Dr Dissanayake Mudiyanselage Cyril Wijeratne Bandara Pattapola

Background to this inspection

Updated 29 June 2017

Dr Dissanayake Mudiyanselage Cyril Wijeratne Bandara Pattapola’s practice is a partnership providing services to approximately 2600 patients in the Penge area of south east London under a General Medical Services contract (an agreement between NHS England and general practices for delivering general medical services). It sits within the Bromley clinical commissioning group (CCG) which has 45 member practices serving a registered patient population of more than 340,000. Dr Pattapola’s practice provides a number of enhanced services including timely diagnosis and support for people with dementia, minor surgery and extended hours access.

The staff team at the practice consists of one full time female GP, a male practice manager, a female practice nurse and administrators/receptionists. The practice provides 10 GP sessions per week. The service is provided from this location only.

The practice is open between 8am and 6.30pm Monday to Friday; with late opening on Wednesdays until 8pm. Appointments are from 9am to 12pm every morning and 4pm to 6.30pm every afternoon daily except for Thursday afternoons when the practice is closed. Extended hours appointments are offered on Wednesdays until 8pm. Outside of these hours, patients are advised to contact the NHS 111 service. The practice provides an online appointment booking system and an electronic repeat prescription service. The premises are not purpose built but all services are provided from the ground floor of the building, providing ease of access for patients with mobility difficulties. The practice does not have a hearing loop.

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

The practice has a higher percentage than the national average of people with a long standing health condition (58% compared to a national average of 54%).The average male life expectancy for the practice is 78 years, and for females 83 years. These compare to the CCG averages of 81 years and 84 years; and the national averages of 79 and 83.

The population in this CCG area is predominantly white British. The second highest ethnic group is black or black British. The practice sits in an area which rates within the fourth most deprived decile in the country, with a value of 29.4 compared to the CCG average of 15.2 and England average of 21.8 (the lower the number the less deprived the area).

The patient population is characterised by an above England age average for patients, male and female, between the ages of 25 and 49; for male patients aged 50 – 59, and for female patients aged 0 - 4. It had fewer patients, male and female, aged 5 – 24 and above 60 than the England average.

Overall inspection

Good

Updated 29 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Dissanayake Mudiyanselage Cyril Wijeratne Bandara Pattapola on 2 November 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for Dr Dissanayake Mudiyanselage Cyril Wijeratne Bandara Pattapola on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 6 June 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 2 November 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good. Specifically, following the focused inspection we found the practice to be good for providing effective and well led services.

At our previous inspection on 2 November 2016, we rated the practice as requires improvement for providing effective services as the arrangements to ensure clinical staff were kept up to date needed improving. Clinical audits were carried out but not completed with a second cycle. Records showed that most staff had not undergone training in fire safety, infection prevention and control or information governance. Neither of the GPs had undergone training in the Mental Capacity Act 2005. Two week wait referrals were emailed however the practice did not have any process in place to check the emails had been received. Its systems for actioning test results and follow up action was not sufficiently robust. Sharing of information with other services was not as timely as it could be as the practice did not make use of electronic note sharing.

We rated the practice as requires improvement for providing well-led services as we found some weaknesses in governance systems which impacted on the services being provided, including: gaps in recruitment documentation; gaps in staff training and the lack of a robust system to manage referrals, test results, follow ups, Patient Group Directions and single use equipment.

We also highlighted other areas where the provider should take action:

Monitor Quality and Outcomes Framework (QOF) performance and take action if outcomes start to drop.
Take appropriate steps to identify patients who are also carers to allow the practice to provide support and suitable signposting.
Provide staff and patients with access to translation services.

Our key findings at this inspection were as follows:

We found that the provider had taken action to address the breaches of regulation identified at our previous inspection.

NICE and other guidelines were being stored on the practice’s computer system for ease of access.
Clinical audits had been competed with a second cycle.
Staff had undergone training in a number of areas including fire safety, infection control, the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.
A new referral and test result policy had been implemented.
The practice had signed up to the electronic shared care records scheme.
Gaps in recruitment documentation had been rectified.
Patient Group Directions and single use equipment was in date.

The practice was rated as good for providing safe services at the inspection in November 2016, however at that time we had found out of date single use equipment and a Patient Group Direction. Gaps in recruitment documentation were also found. These issues were rectified during or just after the inspection. We reviewed these areas on this inspection and found that the practice had maintained these improvements.

We also found that the provider had taken the following action to address the areas where we suggested they should make improvements:

The GP and the practice manager regularly reviewed the practice’s QOF performance and told us they would take appropriate action if performance started to fall.
The practice had increased the number of identified patients who were also carers from 28 to 64 (up to 2% from 1%).

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

In addition the provider should:

Provide staff and patients with access to translation services. This was raised at the previous inspection on 2 November 2016.
Put systems in place to ensure staff understand and retain learning undertaken.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice