Dr Thusitha Gooneratne

Updated 25 May 2017

Dr Thusitha Gooneratne/Bramley Avenue Surgery provides primary medical services in Coulsdon to approximately 2500 patients and is one of 59 practices in Croydon Clinical Commissioning Group (CCG). The practice population is in the third least deprived decile in England.

The practice population has a lower than CCG and national average representation of income deprived children and older people. The practice population of children is in line with the CCG and higher than the national average and the practice population of working age people is lower than the CCG and in line with national average; the practice population of older people is higher than the local average and in line with national average. Of patients registered with the practice for whom the ethnicity data was recorded 38% are White British, 5% are Other White and 3% are Indian or British Indian.

The practice operates in a purpose built premises. All patient facilities are wheelchair accessible. The practice has access to one doctor consultation room and one nurse consultation room on the ground floor.

The clinical team at the surgery is made up of one full-time male lead GP, one part-time female long term locum GP, one part-time female nurse practitioner and one part-time female practice nurse. The non-clinical practice team consists of a practice manager and four administrative and reception staff members. The practice provides a total of nine GP sessions per week.

The practice operates under a General Medical Services (GMS) 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).

The practice reception and telephone lines are open from 8:00am to 1:30pm and 4:30pm to 6:30pm Monday to Friday. Appointments are available from 8:30am to 1:00pm every day and from 4:30pm to 6:30pm Monday to Friday except Wednesday. During the lunch time and on Wednesday afternoons the patients are given an emergency number to contact the surgery; patients are triaged and offered telephone advice or emergency same day appointments as required. Extended hours surgeries are offered on Tuesdays from 6:30pm to 7:20pm and on alternate Saturdays from 9:00am to 12:00pm.

The practice has opted out of providing out-of-hours (OOH) services to their own patients between 6:30pm and 8:00am and directs patients to the out-of-hours provider for Croydon CCG.

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

Updated 25 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of the practice on 22 September 2016. Breaches of legal requirements were found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breach of regulation 12(1) and 12(2) (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook this desk-based focussed inspection on 25 April 2017 to check that the practice had followed their plan and to confirm that they now met the legal requirements. This report covers our findings in relation to those requirements and also where additional improvements have been made following the initial inspection. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Dr Thusitha Gooneratne on our website at www.cqc.org.uk.

Overall the practice is rated as Good. Specifically, following the focussed inspection we found the practice to be good for providing safe services.

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

• Risks to patients were assessed and well-managed, including arrangements to deal with a range of medical emergencies.
• All staff had undertaken infection control, information governance and Mental Capacity Act training appropriate to their role.
• The practice had identified 0.6% (14 patients) of the practice list as carers, which is six more than they had identified during the inspection on 22 September 2016.

There were areas of the practice the provider should still make improvements:

• Review practice procedures to ensure there are documented care plans especially for all patients with long term conditions.
• Review systems in place to ensure that patients with a learning disability are regularly reviewed.
• 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.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 27 October 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.
• The national Quality and Outcomes Framework (QOF) data showed that 76% of patients had well-controlled diabetes, indicated by specific blood test results, compared to the Clinical Commissioning Group (CCG) average of 72% and the national average of 78%. The number of patients who had received an annual review for diabetes was 86% which was in line with the CCG average of 86% and national average of 88%.
• The national QOF data showed that 85% of patients with asthma in the register had an annual review, compared to the CCG average of 75% and the national average of 75%.
• Longer appointments and home visits were available for people with complex long term conditions when needed.
• All these patients had a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• The practice provided phlebotomy, spirometry and electrocardiography to improve monitoring of patients with long term conditions and managed complex leg ulcer dressings which reduced the need for referrals to hospital.

Updated 27 October 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 urgent care and Accident and Emergency (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.
• The practice’s uptake for the cervical screening programme was 85%, which was in line with the Clinical Commissioning Group (CCG) average of 82% and the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.

Updated 27 October 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.
• The practice GP provided care for five local care, nursing and residential homes supporting the needs of 14 residents.
• The practice nurse did home visits for elderly patients, provided flu vaccines and reviewed patients with long-term conditions. The reception staff sometimes visited patients homes to deliver or collect items. The practice had arrangements with a local pharmacy to deliver medicines to patients on the same day after home visits.
• Patients who had difficulty remembering their appointment time and date and subsequently attended the practice on incorrect days were always seen and not turned away.

Updated 27 October 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 reflects the needs for this age group; however the practice had no website.

Updated 27 October 2016

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

• The number of patients with dementia who had received annual reviews was 89% which was above the Clinical Commissioning Group (CCG) average of 85% and national average of 84%.
• 86% of 20 patients with severe mental health conditions had a comprehensive agreed care plan in the last 12 months which was in line with the CCG average 85% and national average of 88%.
• The practice regularly worked with multi-disciplinary teams in the case management of people 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 27 October 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, carers, travellers and those with a learning disability.
• The practice offered longer appointments and extended annual reviews for patients with a learning disability; only 69% (9 patients) out of 13 patients with learning disability had received a health check in the last year.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• 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.