Archived: Hurst & Hurst Also known as Hartington Surgery

Updated 9 November 2016

Hurst and Hurst is run by a partnership of a GP and an advanced nurse practitioner. The practice is known as Hartington Surgery, which is located in the rural village of Hartington in the Peak District National Park of North Derbyshire.

The practice provides primary medical services to approximately 3,050 patients who live over a vast rural area within the Derbyshire and Staffordshire borders. Local employment is largely in farming , quarrying, leisure and tourism .The practice population are over 99% white British background, and 72% of patients are aged over 45. 

There are areas of rural deprivation and social isolation within the practice boundary. There are limited local services and public transport links. There is very little social housing and there are no care homes. 

The partners own the premises, which is  on one level and provides good access and facilities for patients .  The practice has its own dispensary which dispenses to virtually all registered patients, as there is no other pharmacy provision within the practice boundary. We reviewed the dispensary service as part of this inspection. 

The practice team includes receptionists and administrative staff, a practice manager, two practice nurses, an advanced nurse practitioner and a GP who are partners,  two health care assistants, dispensing staff and a dispensary manager.  In view of the small staff team several members of staff have joint roles.

Two regular locum GPs also provide medical support to the practice, along with a further two locum GPs who provide support as required. The arrangements for seeing a female clinician includes an advanced nurse practitioner, two practice nurses and two GP locums who provide regular sessions at the practice.

The practice is open between 8am and 6.30pm Monday, Tuesday, Thursday and Friday and from 7am to 6.30pm on Wednesday. Appointments times are flexible but are broadly available from 8.15am to 11.30am and 2pm to 6.30pm daily. An extended hours surgery is available Wednesday from 7.15am.

The practice does not provide out-of-hours services to the patients registered there. During the evenings and at weekends an out-of-hours service is provided by Derbyshire Health United. Contact is via the NHS 111 telephone number.

The practice holds the General Medical Services (GMS) contract to deliver essential primary care services.

Updated 9 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hurst and Hurst, Hartington Surgery on 5 July 2016.

Overall the practice is rated as outstanding. Our key findings across all the areas we inspected were as follows:

• Importance was placed in treating patients with dignity and respect. The practice had recently received the Derbyshire Dignity Campaign Award, an initiative developed by the local County Council.
• Overall feedback from patients was extremely positive with regards the care and services they received. Patients said they were treated with compassion, dignity and respect, and were involved in decisions about their care and treatment.
• Patient survey satisfaction scores in respect of care and how they were treated were significantly above local and national averages. 
• Feedback from community based staff we spoke with, was consistently positive with regards to the high levels of care provided by the practice team.
• The services were delivered in a way to ensure flexibility, choice and continuity of care.
• The appointment system and services were flexible to meet the needs of patients. Most patients told us they were able to access appointments or telephone consultations in a way, and at a time that suited them.
• ​The standard appointment times for all clinical staff with the exception of locum GPs, had been extended from 10 to 15 minutes for each patient. This meant that the clinical staff had more time to assess patients needs, and provide advice and support.
• Patients lived over a vast rural area. The practice had a small staff team who lived in the area, and had a wealth of local knowledge and knew their patients well.  
• The practice had  close links with the local community and  worked in partnership with other services to meet patients’ needs.
• The practice provided a range of services on site to enable patients to be treated locally and in response to their needs. For example, the provision of 24 hour cardiac monitoring ( including interpretation)  is funded by the practice in response to patients’ needs.
• The premises were on one level and provided good access and facilities for patients, and were well equipped to meet their needs.
• There was an open and transparent approach to safety. Effective systems were generally in place to keep patients safe, including the management of medicines.
• There was evidence of quality improvement including clinical audits. The culture and leadership empowered staff to carry out lead roles and to drive continuous improvements.

• The practice had a highly motivated, experienced and cohesive staff team to enable them to deliver well-led services. 

• The culture supported learning and innovation.​  The commitment to learning and the development of staffs’ skills was recognised as essential to ensuring high quality care. Staff development was encouraged and we saw how individuals had taken on new roles with the support of senior staff. 

• The practice actively sought the views of patients and staff, which it acted on to improve the services. The patient participation group (PPG) had been established 27 years , and continued to influence practice developments. The PPG worked in partnership with the practice  and were actively involved with many aspects of the practice’s work.

• Complaints were listened to and acted on to ensure that appropriate learning and improvements had taken place.

​We saw several areas of outstanding practice including:

• In response to the problems associated with rural isolation and lack of local services, a practice nurse provided a home assessment service and health checks, for elderly, housebound and vulnerable patients. This helped to identify health or social issues that may not have been reported, and ensure patients needs were met.
• The practice population included a large farming community. The staff team had built up strong relationships with the farming families, to increase their willingness to access support and health services locally. The practice worked closely with the Farming Life Centre, a local charity dedicated to improving the quality of life of farmers and rural communities through its services.

​Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 9 November 2016

• The practice held a register of people with long term conditions.
• Clinical staff had lead roles in in managing long-term conditions and patient reviews, having received appropriate training.
• Patients with long term conditions and other needs were reviewed at a single appointment where possible. Longer appointments and home visits were available where needed.
• Various in-house services were provided to enable patients to be treated locally. This included 24 hour ECG (this measures the rhythm and activity of the heart)and ambulatory blood pressure monitoring, and an anticoagulation service to monitor patient’s blood, to determine the correct dose of their medicine.
• Patients were offered an annual and interim reviews when required, to check their health and medicines needs were being met. Health reviews included education and strategies to enable patients to manage their conditions effectively.
• The practice worked closely with the heart failure, diabetes and respiratory specialist clinicians, and referred appropriate patients to pulmonary and cardiac rehabilitation programmes

• The number of patients who had received a health review in the last 12 months was high. For example, 100% of patients with diabetes, chronic obstructive pulmonary disease, heart failure and chronic heart and chronic kidney disease had received a review. Also, 98.3% of patients with asthma had received a review.

Updated 9 November 2016

• Children were seen the same day if unwell. Appointments and telephone consultations were available outside of school and college hours.
• The premises were equipped and suitable for children and young people.
• Systems were in place to identify and follow up children at risk of abuse, or living in disadvantaged circumstances.
• The practice held a register of children at risk of abuse or harm.
• Children and young people had access to a counselling service.
• The practice provided maternity care and family planning services, and worked in partnership with midwives and health visitors to provide shared maternity and child development care.​
• Teenagers leaving school were sent a letter to invite them for a health and lifestyle check, which included sexual health advice.
• Immunisation rates for all standard childhood vaccinations were high.

Updated 9 November 2016

• The practice was responsive to the needs of older people, and offered home visits for those who needed them. 
• In response to the problems associated with rural isolation and lack of local services, a practice nurse provided a home assessment service and heath checks, for elderly, housebound and vulnerable patients. The community matron also visited patients homes to assess and review their needs. This helped to identify health or social issues that may not have been reported, and ensure patients needs were met.
• A dispenser/health care assistant also visited frail and housebound patients if they were  experiencing difficulties in taking their prescribed medicines to provide support and aid compliance. 
• All patients with palliative care needs and over the age of 75 years had a named GP to oversee  their care. They were also given a separate direct telephone number to contact the practice urgently.
• The practice had 267 patients aged 75 and over;  261 had had a health check or review in the last 12 months . All patients had been offered a review. 
• The practice held a register of patients who were identified as ‘at risk' of hospital admission. The register included 74 patients, of which 82% had a care plan in place to ensure they received appropriate support to help avoid unnecessary admissions.The remainder of patients had recently been added to the register, and care plans were underway. 
• The practice worked closely with other services, and held monthly multidisciplinary meetings to discuss and review patients’needs.
• The 2014 to 2015 flu vaccination rates for the people aged 65 and over were 73.6%, which compared with local and national averages. 

Updated 9 November 2016

• The services were accessible and flexible to the working age population, those recently retired and students.
• Patients were able to book appointments around their working day by telephone or on line. They also had access to telephone consultations.
• Repeat prescription requests were available by telephone or on line.
• The GPs and nurses offered flexible appointment times  to accommodate working patients. Extended appointment times were available on Wednesday morning from 7.15 am for working people. 
• The practice offered access to ‘choose and book’ service for patients referred to secondary services, which provided greater choice and flexibility over when and where their test took place, and enabled patients to book their own appointment.
• The practice offered NHS health checks for patients aged 40 to 74 years.
• The practice promoted health screening programmes to keep patients safe. 
• The practice provided meningococcal vaccines for students, which helps to protect against meningitis and septicaemia.

Updated 9 November 2016

• The practice held a register of patients experiencing poor mental health, including people with dementia.
• Patients were offered same day or longer appointments where needed.
• The practice had 24 patients on the mental health register. All eligible patients had received an annual review and had a care plan in place.
• The practice worked closely with child and adult mental health teams.
• Patients had access to counselling and psychological services, and had the option to self refer to some psychological therapies. The  GPs also routinely sent referrals to the therapists to ensure they had access to essential information about patients.
• The practice had a system in place to follow up patients who had attended the accident and emergency department or discharged from hospital. One of the practice nurse's oversaw all attendances and discharges. and phoned patients where required, to check patients welfare.    
• The practice actively screened appropriate patients for dementia, to support early referral and diagnosis where dementia was indicated.
• The practice had 12 patients on the dementia register and all had received an annual review and had a care plan in place.
• Staff had recently completed dementia friendly training to  improve awareness of dementia and the support available to patients and their carers.  The practice had provided additional signs and prompts to assist  patients to find their way around the premises. 

Updated 9 November 2016

• The practice was responsive to the needs of people whose circumstances may make them vulnerable.
• The practice held a register of patients whose circumstances may make them vulnerable.
• The practice worked with multi-disciplinary teams to meet the needs of vulnerable people, and to safeguard children and adults from abuse or harm.
• All staff had received relevant training on safeguarding vulnerable children and adults. Staff knew how to recognise and respond to signs of abuse in vulnerable adults and children, and how to contact relevant agencies.
• The practice worked in line with recognised standards of high quality end of life care, and held a palliative care register, which included older people with enhanced needs, at risk of harm or vulnerable.
• End of life care plans were in place for patients where appropriate, which set out their needs and wishes.
• Patients were informed about how to access support groups and voluntary organisations. Information was available on support for domestic violence.
• The practice had three patients on the learning disability register and all had received an annual health check and had a care plan in place.