The Care Quality Commission
  • Doctor
  • GP practice

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

Overall: Good read more about inspection ratings

8C Victoria Drive, Wimbledon, London, SW19 6AE (020) 8780 0125

Provided and run by:
Dr Arulnathan Thurairatnam

All Inspections

24/01/2017

During a routine inspection

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

2 June 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Tudor Lodge Health Centre (Dr Arulnathan Thurairatnam) on 2 June 2016. Overall the practice is rated as good.

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

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However, reviews, investigations, and the recording of incidents were not thorough enough in all cases.

  • Areas of the practice which could pose a significant risk to patients and staff were assessed and managed; however, the practice did not have a risk log and there was no evidence that action had been taken to identify and address all risks.

  • Improvement was needed in the security arrangements at the practice; for example, no process was in place to monitor the use of prescription pads and sheets (including methadone prescriptions), and we observed that an area used for storing patient notes was unlocked.

  • 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.

  • Patients 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; however, a record was not always kept of these suggestions or the action taken by the practice.

  • The provider was aware of and complied with the requirements of the duty of candour.

We saw one area of outstanding practice:

  • The practice worked closely with specialist colleagues in order to provide high quality care to patients with long-term conditions. The nurse delivered joint monthly clinics with the CCG’s diabetes specialist nurse for diabetic patients whose conditions were difficult to manage, and joint monthly clinics with the CCG’s chronic obstructive pulmonary disease (COPD) specialist pharmacist for patients with COPD. The practice could not demonstrate the impact of this statistically; however, staff could provide individual examples of patients whose conditions had been quickly brought under control as a result of receiving this expert input. The practice also invited hospital consultants to provide educational sessions to clinical staff, for example, an endocrinologist had recently given a talk on diabetes care.

The areas where the provider must make improvement are:

  • They must ensure that complete and contemporaneous records are kept, particularly in relation to significant events, staff meetings, staff recruitment, and staff appraisals. They must ensure that all significant events are thoroughly investigated and that records show that lessons learned are shared, embedded and analysed.

  • They must put in place robust arrangements to ensure the security of resources and patient information.

  • They must review their fire risk assessment and take action to address the risks identified.

  • They must put in place a formal process for the checking of emergency equipment, and ensure that a record is kept of the completed checks and put in place a process for the fridge temperatures to be checked on every day that the practice is open.

In addition, the areas where they should make improvement are:

  • They should ensure that audit is being used to drive improvements in patient care.

  • They should review their staff recruitment processes to ensure they follow their own procedures with regards to completing pre-employment checks for new members of staff (or complete a risk assessment in cases where the recruitment policy is not followed) and put processes in place to ensure the identity of new members of staff is checked.

  • They should consider whether it would be beneficial for staff to receive an individual annual appraisal and personal development plan.

  • They should review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is made available to them.

  • They should review their business continuity procedure to ensure that the content is up to date.

 Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice