Archived: Dr Nithyanandam Muthu Krishnan Also known as Dr Krishnan's Surgery

Updated 24 March 2017

Dr Nithyanandam Muthu Krishnan provides primary care services to the central area of Gateshead from one location: 108 Rawling Road, Bensham, Gateshead, Tyne and Wear, NE8 4QR. We visited this address as part of the inspection.

The practice provides services to around 1,600 patients The practice is a single handed GP practice with one male GP who provides ten sessions per week. The practice told us that a female GP was available at a neighbouring practice if patients requested to see one. There is one practice nurse whole time equivalent (WTE) 0.5, there is a practice manager WTE 0.86. There are three receptionists whose WTE is 2.2. One of the receptionists is also the trained healthcare assistant who provides this service when needed.

The practice is part of Newcastle Gateshead clinical commissioning group (CCG). The practice population is made up of a higher than average proportion of patients over the age 65 (19.9% compared to the national average of 17.1%). Information taken from Public Health England placed the area in which the practice is located in the fourth more deprived decile. In general, people living in more deprived areas tend to have greater need for health services.

The practice is located in a converted single storey building. All patient facilities are on the ground floor. There is no dedicated car parking at the site however; there is parking in the streets surrounding the surgery. There is a disabled WC and step-free access.

Opening hours are between 8.30am and 6pm on Mondays, Tuesdays, Thursdays and Fridays, between 9am and 3pm on Wednesdays and between 9am and 10am every Saturday. Patients can book appointments in person, on-line or by telephone. Consultation times were between 8.30am and 10.30am and between 4pm to 6pm except for a Wednesday afternoon when the GP would see patients between 1 and 2pm, they were on call until 6pm when the practice was closed. Consulting times on a Saturday morning were 9 to 10am.

The practice provides services to patients of all ages based on a General Medical Services (GMS) contract agreement for general practice.

The service for patients requiring urgent medical attention out of hours is provided by the NHS 111 service and Gateshead Community Based Care Limited, which is also known locally as Gat Doc.

Updated 24 March 2017

Letter from the Chief Inspector of General Practice

On 23 March 2016 we carried out an announced comprehensive inspection at Dr Nithyanandam Muthu Krishnan’s practice . The overall rating for the practice was requires improvement, having being judged as requires improvement for providing Safe, Effective and Well Led services. The full comprehensive report on the March 2016 inspection can be found by selecting the ‘all reports’ link for Dr Nithyanandam Muthu Krishnan on our website at www.cqc.org.uk.

After the comprehensive inspection the practice wrote to us to say what they would do to meet the following legal requirements set out in the Health and Social Care Act (HSCA) 2008:

• Regulation 12 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 Safe care and treatment.
• Regulation 17 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 Good governance.

This announced comprehensive inspection was carried out on the 2 March 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 23 March 2016. Overall the practice is now rated as good.

• S taff understood and fulfilled their responsibilities to raise concerns, and report incidents and near misses.
• Risks to patients were assessed and well managed.
• Data from the Quality and Outcomes Framework (QOF) from 2015/16 showed that the practice had achieved 91.5% of the total number of points available to them. This was below the local and national averages. The practice felt this was due to problems encountered in recruiting a practice nurse. They were in the process of auditing the data to ensure it was being recorded correctly.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance.
• Staff were consistent and proactive in supporting patients to live healthier lives through a targeted approach to health promotion. Information was provided to patients to help them understand the care and treatment available.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice had a system in place for handling complaints and concerns and responded quickly to any complaints.
• Patients said that access to appointments was good with appointments usually available on the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a leadership structure in place and staff felt supported by management. The practice sought feedback from staff and patients, which they acted on.
• The practice was aware of and complied with the requirements of the Duty of Candour regulation.

The area where the provider should make improvements is:

• Take steps to develop a succession plan to ensure the practice could continue to provide services to patients in the future if staffing arrangements changed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 March 2017

The practice is rated as good for the care of patients with long-term conditions.

There were longer appointments and home visits available when needed. The practice’s electronic system was used to flag when patients were due for review. This helped to ensure the staff with responsibility for inviting people in for review managed this effectively. For those people with the most complex needs, the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. Where appropriate patients with complex conditions were discussed amongst the clinicians at their regular multi-disciplinary team (MDT) meetings.

The practice nurse had recently received training in the year of care project. This encourages practices to provide personalised care to patients through shared goals and action plans to enable them to self-manage their condition. This approach was to be implemented at the practice.

Updated 24 March 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. Childhood immunisation rates were in line with clinical commissioning group (CCG) and national averages. For example, the practice had achieved above the 90% target for all four sub-indicators for childhood immunisation rates for children up to age two.

The midwife held a clinic every two weeks at the practice. Appointments were available outside of school hours and the premises were suitable for children and babies. The GP visited all new born babies and their families shortly after the birth. Staff told us that patients appreciated this and feedback from the local midwife had been positive.

The practice’s uptake for the cervical screening programme was 73%, which was below the national average of 81%. The practice also encouraged its patients to attend national screening programmes for bowel and breast cancer screening. Family planning services were available at the practice.

Updated 24 March 2017

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. Patients at high risk of hospital admission and those in vulnerable circumstances had care plans. There were patients in a care home which was linked to the practice.

The primary care navigators who worked with the practice provided support for elderly and vulnerable patients and provided sign posting to benefits advice, clubs or local activities or provided a listening ear for any patient concerns. Prescriptions could be sent to any local pharmacy electronically.

The practice maintained a palliative care register and offered immunisations for pneumonia and shingles to older people.

Updated 24 March 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 which included appointment booking and ordering repeat prescriptions. There was a full range of health promotion and screening that reflected the needs for this age group. Flexible appointments were available, including telephone consultations and extended opening hours. 

Updated 24 March 2017

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

The practice maintained a register of patients experiencing poor mental health and recalled them for regular reviews. The lead GP has a clinical interest in this area. Patients would often be seen at the beginning of surgery so they were not waiting in a busy waiting area. A support group for patients experiencing mental health attended the practice weekly and provided a service to patients, patients external to the practice could also be seen.

Where appropriate patients with complex conditions were discussed amongst the clinicians at their regular MDT meetings.

Updated 24 March 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

The practice regularly worked with multi-disciplinary (MDT) teams in the case management of vulnerable people. Primary care navigators helped to sign post vulnerable patients to 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. Where appropriate, patients with complex conditions were discussed amongst the clinicians at their regular MDT meetings.

The practice worked closely with the local drug and alcohol abuse services and they provided accommodation so they could provide a service in the practice.

The practice’s computer system alerted GPs if a patient was a carer. There were 42 carers coded on the practice system which was 2.6% of the practice population. There was written information available in the practice waiting room for carers to help them understand the various avenues of support available to them.