Background to this inspection
Updated
29 October 2019
Hartington Surgery is registered with the Care Quality Commission as a single-handed GP provider. It is registered to carry out the following regulated activities - diagnostic and screening procedures, maternity and midwifery services, and the treatment of disease, disorder or injury.
The practice has a contract with NHS Derby and Derbyshire CCG to provide General Medical Services (GMS) and offers a range of local enhanced services.
Hartington Surgery is a rural dispensing practice situated within the Derbyshire Peak District, close to the Staffordshire border. It covers a vast rural area which does not encompass any towns, but is roughly equidistance from five major hospitals offering good patient choice for secondary care referrals.
The local population are mainly employed in farming, quarrying, leisure and tourism. 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 practice has approximately 3,040 registered patients. The age profile demonstrates a higher proportion of older patients, and lower numbers of younger patients compared to local and national averages:
- The percentage of people in the 65+ year age group at 24.9% is above the CCG average of 20.5%, and the national average of 17.3%.
- The percentage of people in the under 18 age group at 14.5% is below the local average of 19.3%, and the national average of 20.7%.
- Approximately 70% of registered patients are over 40 years old.
Average life expectancy is 81 years for men and 85 years for women, compared to the national average of 79 and 83 years respectively.
The general practice profile shows that 44% of patients registered at the practice have a long-standing health condition, compared to 54% locally and 51% nationally.
The practice scored six on the deprivation measurement scale; the deprivation scale goes from one to 10, with one being the most deprived. People living in more deprived areas tend to have greater need for health services.
The National General Practice Profile describes the practice ethnicity as being predominantly white at 99.4% of the registered patients, with estimates of 0.3% mixed race and 0.2% Asian.
There are two GPs working at the practice (one male GP principal and one long-term sessional locum female GP). The nursing team consists of an advanced nurse practitioner and a practice nurse, supported by one healthcare assistant.
The non-clinical team is led by a practice manager with a team of administrative and secretarial staff, and a dispensary team. Due to the small size of the practice, some staff work across different roles to ensure continuity of service.
The practice opens Monday to Friday from 8am until 6.30pm with extended hours opening on Thursday evening from 6.30pm to 8pm.
The surgery closes on a Wednesday afternoon on most months for staff training. When the practice is closed, out of hours cover for emergencies is provided by Derbyshire Health United (DHU).
Updated
29 October 2019
We carried out an announced comprehensive inspection at Hartington Surgery on 2 September 2019 as part of our inspection programme. The inspection was triggered by a change in registration status with the Care Quality Commission (CQC). The practice was previously registered as a partnership but became a single-handed GP provider which registered with the CQC on 3 December 2018.
We based our judgement of the quality of care at this service on a combination of:
- what we found when we inspected
- information from our ongoing monitoring of data about services and
- information from the provider, patients, the public and other organisations.
We have rated this practice as outstanding overall. The practice was rated as outstanding for providing caring, responsive and well-led services, and good for providing safe and effective services. All the population groups were rated as outstanding.
We rated the practice as outstanding for providing caring services because:
- The national GP patient survey demonstrated that the practice had performed higher than local and national averages in relation to all the questions related to providing a caring service. This was reinforced by overwhelmingly positive feedback from patients in comment cards, and other sources such as comments posted on the NHS website.
- The practice had been awarded the Derbyshire Dignity Campaign Award from Derbyshire County Council, and ensured this was integrated into the way the practice provided care for their patients.
We rated the practice as outstanding for providing responsive services because:
- Patients’ individual needs and preferences were central to the planning and delivery of tailored services. The services were flexible, provided choice and ensured continuity of care.
- The involvement of other organisations and the local community was integral to how services were planned and ensured that services met people’s needs. There were innovative approaches to providing integrated person-centred pathways of care that involved other service providers, particularly for people with multiple and complex needs.
- There was a proactive approach to understanding the needs of different groups of people and to deliver care in a way that met these needs and promoted equality. This included people who were in vulnerable circumstances or who had complex needs.
- People could access appointments and services in a way and at a time that suited them. The national GP patient survey demonstrated that the practice had performed significantly higher than local and national averages in relation to all the questions related to providing a responsive service. This was reinforced by overwhelmingly positive feedback from patients in comment cards, and other sources such as comments posted on the NHS website.
We rated the practice as outstanding for providing well-led services because:
- There was evidence of proactive and strong leadership.
- We observed that the new provider had instigated a number of positive changes that had produced good outcomes for patient care and enhanced patient safety. The change programme had been handled sensitively with the support and commitment of the practice team, and without any interruption to continuity at the practice. Feedback from patients was wholly positive about the new provider.
- Audit processes were embedded within the practice and we saw how this drove service improvements and patient safety.
- There was a continual drive to further improvement with flexibility to redesign service delivery to meet new challenges. We saw innovation and a commitment to engage with others to highlight and share best practice.
We rated the practice as good for providing safe and effective services because:
- The practice provided care in a way that kept patients safe and protected them from avoidable harm.
- Patients received effective care and treatment that met their needs.
- Patients could access care and treatment in a timely way. The practice organised and delivered services to meet their patients’ needs.
There was one area where the provider should make improvement:
- The practice should collate evidence of their practice team’s immunisation status.
Details of our findings and the evidence supporting our ratings are set out in the evidence tables.
Dr Rosie Benneyworth BM BS BMedSci MRCGP
Chief Inspector of Primary Medical Services and Integrated Care.