Archived: Palacci & Partners Also known as Barnes Surgery

Updated 27 March 2017

Palacci & Partners (also known as Barnes Surgery) is a single location practice which provides NHS primary care services to approximately 3,800 patients living in the Barnes area of West London through a General Medical Services (GMS) contract. The practice is part of Richmond Clinical Commissioning Group (CCG). There are above average numbers of patients in the age ranges 30-49.

The practice staff comprises one male and two female GPs (providing 15.5 clinical sessions per week). The clinical team is supported by a practice manager, senior receptionist and receptionist and a senior administrator.

The practice is open between 8am and 6.30pm Monday, Tuesday and Friday; 8am to 1.30pm Wednesday; and 8am to 8pm Thursday. Appointments are from 8.30am to 11am and 3.30pm to 6pm Monday, Tuesday and Friday; 8.30am to11am Wednesday; and 8.30am to 11am and 3.30pm to 7.30pm Thursday. The practice offers extended hours on Thursday evening until 8pm. In addition to pre-bookable appointments that can be booked up to four weeks in advance, urgent appointments are also available for patients that need them.

The practice has out of hours (OOH) arrangements in place with an external provider and patients are advised that they can also call the 111 service for healthcare advice. Patients are also provided with details of a local minor injuries unit and a walk-in centre they can access seven days a week.

The practice is registered to carry on the following regulated activities:

Diagnostic and screening procedures

Maternity and midwifery services

Surgical procedures

Treatment of disease, disorder or injury

Updated 27 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Palacci & Partners on 6 January 2017.  Overall the practice is 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 a system in place for reporting and recording significant events.

• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• The majority of patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had the facilities and equipment 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

  The areas where the provider should make improvement are:  

• Review the process for producing patient specific directions (PSDs) for the annual flu vaccination programme to ensure the administration of medicines remains safe up to the point of them being administered.
• In carrying out daily temperature checks of vaccine storage fridges, record the name of the member of staff who completes the checks. Arrange for the protocol containing instructions on action to take if fridge temperatures exceeded the required range to be kept by the fridges.
• Review the coding of dementia patients to determine clearly the basis for any clinical exceptions.
• Consider the introduction of a formal ongoing programme of quality improvement, including clinical audit.
• Arrange support training on communicating with patients about notifiable safety incidents to ensure staff take appropriate action.
• Re-establish the patient participation group (PPG) on a more active footing and encourage wider patient membership.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 27 March 2017

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

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• Performance for diabetes related indicators was above the national average, 96% compared to 90%.
• All QOF registers for long term conditions had a named clinical lead and there was a rolling programme of scrutiny of QOF data to ensure performance was maintained and improved.
• Each patient in this population group was made aware of how they can contact their doctors for on the day advice about managing their condition.
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
• There was a system to recall patients for a regular 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 27 March 2017

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

• There were systems 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 accident and emergency (A&E) attendances. At risk families were discussed at formal monthly safeguarding meetings and informally regularly amongst clinical staff
• Immunisation rates were comparable to local and national averages for most standard childhood immunisations. The practice actively monitored immunisation uptake and recalled patients as necessary.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice worked with midwives and health visitors to support this population group. There was shared care of expectant mothers with the midwives from the local hospital trust allowing the practice to educate them during pregnancy and manage their care.
• The practice carried out 6-8 week mother and baby checks, using both the doctors and practice nurse as a ‘one stop shop’.

Updated 27 March 2017

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

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
• The practice offered proactive, personalised care to meet the needs of the older patients in its population.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs. There was open telephone access for older patients, their carers and family. There were close links with local pharmacies who readily created monitored dosing boxes and delivered medication as and when needed.
• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs. The practice carried out daily monitoring of all hospital discharges and patient use of out of hours services.
• Patients with multiple long term conditions were included in the practices ‘Avoiding Unplanned Admissions’ register and had personalised care plans in place. These were reviewed at monthly multidisciplinary meetings, when patients attended for an appointment, when requesting a home visit or opportunistically when prescription requests came in.
• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible. The practice made full use of local services to signpost patients that might be in need of assistance in the community, for example those supporting people to live independently and voluntary carers groups.

Updated 27 March 2017

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

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and mostly offered continuity of care, for example, extended opening hours on Thursday.
• The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.
• The practice takes part in the catch up programme for students aged 17 and above for Measles Mumps and Rubella (MMR) and Meningitis A, C, W and Y vaccinations.
• There is unlimited telephone access for who are at work. They could discuss issues when face to face consultations are unnecessary.

Updated 27 March 2017

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

• The practice carried out advance care planning for patients living with dementia.
• 94% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which was above the national average of 84%.
• Overall performance for QOF mental health related indicators was broadly in line with the national average: 88% compared to 93%.
• The practice specifically considered the physical health needs of patients with poor mental health and dementia. All patients in this group were read coded as such and offered a full health check.
• The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• The practice operated a telephone triage system to ensure patients in this group can be seen on the same day if necessary thus avoiding accident and emergency (A&E) attendances. Where necessary, however, the practice followed up patients who had attended A&E where they may have been experiencing poor mental health.
• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

Updated 27 March 2017

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

• The practice held registers of patients living in vulnerable circumstances including a housebound and loneliness register, patients diagnosed with cancer and those with a learning disability.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• 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 had information available for vulnerable patients about how to access various support groups and voluntary organisations, for example the local community independent living services.
• Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.