Archived: Addiscombe Road Surgery

Updated 6 March 2015

Addiscombe Road Surgery is a single handed practice provided by Dr Bellanage Sunanda Jayaratne. The practice is located in Addiscombe, within the London Borough of Croydon. The practice had 2984 patients at the time of our inspection and had been operating under the current provider for 22 years. The practice provided regulated activities from its main site at Addiscombe road, and from its branch surgery at 139 Northway Road, Croydon.

Addiscombe Road Surgery is registered to carry on the regulated activities of Diagnostic and screening procedures, Family planning services, Maternity and midwifery services, Treatment of disease, disorder or injury to everyone in the population.

Care, treatment and support was provided by one full time male doctor and two regular female locum doctors, one part time practice nurse, a practice manager, and a team of five reception and administrative staff. The locum doctors worked for one and two sessions respectively, and the practice nurse worked for 26 hours a week.

The patient population at the practice was stable and made up of 70% older people (over 65 years of age). The average proportion of patients over the age of 65 registered in GP practices across England is 26%.

The practice operated under a General Medical Services (GMS) contract from NHS England for delivering primary care services to its local community.

The practice had opted out of providing out-of-hours services to their patients.

Updated 6 March 2015

Letter from the Chief Inspector of General Practice

We undertook a comprehensive inspection of Addiscombe Road Surgery on 07 October 2014. The provider, Dr Bellanage Sunanda Jayaratne, has a branch surgery to Addiscombe Road Surgery, 139 Northway Road Surgery, which is also in Croydon. We did not visit the branch surgery as part of this inspection.

We found that overall Addiscombe Road Surgery was rated as requires improvement. We found them Good in the Caring, Responsive and Well Led domains, but there were areas of the Safety and Effectiveness domains that required improvement. 

Our key findings were as follows:

• The practice referenced published best practice guidelines and the local clinical commissioning group guidelines in ensuring positive health outcomes for patients.
• The practice used the Quality and Outcomes framework to measure, monitor and improve performance. The practice was performing well against most indicators compared to other practices in the area and against national averages.
• The practice was well-led and its predominantly long serving staff team felt valued and supported. The staff team displayed a real sense of pride in the work they did.
• The practice had an active patient participation group, members of which praised the support they had received from the practice team and how well the practice responded to their suggestions
• Patients consistently reported good experiences of the care and treatment they had in the practice, and felt the entire staff team contributed in one way or another to their care.

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

Importantly, the provider must:

• Ensure the recruitment policy is followed fully in the recruitment of new staff

In addition, the provider should:

• Ensure clinical audit cycles are completed to determine if improvements had been maintained

• Ensure full job descriptions are in place for all members of the staff team, so that staff are clear about their role and responsibilities.

• Ensure records of the checks of the oxygen cylinder are maintained

• Ensure it takes active steps to increase its flu vaccinations uptake in order to meet set targets.

• Ensure formal training is provided to the practice’s safeguarding lead to support them in performing that role

• Ensure the practice vision and values are shared from the leadership team with the practice staff team and patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 6 March 2015

The practice is rated as requires improvement for the care of people with long term conditions.  Emergency processes were in place and referrals made for patients in this group that had a sudden deterioration in health. When needed longer appointments and home visits were available. All these patients had structured annual reviews to check their health and medication needs were being met. For those people with the most complex needs the clinical team worked with relevant health and care professionals to deliver a multidisciplinary package of care. However, we found that the practice was performing below the national average for the percentage of patients aged over 6 months to under 65 years in the defined influenza clinical risk groups that received the seasonal influenza vaccination.

Updated 6 March 2015

The practice is rated as good for care of families, children and young people. Systems were in place for identifying and following-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; the practice had 93.3% to 96.7% of children up to the age of 12 months receiving the recommended vaccinations, whilst the average for the local area was 88.5% to 89.4%. All of their patients at 24 months had received all their recommended vaccinations, with the exception of the combined measles mumps rubella (MMR) vaccine which 90.5% of patients had received (the average for the local area for MMR was 87.5%).

Patients told us, and we saw evidence, that children and young people were treated in an age appropriate way and recognised as individuals. Appointments were available outside of school hours and the premises were suitable for children and babies. We were provided with good examples of joint working with midwives, health visitors and school nurses.  Emergency processes were in place and referrals made for children and pregnant women who had a sudden deterioration in health.

Updated 6 March 2015

The practice is rated as requires improvement for the care of older people.  The practice had a higher proportion of patients aged 65 and over, than the local average. Nationally reported data showed the practice had good outcomes for conditions commonly found amongst older people. The practice offered proactive, personalised care and worked collaboratively with other services to meet the needs of the older people in its population. The practice delivered a range of enhanced services, for example in dementia and end of life care.  The practice was responsive to the needs of older people, including offering home visits, longer appointments and rapid access appointments for those with enhanced needs.

However we found that the practice was performing below the national average for the percentage of patients aged 65 and older who have received a seasonal flu vaccination.

Updated 6 March 2015

The practice is rated as good for the care of the 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 later appointments on certain days. A full range of health promotion materials was made available in the practice waiting area, on their website and through their patient leaflets. Screening programmes, such as well man and well woman health checks were available to patients. There were no online services, such as appointments booking and ordering of repeat prescriptions, available at the practice.

Updated 6 March 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice regularly worked with multi-disciplinary teams in the case management of these patients.

The practice had sign-posted patients experiencing poor mental health to various support groups and third sector organisations. The practice had a system in place to follow up on patients who had attended accident and emergency where there may have been mental health needs. Staff had received training on how to care for people with mental health needs and dementia.

Updated 6 March 2015

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 people with no fixed abode, and those with learning disabilities. The practice had carried out annual health checks for people with learning disabilities. The practice offered longer appointments for people with learning disabilities.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. The practice had sign-posted vulnerable patients to various support groups and third sector 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 and out of hours.