Dr Umadevi Parameswaran Also known as Ashburton Park Medical Practice

Updated 31 January 2017

Ashburton Park Medical Practice provides primary medical services in Addiscombe to approximately 3200 patients and is one of 59 practices in Croydon Clinical Commissioning Group (CCG). The practice population is in the fourth more deprived decile in England.

The practice population has a higher than CCG and national average representation of income deprived children and older people. The practice population of children is higher than the CCG and national averages and the practice population of working age people is in line with the CCG and higher than the national average; the practice population of older people is lower than the local and national averages. Of patients registered with the practice for whom the ethnicity data was recorded 23% are Black, 12% are Asian and 8% Mixed.

The practice operates in converted premises. All patient facilities are wheelchair accessible. The practice has access to two doctors’ consultation rooms and one nurse / healthcare assistant consultation room on the ground floor.

The clinical team at the surgery is made up of one full-time lead GP and one part-time salaried female GP, two part-time female practice nurses, one part-time male practice nurse and two female healthcare assistants. The non-clinical practice team consists of a practice manager and seven administrative and reception staff members. The practice provides a total of 12 GP sessions per week.

The practice operates under a General Medical Services (GMS) contract, and is signed up to a number of local and national enhanced services (enhanced services require an enhanced level of service provision above what is normally required under the core GP contract).

The practice reception and telephone lines are open from 8:00am to 6:30pm Monday to Friday. Appointments are available from 9:00am to 12:00pm Monday to Friday and from 4:00pm to 6:00pm Monday to Friday except Wednesdays during which appointments are available from 2:00pm to 4:00pm. Booked appointments are not available on Wednesday evening but a GP is available for emergencies. Extended hours surgeries are offered on Tuesdays from 6:30pm to 7:30pm and Thursdays from 6:30pm to 7:00pm.

The practice has opted out of providing out-of-hours (OOH) services to their own patients between 6:30pm and 8:00am and directs patients to the out-of-hours provider for Croydon CCG.

The practice is registered with the Care Quality Commission to provide the regulated activities of diagnostic and screening procedures, maternity and midwifery services and treatment of disease, disorder or injury.

Updated 31 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Umadevi Parameswaran / Ashburton Park Medical Practice on 15 December 2016.  Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
• Patients 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.
• 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 proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the Duty of Candour.

There were areas of practice where the provider should make improvements:

• Review practice procedures to ensure all patients with learning disability are regularly reviewed.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 31 January 2017

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• The national Quality and Outcomes Framework (QOF) data showed that 67% of patients had well-controlled diabetes, indicated by specific blood test results, compared to the Clinical Commissioning Group (CCG) average of 70% and the national average of 78%. The number of patients who had received an annual review for diabetes was 91% compared to the CCG average of 87%. The patients were reviewed by a diabetes specialist nurse who also provided dietary advice.
• The national QOF data showed that 74% of patients with asthma in the register had an annual review, compared to the CCG average of 74% and the national average of 76%.
• Longer appointments and home visits were available for people with complex long term conditions when needed.
• All these patients had a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• The practice provided phlebotomy, spirometry and electrocardiography to improve monitoring of patients with long term conditions and reduced the need for referrals to hospital.

Updated 31 January 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, for example, children and young people who had a high number of urgent care and Accident and Emergency (A&E) attendances.
• Immunisation rates were relatively high for all standard childhood immunisations.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
• The practice’s uptake for the cervical screening programme was 80%, which was in line with the Clinical Commissioning Group (CCG) average of 81% and the national average of 82%. The practice had a designated administrative staff who monitored the uptake of cervical smears.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice prioritised appointments for children aged under five years.
• The practice had a designated reception staff who arranged eight week check appointments for babies and postnatal appointments. This member of staff also monitored immunisations for children and arranged appointments. 

Updated 31 January 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.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs; housebound patients are annually reviewed.
• The practice used a risk stratification tool to identify high risk patients.
• The practice GPs provided care for one local nursing home supporting the needs of four residents.
• The practice healthcare assistants provided health checks for patients over the age of 75 and patients were signposted to local support if necessary.

Updated 31 January 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 as well as a full range of health promotion and screening that reflects the needs for this age group.
• The practice provided telephone consultations and extended hours GP appointments which suited working people.
• The practice had a dedicated e-mail for routine patient queries which was regularly monitored.

Updated 31 January 2017

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

• The number of patients with dementia who had received annual reviews was 92% which was above the Clinical Commissioning Group (CCG) average of 83% and national average of 84%.
• 91% of 42 patients with severe mental health conditions had a comprehensive agreed care plan in the last 12 months which was above the CCG average 86% and in line with the national average of 89%.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for patients with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 31 January 2017

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 homeless people, carers, travellers and those with a learning disability.
• The practice offered longer appointments and extended annual reviews for patients with a learning disability; Only 50% (six patients) of 12 patients with learning disability had received a health check in the last year.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
• The practice informed vulnerable patients about how to access 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.
• The practice referred patients with drug alcohol and drug dependence for rehabilitation.