Nightingale Surgery Also known as Dr GAJ Selvanathan

Updated 6 October 2016

Nightingale Surgery is based in a purpose-built health centre, owned and maintained by Lewisham Health Trust. Also in the building are another GP practice and several community services, such as health visitors and foot health.

The practice has four clinical rooms, a reception area, administration space and a waiting area. All of the rooms are on the ground floor. The practice has tried but not so far succeed in getting more space in the building, which limits the services it can provide..

Five doctors work at the practice: four male and one female. Three of the doctors are partners and there are two salaried GPs (one female and one male). Some of the GPs work part-time. The working hours added together equate to just over three and a half full time roles (whole time equivalents).

There is one female nurse practitioner, who is a diabetic specialist, and works full-time.

The practice is open 8.00am to 6.30pm Monday to Wednesday, and 7.00am to 6.30pm Thursday and Friday. Appointments with the nurse were available between 8.15am and 12.15pm and 2.00pm – 6.45pm Monday, Tuesday, Wednesday and Friday. Appointments with GPs were available every week day. In the morning, appointments were available: on Monday between 9.00am and 11.30am, on Tuesday and Wednesday between 08.30am and 11.30am, Thursday 07.30am and 12.00 noon and Friday between 7.00am and 11.00am. In afternoon, GP appointments were available Monday to Friday between 3.00pm and 6.00pm. When the practice is closed cover is provided by SELDOC, a GP co-operative that runs out-of-hours care.

There are approximately 5890 patients at the practice. Compared to the England average, the practice has more young children as patients (up to age four) and fewer older children (age 10 – 19). There are many more patients aged 20 – 44, and fewer patients aged 45+ than at an average GP practice in England.

The surgery is based in an area with a deprivation score of five out of 10 (1 being the most deprived), and has a higher level of income deprivation affecting older people and children. Compared to the average English GP practice, more patients are unemployed.

Updated 6 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Nightingale Surgery on 27 July 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 been trained to provide them with 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and 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.

The areas where the provider should make improvements are:

• Consider introducing easy read materials to support patients with learning difficulties to engage with their annual health checks and treatment.
• Develop more extensive quality improvement arrangements.
• Consider introducing an annual review of complaints to ensure that lessons can be learnt from analysis of trends.
• Introduce a system to monitor the use of prescription forms within the practice.

• Review how patients with caring responsibilities are identified and recorded on the clinical system to ensure information, advice and support is made available to them.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 6 October 2016

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 nurse was a diabetes specialist, allowing her to provide particular support to patients with this condition.
• Performance for diabetes related indicators was generally similar to the national average.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• 98% of patients with COPD who had a review undertaken including an assessment of breathlessness using the Medical Research Council dyspnoea scale in the preceding 12 months, compared to the national average of 90%.

Updated 6 October 2016

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 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 79%, which was comparable to the national average of 82%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses.

Updated 6 October 2016

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.
• 82% of patients over the age of 65 had received a flu vaccination, compared to the CCG average of 66%. Flu can be more severe in older people, and is more likely to lead to serious complications such as pneumonia. Practice staff felt that this was a reflection of the relationships built between the GPs and these patients, many of whom have been with the practice for a considerable number of years. Patients who have not responded to the invitation receive a call from one of the GP partners – often during the weekend.

Updated 6 October 2016

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.

Updated 6 October 2016

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

• 83% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average. Other mental health indicators were also in line with national averages.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 6 October 2016

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, travellers and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients.
• 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.