Dr Sinnadurai Thillainathan

We carried out an announced comprehensive inspection at Dr Sinnadurai Thillainathan (Arnos Grove Medical Centre) on 19 September 2023. Overall, the practice is rated as Requires improvement.

The ratings for each key question were rated as:

Safe - Requires improvement

Effective - Good

Caring - Good

Responsive – Requires improvement

Well-led - Good

Following our previous inspection on 4 May 2016, the practice was rated Good overall and for all key questions.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Dr Sinnadurai Thillainathan on our website at www.cqc.org.uk

Why we carried out this inspection

We carried out this inspection in line with our inspection priorities.

The key focus of the inspection looked at:

• All five key questions (Safe, Effective, Caring, Responsive and Well-led).
• Areas identified as ‘shoulds’ in the previous inspection.

How we carried out the inspection

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included:

• Conducting staff interviews both on-site and using video conferencing.
• Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
• Reviewing patient records to identify issues and clarify actions taken by the provider.
• Requesting evidence from the provider.
• A short site visit.

Our findings

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We found that:

• Staff had the appropriate safeguarding training applicable to their roles.
• The practice had a robust system in place to monitor two week wait referrals.
• The practice held a risk register for vulnerable adults and children and ensured that those listed were always offered a same day appointment at the practice, regardless of whether the appointment was routine or urgent.
• The practice had regular contact with other teams, services and organisations, and demonstrated in-depth knowledge of local services that were available for patients to access.
• There appeared to be a strong rapport between staff members and patients, which was further supported by patient feedback obtained on the day of inspection.
• The practice took a proactive approach in responding to patient feedback and engaged collaboratively with their Patient Participation Group (PPG).
• The practice adopted a proactive approach to quality improvement and had devised a quality improvement plan, which detailed what improvements had been made so far and what improvements were ongoing.
• Whilst [JC1] the practice was making ongoing efforts to improve patient access, this had not yet been fully embedded and reflected in the majority of patient feedback. Current and previous performance of the practice’s feedback on the National GP Patient Survey in relation to access has fallen below local and national averages.
• Patients prescribed some medicines did not always have the appropriate monitoring to check it was safe for them to continue to be prescribed the medicine.
• Some patients had been incorrectly coded as having a medication review done, when this had not been completed.
• Patients who were prescribed pregabalin (a medicine used to treat epilepsy, anxiety or neuropathic pain) were not always fully informed of the associated side effects regarding the risks of taking the medicine during pregnancy.

We found one breach of regulations. The provider must:

• Ensure care and treatment is provided in a safe way to patients.

In addition to the above, the provider should:

• Review the practice’s clinical records system to ensure that the content of a patient review is accurately captured.
• Continue proactively engaging with patients to encourage uptake of cervical smears.
• Continue proactively engaging with patients to encourage uptake of childhood immunisations.
• Review and consider how to improve performance in lower scoring areas of the National GP Patient Survey, particularly in relation to access issues.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Health Care