Hindon Surgery

Updated 4 October 2016

Hindon surgery is small rural practice located close to the centre of the village of Hindon in Wiltshire. It has a dispensary.

The practice is part of the Wiltshire Clinical Commissioning Group and has approximately 2,260 patients. The practice has a higher than average patient population over 50 years old and lower than average under 40 years old. The practice area is in the low to mid-range for deprivation nationally, although it is important to remember that t he data is only an indication of deprivation and does not accurately reflect all local communities.

There are two GP partners and a salaried GP making the whole time equivalent of two GPs. The senior partner is also the practice manager. They are supported by two practice nurses, one health care assistant and an administrative and dispensing team of six people.

The practice provides services from the following location:-

               Hindon Surgery, High Street, Hindon, Salisbury, SP3 6DJ

The practice is open between 8am and 6.30pm on Monday, Wednesday and Friday, 8am and 12pm on Tuesdays and 8am and 5pm on Thursday. GP appointments are available between 8.40am and 11.30am every morning and 3pm to 5pm every afternoon except Tuesday when they are closed and Thursdays when appointments are until 4.30pm. Extended hours appointments are offered from 6.30pm and 7pm on Monday and Wednesday. Between September and April they also offered an extended hours surgery on Friday evenings between 6.30pm and 7pm. Appointments can be booked over the telephone, online or in person at the surgery. On Tuesday afternoons when they are closed the practice has reciprocal arrangements with a neighbouring practice to see their patients who need to be seen in an emergency. 

In addition to pre-bookable appointments that could be booked some months in advance, they run a ‘Never Full surgery’ for patients who want to be seen the same day. This runs Monday to Friday from 11.30am and Monday, Wednesday and Friday from 5pm.  

When the practice is closed patients are advised, via the practice website that all calls will be directed to the out of hours service. Out of hours services are provided by Medvivo.

The practice has a General Medical Services contract to deliver health care services. This contract acts as the basis for arrangements between NHS England and providers of general medical services in England.

This practice had not been previously inspected.

Updated 4 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Hindon Surgery on 9 August 2016. Overall the practice is rated as outstanding.

Our key findings across all the areas we inspected were as follows:

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs. For example, the practice was instrumental in establishing an Elderly Care Facilitator service in the locality. One of their roles was to send a birthday card and questionnaire to patients aged 75 and over on their birthday to help identify patients at increased risk.
•   Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they were managed and responded to, and made improvements as a result.
• The practice had strong and visible clinical and managerial leadership and governance arrangements.

We saw several areas of outstanding practice including:

• The practice had identified 131 patients as carers (6% of the practice list) and had been awarded a gold plus award for caring for carers by a local charity working in partnership with the local authority.
• The practice had an ethos of providing a one stop surgery to reduce patients’ visits to the surgery and to reduce the need for patients to visit hospital. They worked to remove all barriers and encourage service uptake. For example, following patient feedback and discussions with the Patients Participation Group the practice had introduced eight ‘never full’ surgeries per week. The practice was committed to offering same day access to a GP if this was what the patient wanted and this was confirmed by feedback from patients which was consistently highly positive. Data from the national GP patient survey showed patients rated the practice as the best performing practice in the local clinical commissioning group  area. For example, 100% of patients described the overall experience of this GP practice as good compared to the national average of 85%. This was supported by the latest data available from the Family and Friends test which showed that 100% of the patients responding to said they would recommend this practice to their friends and family.

     The areas where the provider should make improvement are:  

• Ensure they adequately assess the risks inherent in the building, such as the security of consulting rooms.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 4 October 2016

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

• The practice offered six monthly health checks for patients with long term conditions.
• 90% of patients with diabetes on the register had their last blood test result within the target range in the last 12 months (04/2014 to 03/2015) compared to the clinical commissioning group average of 83% and national average of 81%.
• Longer appointments and home visits were available when needed.
• All patients had a named GP and a structured annual 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.
• The practice had an ethos of providing a one stop surgery to reduce patients’ visits to surgery and to reduce the need for patients to visit hospital.
• The practice had low number of people being admitted to hospital as an emergency. Six patients per thousand had an emergency admission for ambulatory care sensitive (ACS) conditions (04/2014 to 03/2015) compared to the clinical commissioning group of average of 13 and national average of 15 per thousand patients. (ACS conditions are a group of diverse health conditions that can often be managed with timely and effective treatment in a primary care setting without hospitalisation. The rates of admission for these conditions are a common marker of success for health systems.)

Updated 4 October 2016

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

• 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 had a policy of the GP phoning to speak to parents of all children seen by medical services outside the practice such as A&E and NHS 111 services.
• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw spoke to patients who confirmed this.
• The practice’s uptake for the cervical screening programme was 81%, which was higher than the CCG average of 77% and the national average of 74%.
• The practice’s uptake or bowel cancer screening programme was 69% which was higher than the CCG average of 63% and the national average of 55%.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• New parents were sent a card that included the patient registration form to complete and a provisional date for the post-natal check. New mothers were telephoned or seen by a GP soon after delivery in addition to midwife and health visitor visits.
• We saw positive examples of joint working with midwives, health visitors and school nurses. For example the practice had recently decided to work more closely with local primary schools to help increase the uptake of child immunisation.
• Immunisation rates were high for all standard childhood immunisations. 

Updated 4 October 2016

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

• 14.5% of the practice register were over 75 years of age and had been identified as a priority.
• The practice sent a birthday card and questionnaire to patients aged 75 and over on their birthday to help identify patients at increased risk.
• They offered admission avoidance appointments to patients identified as being at risk.
• The practice offered proactive, personalised care to meet the needs of the older people in its population.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• The practice conducted weekly visits to one nursing home in the area.
• The practice used every opportunity to encourage patients to take advantage of preventative measures, such as flu vaccination, which they offered  and delivered opportunistically during appointments made for other reasons.
• They prioritised supporting patients on end of life care and in the last two years over 70% of patient deaths had been in a place of patients’ choosing. (The majority of patients prefer to die at home.)

Updated 4 October 2016

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

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
• 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. 33% of the patient list had signed up for on-line services.
• The practice offered extended hours surgeries between 6:30pm and 7pm on Mondays and Wednesdays for patients who worked and found  it difficult to attend during normal working hours. Between September and April they also offered an extended hours surgery on Friday evenings between 6.30pm and 7pm. These were in addition to the ‘Never Full’ surgeries which ran from 5pm on Monday, Wednesday and Friday evenings.
• The practice offered two weekend flu clinics in October, which was  advertised on repeat prescription forms, in articles in the village newsletter and on their website.
• Last year the practice identified those patients aged 40 – 74 who had not taken up the invitation for a health check in the past two years and a nurse telephoned these patients. Many of these subsequently attended a health check increasing the practice uptake from about 50% to 75% of patients identified for the checks.

Updated 4 October 2016

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

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• 100% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is better than the clinical commissioning group average of 88% and national average of 84%.
• 100% of patients with a psychosis had a comprehensive agreed care plan documented in their record (from 04/2014 to 03/2015 inclusive) compared to the clinical commissioning group average of 93% and the national average of 88%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for patients with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 4 October 2016

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

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• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
• 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 informed vulnerable patients about how to access various support groups and voluntary organisations.
• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff 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 nurse undertook regular home visits for people who were vulnerable and housebound.