Dr Sukumaran and Partners

Updated 8 August 2017

Dr Sukumaran and Partners, otherwise known as Third Avenue Health Centre, is located within a purpose built premises in a residential area in Canvey Island, Essex. The practice has parking available for staff and patients. The practice has a tenancy of the building, which is owned and managed by NHS Property Services. The practice holds a general medical services (GMS) contract. At the time of our inspection, there were 7450 patients on the practice list. There was a higher than average percentage of patients aged between 10 and 24, 50 and 74, and a lower than average percentage of patients aged between 25 and 39.

The practice has two male GP partners, and supported by long-term, and short-term locum GPs, and a locum nurse. There is a diploma trained associate practitioner and a healthcare assistant. The administrative team is a practice manager, an administrator, five receptionists and a secretary. The practice is open 8.30am to 6.30pm Monday to Friday. Patients requiring a GP outside these hours are directed to an external out of hour’s service via 111.

When Dr Sukumaran and partners was inspected on 04 November 2015, they were rated inadequate overall and placed into special measures. Since this inspection, the practice has been supported by NHS Property Services and the CCG to improve the premises, with significant repairs and some internal refurbishment. However when we inspected on 22 July 2016, the practice was rated inadequate overall and placed into an extended period of special measures.

Updated 8 August 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Sukumaran and Partners on 04 November 2015. Safe and well-led services were inadequate, effective services required improvement, caring and responsive services were good. The practice was rated inadequate overall and placed into special measures for six months.

We carried out a further announced comprehensive inspection at Dr Sukumaran and Partners on 22 July 2016 to check whether sufficient improvements had been made to take the practice out of special measures. Safe and well-led services were inadequate, effective caring and responsive services required improvement. The practice was rated inadequate overall and was placed into an extended period of special measures for six months.

The practice has been kept under review and told urgent enforcement action could be escalated if necessary, and another inspection would be conducted within six months. We told Dr Sukumaran and Partners if they had not carried out enough improvement we would move to close the practice by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

The full reports for 04 November 2015 and 22 July 2016 can be found by selecting the ‘all reports’ link for Dr Sukumaran and Partners on our website at www.cqc.org.uk.

We carried out an announced comprehensive follow-up inspection at Dr Sukumaran and Partners on 06 June 2017. The practice was rated as good, for all domains making the practice good overall.

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

• Staff members knew how to raise concerns, and report safety incidents. However, they had not been reviewed or analysed them to monitor trends and avoid re-occurrences.
• Safety information was appropriately recorded; learning was identified and shared with all staff members.
• The infection control policy met current guidance with audits having been undertaken to review, analyse and monitor effectiveness.
• Clinical audits were undertaken but only one was a completed cycle to enable improvements to be measured.
• Risks to patients and staff members had been assessed, documented and acted on appropriately. These had not been reviewed to check for themes or trends.
• Staff members assessed and delivered patient care in line with current evidence based guidance. However, the monitoring of patients suffering from poor mental health required strengthening despite considerable improvements having been made.
• Staff showed they had the skills, knowledge, and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity, respect, and involved in their care and treatment decisions.
• Information about the practice services and how to complain was available at the reception desk and on the practice website in easy to understand formats. Although, complaints were not monitored to understand any trends, or to avoid re-occurrences.
• The practice was aware of and complied with the requirements of the duty of candour when dealing with complaints and significant events in an open and honest approach.
• Patients said they were able to make an appointment with a named GP and they received continuity of care. We were also told they had access to urgent appointments on the day.
• The practice facilities, and equipment was appropriate to treat patients and meet their needs.
• There was a clear leadership structure and in addition, staff members felt supported by the GPs and practice management team.
• The practice patient participation Group (PPG) worked proactively with the practice.

The areas where the provider should make improvements are:

• Analyse and review safety incidents, risk assessments and complaints to monitor themes and trends to avoid re-occurrences.
• Continue to monitor and improve patient satisfaction about the services provided.
• Continue to improve the performance of the practice in relation to patients suffering from poor mental health.

I am taking this service out of special measures. This recognises the significant improvements made to the quality of care provided by this service.

Updated 8 August 2017

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

• Nursing staff and GPs had lead roles in chronic disease management.
• People with long-term conditions were provided with a named practice GP and a structured annual health review. They worked with relevant health and social care professionals to deliver a multidisciplinary package of care, to reduce the need for hospital visits.
• Patients at risk of a hospital admission were identified as a priority, and personalised care plans had been produced to ensure their continuity of care.
• Diabetic quality data from 2015 to 2016 showed the practice averages were significantly higher at 14% and 8% greater than local and national practices. The practice offered advanced diabetes care, including the initiation of injectable medicine for type 2 diabetes. This reduced the need for patients to attend hospital and gave them access to doppler checks for circulation to maintain their treatment locally.
• Respiratory care with in house peak flow meters, spirometry, pulse oximetry, oxygen therapy and nebulisers.
• A blood pressure machine lending service, for home blood pressure recording.
• A mole diagnosis service including dermascope.
• There was provision of joint injections and minor surgery.

Updated 8 August 2017

The practice is rated 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 or at risk, for example, those who had a high number of A&E attendances.
• Immunisation rates were significantly higher than local and national practices, for all standard childhood immunisations.
• A range of contraception services was available. This included contraceptive implant, insertion and removal of intrauterine systems or devices and change of ring pessaries.
• Cervical screening data showed the practice was higher than local and national practices.
• Appointments were available outside of school hours and college hours, and the premises were suitable for children and babies.
• On-line appointments and prescriptions were available.

Updated 8 August 2017

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

• The practice offered older people in its population personalised care to meet their needs.
• Home visits and urgent appointments for those that needed them was offered to older people and they all had a named GP.
• Quarterly palliative care meetings operated to understand and discuss patients identified as frail, and at risk of deteriorating health.
• The nursing staff provided housebound patients home visits for; BP checks, diabetic checks, asthma checks, ear irrigation and flu vaccinations to support their continued health.
• The uptake for shingles and flu vaccinations was high in comparison with local and national practices.
• Senior health checks were offered, on an ad-hoc basis to maximise their uptake.

Updated 8 August 2017

The practice is rated 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 services had been adjusted. For example:

• The practice offered early or later appointments to patients in this population group.
• They offered online services to book appointments, request repeat prescriptions, and to receive text alerts.
• Travel health advice and immunisations were available.
• Occupational vaccinations to support those needing them for work purposes.
• A full range of health promotion and screening was available at the practice to reflect the needs of this population group.

Updated 8 August 2017

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

• 88% of people diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months; this was comparable with local and national practices. Some improvements were still required in relation to the monitoring of patients with poor mental health.
• The practice worked with multi-disciplinary professionals to support patients experiencing poor mental health, including those with dementia.
• Staff members had received training to help safeguard adults and children from abuse. We found staff were familiar with the details of the Mental Capacity Act.
• Information was available for patients in this population group about how to access various support groups and voluntary organisations.
• The clinical lead had a system in place to follow up patients attending accident and emergency that may have been experiencing poor mental health.
• Staff members told us they would find a suitable quiet area for patients to wait if they were feeling anxious, depressed, or too unwell to wait in the busy waiting room.

Updated 8 August 2017

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

• The practice recognised patients living in vulnerable circumstances including, homeless people, travellers and those with a learning disability.
• The practice offered longer or double appointments for patients with a need.
• 33 people had been identified with a learning disability, and each of them had been offered a health review.
• The practice clinical members of staff worked with other health care professionals in the case management of vulnerable patients.
• They worked with local care homes to provide treatment planning, and home visits when needed.
• Information was available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff members knew how to recognise the signs of abuse and were aware of their responsibilities concerning the sharing of information regarding safeguarding concerns.
• The practice safe guarding policy had the local team contact details and staff members knew where to find these.
• All staff members had recently undergone safeguarding training of vulnerable adults and children.
• The GP safeguarding lead at the practice attended forums, and provided reports for other agencies.