Archived: Dr Sivasundaram Sivagnanasundaram Also known as Winlaton Surgery

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Sivasundaram Sivagnanasundaram on 10 June 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing effective, caring, responsive and well-led services. It was also good for providing services for the older people; people with long-term conditions; families, children and young people; working age people (including those recently retired and students); people whose circumstances may make them vulnerable and people experiencing poor mental health (including people with dementia).

We found the practice to require improvement for providing safe services.

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. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed, with the exception of equipment for medical emergencies, areas of infection control and risks relating to recruitment checks.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients were very complimentary about the service and 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, although it was not available in other languages.
• Patients said they found it easy to make an appointment with a named GP and that 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 encouraged a team approach to day to day management.
• The practice had not fully established methods to gather feedback from patients.

We saw one area of outstanding practice:

• The practice provided a tailored service for the most at risk patients, providing a one hour call back and we were provided with numerous examples where the practice met the needs of patients most at risk. They kept detailed care plans for patients at risk of unplanned admissions which clinical and non-clinical staff routinely referred to, to ensure a collective approach to patient care.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider must:

• Ensure Resuscitation Council guidance is followed regarding the provision of emergency equipment, including access to oxygen and a defibrillator.
• Ensure that criminal records checks are undertaken with the disclosure and barring service (DBS) or a risk assessment is completed for non-clinical staff who are undertaking chaperoning duties and staff are provided with chaperoning training.
• Ensure the practice has robust infection control processes in place, to include updating the infection control policy and procedures and following national guidance related to adequate waste management, Hepatitis B vaccinations for staff handling sharps, control of substances hazardous to health and providing infection control training for all staff.

In addition, the provider should:

• Ensure recruitment arrangements include all necessary employment checks for all staff.
• Implement a system to track and log prescription pads used in the practice.
• Ensure all staff have access to an annual appraisal.
• Improve access to medical services for patients who require a female GP and improve access to practice nursing resources.
• Consider keeping a record of verbal complaints so that complaint themes can be identified to aid in service improvements.
• Establish ways of gathering feedback from patients to assist in improving services and establish the patient participation group.
• Ensure clinical audits are thoroughly documented to demonstrate improved outcomes for patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice