to drive improvements in patient care.
• The practice had updated their business continuity plan to include details of an alternative location that could be used to operate a service from in the event of a problem with their premises.

However, there were two areas where the practice should take action. They should:

• Ensure that the actions identified by the fire risk assessment are completed.
• Ensure that the planned staff appraisals are completed.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 24 August 2016

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.

• Performance for diabetes related indicators were comparable to local and national averages. Overall the practice achieved 90% of the total QOF points available for diabetes indicators, compared with an average of 83% locally and 89% nationally.

• 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 24 August 2016

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.

• Cervical screening had been carried-out for 87% of women registered at the practice aged 25-64, which was comparable to the CCG average of 81% and 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 and health visitors.

Updated 24 August 2016

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.

• Arrangements were in place to allow housebound patients to request repeat prescriptions by phone.

• The practice worked closely with the wider primary care team, such as district nurses, community matron, social services and the Falls Prevention Team to deliver a complete package of care to older patients.

Updated 24 August 2016

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 reflected the needs for this age group.

• The practice sent appointment reminders and health promotion information by text message.

Updated 24 August 2016

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

• The practice had 18 patients diagnosed with dementia and 89% had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the CCG average of 87% and national average of 84%.

• The practice had 55 patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses, and had recorded a comprehensive care plan for 87% of these patients, compared to a CCG average of 90% and national average of 88%.

• 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 24 August 2016

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. They also registered patients who had been de-registered from other practices due to being violent; they had 53 of these patients registered.

• The principal GP held an advanced qualification in substance misuse and was able to manage patients at the practice with these issues.

• 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, including those at risk of unplanned admission to hospital.

• 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.