Dr Kirit Shah - Care Quality Commission

Background to this inspection

Updated 4 August 2017

Dr Shah’s practice provided services to approximately 3400 patients in the Vauxhall area of south east London under a Personal Medical Services contract (an agreement between NHS England and general practices for delivering personal medical services). It sits within the Lambeth clinical commissioning group (CCG) which has 48 member practices serving a registered patient population of more than 380,000. Dr Shah’s practice provides a number of enhanced services including timely diagnosis and support for people with dementia; support for patients with a learning disability; minor surgery and remote care monitoring.

The staff team at the practice consists of one full time male GP, a locum male GP, a female practice manager, a practice nurse, a locum practice nurse and one full time and three part time administrators/receptionists. The practice provides nine GP sessions per week. The service is provided from this location only, and is located in rented property. It provides an online appointment booking system and an electronic repeat prescription service. Patients can also view test results online. The premises are not purpose built but a ramp has been fitted to enable ease of access for patients with mobility difficulties and a hearing loop has been installed.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments with the practice nurse start at 8am, and with a GP from 9am. The practice provides extended opening hours with GP appointments on a Tuesday morning from 7.15am and on Monday and Tuesday evenings until 7pm. No appointments are provided on Thursday afternoons. Patients who wish to see a GP during this time or between 8am and 9am are referred to the Lambeth GP access hub (which provides additional GP and nurse appointment at four specific GP practices spread across the borough). Outside of these hours, patients are advised to contact the practice’s out of hours provider, whose number is displayed on the practice noticeboard.

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 lower percentage than the national average of people with a long standing health conditions (46% compared to a national average of 54%) but is comparable to the national average for people with health related problems in daily life (48% compared to a national average of 49%). The average male and female life expectancy for the CCG area and the practice is in line with the national average for both males and females.

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 30% most deprived neighbourhoods in the country with a value of 36.5 compared to the practice average across England of 23.6. The patient population is characterised by a below England average for patients, male and female, over the age of 55; and an above England average for patients, male and female, between the ages of 25 and 49.

Overall inspection

Good

Updated 4 August 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Dr Kirit Shah on 3 February 2016. Breaches of legal requirements were found. After the comprehensive inspection, the practice submitted an action plan, outlining what they would do to meet the legal requirements in relation to the breaches of regulations 9 (Person centred care); 12 (Safe care and treatment); 13 (Safeguarding service users from abuse and improper treatment); 17 (Good governance) and 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook a focussed inspection on 1 December 2016 to check that the practice had followed their plan and to confirm that they now met the legal requirements. We found that there remained one breach of regulation in relation to regulation 17, good governance.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Dr Kirit Shah on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 3 July 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 1 December 2016. This report covers our findings in relation to those requirements.

Overall the practice remains rated as Good. The rating for providing Effective care is now Good. Our key findings were as follows:

Clinical audits had been carried out and completed with a second cycle. Clinical audits related to NICE guidelines and resulted in changed and better outcomes for patients.
The practice monitored that these guidelines were followed through, for example, regular discussion at clinical meetings. We saw copies of minutes of these meetings.
We reviewed a number of care plans and found them to be well documented.
Clinical staff participated in multi-disciplinary meetings where the needs of specific patients were discussed and the opportunity given to discuss concerns, issues and ongoing care.
We found that the practice had adequate levels of clinical staff, through the use of a long term locum GP and a locum practice nurse to supplement the existing practice nurse availability. However, we noted that patients did not have access to a female GP, the long term female locum GP having recently left the practice.

At our initial inspection on 3 February 2016 we found a number of single use pieces of equipment that were of out of date. We found similar issues when we re-inspected on 1 December 2016. Disappointingly, at the visit on 3 July 2017 we again found out of date dressings, blood test tubes, blood collection kits and a stitch cutter. This was in spite of the provider telling us they had a new standard operating procedure template in place to use to carry out equipment checks. The provider needs to make improvements in this regard, as outlined below.

Importantly the provider should:

Keep under review the lack of access to a female GP to ascertain if the needs of patients are being met in this regard.
Review the process for checking single use equipment to ensure the system is robust.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice