Archived: Dr Maher Shakarchi Also known as Dr Shakarchi's Practice

Updated 24 April 2017

Dr Maher Shakarchi (also known as Dr Shakarchi’s Practice) is a well-established GP practice situated within the London Borough of Westminster. The practice lies within the administrative boundaries of NHS Central London (Westminster) Clinical Commissioning Group (CCG) and is a member of the South Westminster GP Locality Group and a member of Central London Healthcare (CLH) GP provider network.

The practice provides primary medical services to approximately 3,700 patients living within the practice boundaries of Victoria, Pimlico, Belgravia, Westminster, Kensington, Chelsea and North Battersea and accepted out of area patient registrations. The practice holds a core Personal Medical Services Contract (PMS) and Directed Enhanced Services Contracts. The practice is located at Belgrave Medical Centre, 13-13A Pimlico Road, SW1W 8NA with good transport links by bus and rail services.

The practice operates from a converted building which is jointly owned with another GP practice. The building is set over two floors with stair access and has a total of three consultation rooms two in the basement and one on the ground floor. The reception and waiting area are on the ground with another waiting room in the basement. There are accessible facilities for people with disabilities. There are no parking facilities at the practice but there is limited off street pre-payable parking in the roads around the practice.

The practice population is ethnically diverse and has a lower number of patients between 0 and 19 years of age and 60 years plus than the national average. There are a much higher number of patients between 25 to 44 years of age and a higher number of male patients aged 45 to 54 years of age, than the national average. The practice area is rated in the fourth more deprived decile of the national Index of Multiple Deprivation (IMD) and there is wide variation in the practice population from relatively deprived to very affluent. People living in more deprived areas tend to have greater need for health services. Data from Public Health England 2014/15 shows that the practice has a lower percentage of patients with a long-standing condition compared to CCG and England averages (50%, 47%, and 54% respectively).

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

The practice team comprises of a male Principal GP and one female and one male locum GPs who collectively work a total of 11 clinical sessions per week. The GPs are supported by one full time practice nurse, a practice manager and two administration staff.

The practice opening hours are from 8am to 6.30pm Monday to Friday. Consultation times in the morning are from 9am to 12pm and in the afternoon from 2pm to 6pm each day. Extended hour appointments are offered from 7.30am to 8am Monday to Friday, 6.30pm to 8pm Monday and Wednesday and from 10am to 12pm on Saturday mornings. Pre-bookable appointments can be booked twelve weeks in advance and telephone consultations are available daily. The out of hours services are provided by an alternative provider. The details of the out-of-hours service are communicated in a recorded message accessed by calling the practice when it is closed and on the practice website. The practice does not close for a lunch hour period.

The practice provides a wide range of services including chronic disease management, minor surgery and health checks for patients 40 years plus. The practice also provides health promotion services including, cervical screening, childhood immunisations, contraception and family planning.

Updated 24 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Maher Shakarchi (also known as Dr Shakarchi’s Practice) on 10 December 2014. The overall rating for the practice was requires improvement. The full comprehensive report on the 10 December 2014 inspection can be found by selecting the ‘all reports’ link for Dr Maher Shakarchi on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 11 November 2016 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 10 December 2014. 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.

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.
• The practice had clearly defined and embedded systems to minimise risks to patient’s safety.
• 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.
• The practice had effective systems in place to minimise risks to patient safety.
• Staff were aware of current evidence based guidance.
• Staff had the skills and knowledge to deliver effective care and treatment.
• Patients said they felt the practice offered an excellent service and staff were kind, attentive, caring and helpful and treated them with dignity and respect.
• Information about services and how to complain was available, but the complaints policy required updating. Improvements were made to the quality of care as a result of complaints and concerns.
• The majority of patients found it easy make an appointment with a GP with urgent appointments available the same day.
• The practice had adequate facilities and was equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management.
• The practice 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.

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

The areas where the provider should make improvement are;

• Ensure a health and safety poster is displayed which identifies local health and safety representatives and implement a log of weekly fire alarm checks.
• Continue to make improvements in the performance for QOF, including patient outcomes in long-term conditions, childhood immunisations and cervical screening programme to align with local and national averages.
• Continue to identify and support more patients who are carers.
• Review the complaints policy to ensure all content is up to date.
• Consider permanent installation of the hearing loop to assist patients with hearing impairment.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 24 April 2017

The practice is rated as good for the care of people with long-term conditions.

• All patients with long term conditions were invited for structured annual health checks including medication review, blood tests and immunisations if required. Patients who did not attend for annual review their records were highlighted so when repeat prescriptions were requested they were advised to make an appointment.
• Longer appointments and home visits were available when needed.
• The practice held monthly multi-disciplinary team meetings to discuss and manage cases of patients with complex medical needs. These meetings were attended by the primary care navigator, members of the community nursing team, community matron and palliative care nurse.
• Patients with risk factors for developing long term conditions were identified through NHS Health checks and routine screening. Patients were referred to appropriate services to help modify risk factors, such as the national diabetes prevention programme and in house smoking cessation services.
• The practice offered out of hospital diagnostic facilities, including spirometry, electrocardiograms (ECGs) and ambulatory blood pressure monitoring.
• Patients with long term conditions at risk of hospital admission were identified and invited for review to create integrated care plans aimed at reducing this risk.
• The practice offered flu immunisation to patients with long term conditions in line with national guidance.

Updated 24 April 2017

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

• There was a named GP lead for safeguarding children, staff had received role appropriate training and were aware of their responsibilities to raise concerns.
• 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.
• The practice provided shared antenatal care with the local midwife team and routine post-natal care including family planning.
• Childhood Immunisation rates for 2015/16 were similar to or above CCG averages for all standard childhood immunisations. The practice had a recall system for babies and children who had not attended for their immunisation.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice had access to specialist advice from local paediatric consultants via a specific telephone number and email address.
• We saw positive examples of joint working with midwives, health visitors and school nurses.
• The uptake rate for cervical smears was 70%, which was similar to the CCG average of 73% and below the national average of 81%.

Updated 24 April 2017

The practice is rated as good for the care of older people.

• All patients over 75 years of age had a named GP and personalised care plan reviewed annually in coordination with the primary care navigator. These patients were reviewed three monthly or sooner if they were admitted to hospital.
• Annual medication reviews were offered to patients with polypharmacy of 10 prescribed medicines or more.

• The practice had a policy to telephone any older patient after they were discharged following an admission to hospital, to review their needs and assess if a follow up consultation or home visit was required. Referrals were made to the community independence service if appropriate which aimed to support patients at home and reduce the risk of hospital admission.

• Older patients with complex care needs were discussed with the primary care navigator and they were involved in arranging and following up on community support service referrals.
• The practice held monthly multi-disciplinary team meetings to discuss and manage cases of older patients with complex medical needs. These meetings were attended by the primary care navigator, members of the community nursing team, community matron and palliative care nurse.
• The practice offered home visits and urgent appointments for those with enhanced needs.
• The practice referred patients at risk of social isolation to befriending and local support services.
• There was a named GP lead for safeguarding vulnerable adults and staff were aware of their responsibilities to raise concerns.
• The practice offered flu and shingles immunisation for older patients in line with national guidance. Home visits for immunisations were offered to housebound patients.

Updated 24 April 2017

The practice is rated as good for the care of working-age people (including those recently retired and students).

• Extended hour appointments were available including Saturday morning appointments for patients unable to attend the practice during normal working hours. Telephone consultations with a GP were also available daily.
• There was the facility to book appointments and request repeat prescriptions online. The practice also used the electronic prescribing service to send repeat prescriptions directly to the patients’ pharmacy of choice.
• The practice offered health checks for new patients and NHS health checks for patients aged 40 to 74 years of age with appropriate follow-up of any risk factors identified.
• Patients were able to receive travel vaccinations available on the NHS as well as those only available privately.

Updated 24 April 2017

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

• 100% of the 11 patients’ diagnosed with dementia on the practice list had their care reviewed in a face to face meeting in the last 12 months, compared to the CCG average of 87% and the national average of 84%.
• 86% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the record in the last 12 months compared to the CCG average of 86% and national average of 89%.
• The practice used a screening tool to review patients with suspected dementia or those at risk, with referral on to local memory services if appropriate.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice advised patients experiencing poor mental health how to access various support groups and voluntary organisations.
• The practice had a psychiatric community liaison nurse who ran weekly clinics at the practice for patients experiencing poor mental health.
• The practice held out of hospital clinics weekly for patients experiencing poor mental health that had been discharged from secondary care services. These clinics provided psychological and physical reviews.
• All patients on the mental health register were invited to annual health checks including medication review and blood tests if required.   

Updated 24 April 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• There was a named GP lead for safeguarding vulnerable adults. Staff knew how to recognise signs of abuse in vulnerable adults and children and 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.
• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
• The practice offered annual health checks for patients with a learning disability with longer appointments available if required.
• 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.