Archived: Dr Thyagarajagopalan Krishnamurthy

Updated 11 January 2018

Dr Krishnamurthy’s Practice is located in a purpose built medical centre at the East Ham Memorial Hospital Building, Shrewsbury Road, Forest Gate, London E7 8QR, it shares the building with other services including an Early Intervention Unit and another GP practice. The premises are owned and maintained by NHS Property Services.

The practice is commissioned by Newham Clinical Commissioning Group to provide NHS primary medical services to approximately 2000 patients through a General Medical Services (GMS) contract, this is a contract between general practices and NHS England for delivering primary care services to local communities.

The practice premises has step free access with an accessible toilet and parking space for disabled patients, it is located off the main road and well served by local buses and East Ham underground and over ground stations.

There is one male principal GP working five sessions per week, a salaried male GP also working five sessions per week, and a female practice nurse working four sessions per week. The practice manager works part time and there are three administration and reception staff working a variety of part time hours.

The practice is open:

• Monday and Tuesday 9am to 7pm (6.30pm to 7pm are extended hours)
• Wednesday and Friday 9am to 6.30pm
• Thursday 9am to 12pm

GP appointments are available:

• Monday and Tuesday 9am to 11am, 4.30pm to 6pm, and 6.30pm to 7pm
• Wednesday and Friday 9am to 11am and 4.30pm to 6pm
• Thursday 9am to 11am

The practice provides telephone consultations and home visits. The home visits are carried out between morning and evening surgery and after evening surgery. Out of hour’s services and weekends are covered by the GP Co-op at the local Hospital’s Urgent Care Centre and the 111 service.

Information published by Public Health England rates the level of deprivation within the practice population group as three on a scale of one to ten. Level one represents the highest levels of deprivation and level ten the lowest.

Updated 11 January 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Thyagarajagopalan Krishnamurthy on 9 August 2016. The overall rating for the practice was good. However, the rating for the practice providing safe services was requires improvement and we found six areas where the provider should make improvements that mostly related to safety. The full comprehensive report on the 9 August 2016 inspection can be found by selecting the ‘all reports’ link for Dr Thyagarajagopalan Krishnamurthy on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 1 December 2017 to check that the provider had made improvements and to confirm that they met requirements. This report covers our findings in relation to the areas where the provider should make improvements.

Overall the practice remains rated as good overall and requires improvements for providing safe services.

Our key findings were as follows:

• The practice did not have an effective process for identifying and managing significant events.
• The practice had liaised with relevant health and social care professionals to identify children at risk but systems were not in place to identify and flag vulnerable patients.
• Medicines including emergency medicines were stored appropriately.
• Prescription pads were securely stored and monitored.
• The practice had improved patients telephone access by staggering opening up of appointments throughout the day, to manage incoming calls activity and allow better access to appointments for patients calling later in the day.
• The practice had completed a programme of clinical audit improve outcomes for patients.
• Patients with caring responsibilities were identified and received appropriate support. For example, the practice had identified 1% of its patient list as carers that were given priority appointments and offered annual flu vaccinations, as well as signposting to local support groups and services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 January 2017

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 percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/80 mmHg or less was 82% which is comparable to the CCG percentage of 82% and higher than the national average of 78%.

• 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 6 January 2017

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.

• 86% of women aged 25-64 had received a cervical screening test which was comparable to the CCG and national averages of 81% and 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, health visitors and school nurses.

Updated 6 January 2017

The practice is rated as good for the care of older people.

• All patients over 65 had a named GP.

• 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.

• An avoiding unplanned admissions (AUH) list was in place which had been designed to improve the level and frequency of services for vulnerable patients and those with complex physical or mental health needs.

Updated 6 January 2017

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.

• Telephone consultations with clinicians were available to meet the needs of this population group.

• Patients aged 40–74 had access to appropriate health assessments and checks that were followed up where abnormalities or risk factors were identified.

Updated 6 January 2017

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

• 100% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the CCG and national averages of 87% and 84%. The practice carried out advance care planning for patients with dementia.

• 90% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the record, in the preceding 12 months (01/04/2014 to 31/03/2015). This was higher than the CCG average of 84% and the 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 6 January 2017

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.

• All of the patients on the practices learning disability list had received an annual health check in the last 12 months.

• 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.

• 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.