Archived: Dr Velupillai Ravikumar Also known as Headstone Lane Medical Centre

Updated 9 August 2018

Dr Velupillai Ravikumar's practice is also known as Headstone Lane Medical Centre and is located in Harrow in North West London. The practice provides NHS primary medical services through a personal medical services contract to around 3800 patients from one surgery.

The practice has a relatively small proportion of older adults on its patient list, particularly patients aged over 65. Income deprivation and employment levels for the practice population are slightly above the English average. The practice has a high number of patients from Indian and Sri Lankan cultural backgrounds and the staff can speak a number of languages including Tamil. The prevalence of diabetes in the practice population is unusually high at 15%.

The practice is led by the principal GP who owns the practice. The practice employs a salaried GP, part-time nurses, a practice manager, business manager and receptionists and administrators. The GPs typically provide 15 clinical sessions in total per week. Patients have the choice of a male or female GP.

The surgery is open between 9am and 7pm from Monday to Wednesday; 9am to 1pm on Thursday and 9am to 6.30pm on Friday. The practice is also open between 8am and 10am on Saturday morning. Appointments with a doctor are available between 9am and 12 noon every weekday; between 3pm and 6.30pm on Monday, Tuesday, Wednesday and Friday and between 8am and 10am on Saturday.

Appointments with a GP or nurse are available outside of normal working hours. The GPs also undertake home visits for patients who are housebound or are too ill to visit the practice.

When the practice is closed, patients are signposted to the local out-of-hours primary care service. The practice provides information about local walk-in and emergency services on its website and on a recorded telephone message.

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

CQC previously inspected this practice on 18 November 2016. The practice was meeting all legal requirements at that time.

Updated 9 August 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive follow up inspection at Headstone Lane Medical Centre on 18 November 2016. The overall rating for the practice was good. However we rated the practice as requires improvement for providing a caring service and for the care provided to people with long term conditions.

More specifically, we found that the practice:

• scored below the local and national average for patient experience of consultations and involvement in decisions on the national GP patient survey in 2016
• was performing below the local and national average for its management of diabetes
• had lower than average uptake rates for cancer screening services
• had not fully embedded completed clinical audit cycles as a quality improvement tool.
• was not always implementing non-clinical safety alerts
• did not have systems to maintain full prescription security.

The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for Dr Velupillai Ravikumar on our website at www.cqc.org.uk.

This inspection was a focused inspection carried out on 8 December 2017 to confirm that the practice had made improvements since our last inspection.

Overall the practice is rated as good. We have also rated the practice as good for providing a caring service and for the care provided to people with long term conditions.

Our key findings were as follows:

• The practice results for the national GP patient survey had improved in 2017 and were comparable with the local and national averages. The practice had engaged with patients and taken action to improve the patient experience.
• The practice had improved its performance in managing diabetes and its results were comparable with local average on the relevant Quality and Outcomes Framework indicators. For example, in 2016/17, 71% of diabetic patients recorded blood sugar levels that were adequately controlled (that is, their last IFCC-HbA1c measurement was 64 mmol/mol or less) compared to the local Clinical Commissioning Group and national average of 80%. The practice exception reporting rate for this indicator was 3% compared to the national exception reporting rate of 12%. (Exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects). The practice had taken action to improve its care in this area, for example doubling the number of sessions offered by the local specialist diabetic nurse at the practice.
• The practice had taken action to improve cervical screening uptake rates. The practice had identified that low uptake was more often associated with patients originating from Sri Lanka. The practice had assigned a member of the reception team to follow up women who did not respond to their invitation to attend for cervical screening. This member of staff could speak Tamil and was able to discuss the screening test in a culturally sensitive way. The practice had also engaged a locum nurse who was Tamil-speaking and displayed posters about the screening test in the waiting area in Tamil.
• The practice carried out completed clinical audit cycles as part of its quality improvement work. The practice demonstrated that audit was used to ensure that effective practice was being sustained. For example the practice had completed two-cycle audits focusing on the prescribing of methotrexate and warfarin (higher risk medicines); its cryotherapy service and the identification and management of "two week wait" cancer referrals.
• The practice provided evidence that it routinely circulated information about non-clinical safety alerts and acted on these when relevant.
• The practice had improved prescription security, for example by keeping a record of serial numbers and routinely tracking the use of prescription materials.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 9 August 2018

Updated 9 August 2018

Updated 9 August 2018

Updated 9 August 2018

Updated 9 August 2018

Updated 9 August 2018