Twickenham Park Medical Centre Also known as The Medical Centre

Updated 26 April 2017

Dr Varendar Winayak and Partner provides primary medical services in Hanworth to approximately 3,700 patients and is one of 54 practices in Hounslow Clinical Commissioning Group (CCG).

The practice population is in the fifth least deprived decile in England. The proportion of children registered at the practice who live in income deprived households is 21%, which is comparable to the CCG average of 22%, and for older people the practice value is 18%, which is lower than the CCG average of 21%. The age distribution of the practice’s patients followed local averages. Of patients registered with the practice, the largest group by ethnicity are white (73%), followed by asian (15%), black (5%), mixed (4%), and other non-white ethnic groups (2%).

The practice operates from a 2-storey purpose-built premises. A small amount of car parking is available at the practice, and there is plenty of space to park in the surrounding streets. The reception desk, waiting area, and four consultation rooms are situated on the ground floor. The practice manager’s office, a consultation room which is seldom used, administration offices and staff kitchen are situated on the first floor. The practice has access to three doctors’ consultation rooms and two nurse consultation rooms.

The practice team at the surgery is made up of one part time male GP is a partner, in addition, one part time male salaried GP and two part time female salaried GPs are employed by the practice. In total 15 GP sessions are available per week. The practice also employs one part time female nurse, one part time female nurse practitioner, and one part time healthcare assistant/phlebotomist. The clinical team are supported by a practice manager who is a partner in the practice, four reception staff, one administrator and one medical secretary.

The practice operates under a Personal Medical Services (PMS) 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 is open between 8am and 6:30pm Monday to Friday. Appointments are from 9am until 12:20pm on Monday, Thursday and Friday mornings and until 12pm on Tuesday and Wednesday mornings. In the afternoon appointments are from 1:20pm to 5:50pm on Mondays; from 4:40pm to 6:30pm on Tuesdays; from 3:50pm to 5:50pm on Wednesdays and Thursdays; and from 4:20pm to 5:50pm on Fridays. The practice’s telephone lines remain open all day, and in the event of a medical emergency, a member of the clinical team is on site at all times to speak to the patient and determine whether they needed to be seen urgently. Extended hours appointments with both GPs and nurses are offered from 6:30pm to 7:30pm on Tuesdays.

When the practice is closed patients are directed to contact the local out of hours service.

The practice is registered as a partnership with the Care Quality Commission to provide the regulated activities of diagnostic and screening services; maternity and midwifery services; treatment of disease, disorder or injury; and family planning.

Updated 26 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Dr Varendar Winayak and Partner on 15 September 2016. The practice was rated as good overall. A breach of legal requirements was found relating to the Safe domain. After the comprehensive inspection, the practice submitted an action plan, outlining what they would do to meet the legal requirements in relation to the breach of regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During the comprehensive inspection we found that the practice had failed to ensure that all significant events were fully recorded and that lessons were learned from incidents. We also identified areas where improvements should be made, which included reviewing how they identified patients with caring responsibilities, ensuring that details of verbal complaints were recorded, ensuring that audits were used to drive improvement, reviewing their buddy arrangement with a neighbouring practice to ensure that associated risks are identified and mitigated, ensuring that all staff knew how to use the defibrillator, ensuring that they had adequate security arrangements for the storage of prescription sheets and pads, and ensuring that uncollected prescription were reviewed.

We undertook this focussed desk-based inspection on 16 March 2017 to check that the practice had followed their plan and to confirm that they now met the legal requirements. This report covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Dr Varendar Winayak and Partner on our website at www.cqc.org.uk.

Following the focussed inspection, we found the practice to be good for providing safe services.

Our key findings were as follows:

• The practice had an effective system in place for reporting and recording significant events. Learning from significant events was shared with staff in order to make improvements to safety.
• Since the initial inspection, the practice had reviewed its protocol for recording details about patients with caring responsibilities and had identified various opportunities where staff could potentially identify whether a patient was a carer. As a result, the number of patients recorded as carers on their clinical system had increased from 35 patients (approximately 1%) to 441 patients (approximately 11%).
• The practice had an effective system for recording verbal complaints. We saw evidence that all staff were engaged in this process and that complaints were discussed in practice meetings in order that learning could be shared.
• The practice had a programme of audit in place. We saw evidence that this was used to identify areas for improvement and that the impact of changes made were analysed.
• The practice had a reciprocal buddy arrangement with a local small practice, who were available to provide clinical and leadership cover when the partners were absent (for example, during holidays). The practice performed background checks on staff providing cover and had taken all reasonable steps to ensure that they were appropriately trained.
• The practice had purchased a defibrillator following the initial inspection, and we saw evidence that all staff had been trained to use it.
• The practice had arrangements in place to ensure that blank prescription pads and sheets were stored securely, and we saw evidence that all staff had been made aware of these arrangements and their responsibilities in relation to them.
• The practice had a process in place to regularly review prescriptions which had not been collected, and patients were contacted by phone and text message to remind them to collect their prescriptions.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 23 November 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.
• Overall, performance for diabetes related indicators was better than the CCG and national average. The practice achieved 93% of the total QOF points available, compared with an average of 81% locally and 89% nationally.
• Longer appointments and home visits were available when needed; however, these were only allocated on the specific direction of a clinician.
• 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.

Updated 23 November 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.
• Cervical screening had been carried-out for 83% of women registered at the practice aged 25-64, which was better than the CCG average of 78% and 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 and health visitors.

Updated 23 November 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.
• The practice offered annual health checks for elderly patients, and in the past year had completed health checks on 81% of their elderly patients; 37 of these were conducted in the patient’s home.
• The practice used their patient records system to identify elderly patients who were at risk of hospital admission and had completed care plans for the most vulnerable 5%, and for 2% of patients most likely to be admitted to hospital, as part of the unplanned admission enhanced service.

Updated 23 November 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 23 November 2016

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

• The practice had 19 patients diagnosed with dementia and 93% of these patients had had their care reviewed in a face to face meeting in the last 12 months, which was better than the CCG and national average of 84%.
• The practice had 25 patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses, and had recorded a comprehensive care plan for 100% of these patients, compared to a CCG and national average of 88%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients 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 23 November 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 and those with a learning disability.
• The practice offered longer appointments for patients with a learning disability; however, we were told that longer appointments were only booked on the specific instruction of a clinician, and there was no process in place to allow for reception staff to routinely book longer slots for particular patients who needed them.
• 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.