Archived: Dr Nagappan Selvan Also known as Gough Walk Practice

Updated 24 March 2017

Dr Nagappan Selvan (Gough Walk Practice) provides primary medical services in Tower Hamlets to approximately 5000 patients and is a member of NHS Tower Hamlets Clinical Commissioning Group (CCG).

The practice population is in the most deprived decile in England. Forty-three percent of children live in income deprived households compared to a local average of 39% and a national average of 20%. The practice had surveyed the ethnicity of the practice population and had determined that 24% of patients described themselves as white, 45% Asian, 11% black and 20% as having mixed or other ethnicity.

The practice operates from a purpose built property with patient facilities on the ground and first floors that are wheelchair accessible. There are offices for administrative and management staff on the ground floor. All floors are accessed via a lift or stairs.

The practice operates under a General Medical Services (GMS) contract and provides a number of local and national enhanced services (enhanced services require an increased level of service provision above that which is normally required under the core GP contract). The enhanced services it provides are: meningitis immunisation; childhood vaccination and immunisation scheme; extended hours access; facilitating timely diagnosis and support for people with dementia; influenza and pneumococcal immunisations; rotavirus and shingles immunisation; and unplanned admissions.

The practice team at the surgery is made up of two male GP partners, one full-time and one part-time, along with two part-time female locum GPs. The doctors provide 16 clinical sessions per week. The nursing team consists of two part-time female practice nurses and a part-time male health care assistant. There are five administrative, reception and clerical staff including a full-time practice manager.

The practice is open Monday to Friday between 8.00am to 1.00pm and 2.00pm to 6.00pm.

Appointments are from 9.00am to 12.00pm and 3.00pm to 6.00pm daily. Extended surgery hours are offered from 9.00am until 2.00pm on Saturdays. The practice has opted out of providing out of hours (OOH) services to their own patients when it is closed and directs patients to the OOH provider for NHS Tower Hamlets CCG. The practice is also part of the local GP hub enabling patients to get appointments up to 10.00pm on weekdays, appointments are also available on Saturday and Sundays.

Dr Nagappan Selvan (Gough Walk Practice) is registered as a sole principal with the Care Quality Commission to provide the regulated activities of treatment of disease, disorder or injury; maternity and midwifery services; family planning; diagnostic and screening procedures. The practice is aware that it needs to take action to correct its registration with CQC, and is in the process of applying to de-register as a sole practitioner and re-register as a partnership.

This practice has not previously been inspected by CQC.

Updated 24 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Nagappan Selvan (Gough Walk Practice) on 15 December 2016. Overall the practice is rated as good.

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

• Pre-employment reference checks had not been completed for all staff.
• Not all staff had received a DBS check (Disclosure and Barring Service) or suitable risk assessment of the need.
• The national GP patient survey showed that patient satisfaction was below both local and national averages in a number of areas.
• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• The practice did not have a business plan to help it to develop and reach its future goals.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance.
• 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.
• 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 improvement are:

• Ensure that all relevant pre-employment checks are carried out for all staff as specified in Schedule 3 of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

• Address the issues highlighted in the national GP survey in order to improve patient satisfaction.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 24 March 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.

• 89% of patients with diabetes, on the register, had a last blood pressure reading (measured in the preceding 12 months) within the recommended range, which was above the CCG and national averages.

• 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.

Updated 24 March 2017

The practice is rated as good for the care of families, children and young people.

• 77% of women aged 25-64 had a cervical screening test in the preceding 5 years, which was below the CCG (79%) and national (82%) averages.

• 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.

• 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.

• 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 24 March 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.

• Older patients with mobility issues are offered home visits for routine as well as emergency issues.

Updated 24 March 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 offered Saturday appointments for the benefit of patients who could not attend during working hours.

Updated 24 March 2017

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

• 93% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in their record, in the preceding 12 months, which was above the CCG and 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 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 24 March 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, 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.