Our Services

                       ....And how to use them!

This page describes: -

"What we do", "Where we do it" (the Practice Area) & "How we do it": The range of services we provide & how to access and best use those services.

Services quick-reference index: Just click on the one you want, or read through sequentially to get the bigger picture!

The "Practice Area":

The practice covers the following areas of Dronfield & District:

The services we provide are defined and governed in part by the General Medical Services (GMS2) contract: A new contract launched on 1st April 2004, and this conveniently places services into categories:

Essential Services:

All GPs must provide these services; they consists of the following: -

a) The "bread & butter" of general practice:

The important work of seeing patients who are ill or believe themselves to be ill. 

You can either make an appointment in person, by telephone, or by the internet. See Internet bookings.

It is worth mentioning our Chaperone Policy at this point: -

If you are in need of an intimate examination by a doctor or nurse of the opposite sex, they should ask whether or not you would prefer to have a staff member present as a chaperone. The choice is entirely yours. 

In some situations, the doctor or nurse will ask to have one present anyway. 

For further details, see the Chaperone policy.

b) Prescribing:

This can be either "acute" or "repeat".

"Acute" prescriptions are either issued within a consultation (face-to-face or telephone) by either the GP or Practice Nurse (PN). They are (or anticipated to be) a "one-off" course.

"Repeat" prescriptions are medications that are added to the computer system where prior authorization is given by the GP for repeat issues on a monthly (usually) basis up to a predefined limit. This limit is usually 12 months and coincides with a clinical review of the condition for which it is given (see Chronic Disease Management below).

Repeat prescriptions are guaranteed within 2 working days (although often within one day) and can be ordered in a variety of ways: -

Telephone: The practice has a dedicated 24 hour Prescriptions phone line/answer-phone. Just ring 01246 417555 (or alternatively the surgery number (419040) and press #1) & leave: -

You are then able to simply pick up your medication at the pharmacy 48 hours later, saving a visit to the surgery and a wait at the pharmacy! This is the preferred method (more accessible, more efficient for Patient, Practice and Pharmacist).

In person: At reception, just pass to the receptionist, or place in the basket marked "Repeat Prescriptions", your repeat prescription slip (this is the right hand side of the prescription with all your repeat medication listed and a tick box for those items requested).

Letter/note: You can write to the Practice (or drop in a note to Reception or the letter box) requesting repeat medication. If you include a SAE, we will post the prescription back to you (or, if you address the envelope accordingly, whichever pharmacy you prefer)

c) Chronic Disease Management (CDM):

Within Essential Services, the Practice offers structured care for Chronic Disease Management (CDM). These are a range of common conditions that require annual & occasionally interim review by either the Practice Nurse (PN), GP or both.

CDM is subject to a Quality & Outcomes Framework (QOF) and the Practice is in a good position to perform well against these criteria, since we have been offering evidence-based, structured CDM for many years (see our Protocols & Audit page).

We offer structured care for the following conditions: -

If you have any of these conditions, please ensure you are enrolled into the relevant surveillance programme: Just ask at Reception, or ask either the PN or GP next time you visit.

Most reviews are annual, unless asked by the PN or GP to attend for an interim check (e.g. after a change of treatment).

If changes are made to medication or other aspects of management, a follow-up review is usually made for 4-8 weeks later to check the intended result. Where satisfactory, review reverts back to the annual schedule, otherwise further changes are made and the 4-8 week review repeated, until a satisfactory state is achieved.

Temporary residents:

We welcome patients to join our list as a Temporary Resident when they are residing outside their own GPs area for more than 24hrs but less than 3 months. (If longer, please simply apply to join our list as a ordinary patient).

You will be required to sign a form and give some details relating to your usual address, name and address of your usual GP, and your intended length of stay. When the Temporary Resident period is over, a copy of your clinical notes will be forwarded to your usual GP so that their records are complete.

New Patient Registration checks:

All new patients joining the Turner & Bull practice will be asked to attend an appointment with our Practice Nurse (Kathryn) to undertake a simple health check. This also enables us to get some basic details about your current health status long before your notes arrive from your previous GP.

If you are on repeat medication, you will also be asked to make a separate appointment with a GP to do a brief medication check and add your Repeat Prescription drugs onto the computer.

Please note that not all GPs think alike when it comes to prescribing, and the GPs reserve the right to adjust your medication as seems most appropriate. Please be assured that they will give an explanation/justification for any changes made. 

The GPs have a well tested Practice Prescribing Formulary which has been drawn up with the help and experience of the PCT's Pharmaceutical Adviser. Such formularies ensure safe, effective and cost-effective prescribing. (Money wasted on medication cannot be used for other purposes, e.g. cataract or hip operations.) 

Additional Services:

These are the traditional GP services, but they are no longer compulsory, although GPs are encouraged to continue doing them unless there are extenuating circumstances. (This Practice offers them all bar OOH cover).

They include: -

Out Of Hours (OOH) cover: 

All GPs handed over responsibility for providing OOH cover to the Primary Care Trust (PCT) on 1/08/2004. Since then, Derbyshire Healthcare Ltd (based at Scarsdale, Newbold Road, Chesterfield) has been responsible for all OOH care (I.e. 6:30pm-8am on Mondays-Fridays, all day Saturdays & Sundays & Bank Holidays). Also see the Surgery Closed page.

Cervical Cytology:

The call & recall system for cervical smears is in the process of changing!

Women are invited for cervical smears from the age 25 (formerly 20) to 65 years.

Smears are performed by our Practice Nurse (Kathryn): They are transposed to a glass slide, fixed, boxed and sent to the local cytology laboratory for assessment. The results take about 3-4 weeks to return to the practice.

(However, later this year, we expect to transfer to the new "Liquid- Based Cytology" (LBC) system when made available, as this has distinct advantages: Reduction in the rate of inadequate smears and a shortening in the time taken for results).

Smear results can be: -

Patients with inadequate or abnormal smear results will be notified by letter explaining the result, (possible reasons for this result if inadequate) and are usually asked to make a further appointment.

Contraception:

The Practice provides the full range of Family Planning services, from simple contraceptive advice to contraceptive implants (Implanon), including mini-pills (PoP), Combined Oral Contraceptive Pills (COCP), diaphragms, condoms, injectables, coils (IUCD) and post-coital contraception ("morning after pill"). No range of contraceptive services is complete without sterilization as an option.

All services are available to all patients on an absolute confidentiality basis, provided that young people below the age of 16 years understand their actions, the purpose and possible consequences of contraception and refuse to involve a parent in the decision (Guillick competency rules).

Our contraception protocols can be accessed through the Protocols & Audits page.

Maternity:

The Practice provides full maternity services involving both the GP and Midwife. "Full" maternity services involves ante-natal and post-natal care, but not GP intra-partum care (deliveries in hospital). The midwife does offer home deliveries for suitable patient.

Patients who are pregnant are advised to make an extended 30 minute "booking" appointment with Dr. Turner at 6 to 8 weeks pregnant (i.e. from the last menstrual period). Thereafter, ante-natal care is provided by Carole Richardson, the Midwife, with reference to Dr. Turner where necessary. Following delivery, Gayle Hazelby, our Health Visitor, will also be involved. You will likely be introduced to Gayle in one of the Ante-natal classes.

For more information, please see our "Congratulations" leaflet. If you really want the medical detail, try our Maternity Services protocol.

Child health surveillance:

All babies are given a thorough check on the day of birth, and selective medical/developmental checks at appropriate "milestones" thereafter: -

For further details of all these checks, click here.

Childhood Immunizations:

The Practice recommends & offers the full range of Childhood Immunizations. We have an excellent record for immunization uptake. Like all other practices in the UK we are experiencing parental concern re the safety of the MMR vaccine and its possible link with Autism, however we have a good relationship with all our families and our health visitor and practice nurses provide up to date information and advice re childhood immunizations for all parents.

Parental informed choice: 

2, 3 & 4 months:

Diphtheria

Whooping Cough (Pertussis)

Tetanus

Poliomyelitis

HIB

Meningitis C

12-18 months:

MMR

3-5years ~ "Pre-school booster":

MMR2

DTP (Diphtheria, Tetanus & Pertussis)

Polio

(Others if required)

Verbal information is provided by the HV and later re-enforced by the Practice Nurses (Pre-school booster/MMR2) and by the GP’s if requested

Excellent uptake of the 2,3 and 4 month immunizations occurs and the Health Visitor (HV) is responsible for prompting mum’s to attend appointments; to this end the immunizations are usually undertaken on Thursday mornings after the Health Visitor facilitates a ‘Mother and Baby ‘group

MMR + Pre-School booster/MMR2 occasionally require some parental prompting. Searches are carried out at 13-15 months and 4½ years and letters sent to the parents of those children who are not yet immunized.

Adult vaccinations & Immunizations:

Adult immunizations can broadly be categorized as:

Routine immunizations include:

Note: 5 Tetanus immunizations should be enough for life, but if a tetanus prone wound occurs >10years from the last immunization, a booster may be given.

Travel related vaccinations:

You are advised to check with the Practice Nurse at least 6 weeks before travel regarding the need for travel vaccinations. Often, less time is needed, but do not leave it too late: Vaccines often last years so getting vaccinated a few weeks in advance is no problem, but we cannot turn back the clock if you are late! This particularly applies if you are making last minute "stand-by" bookings and do not know your exact destination.

(We would also recommend double checking the advice of some travel agents as information can differ!)

The Practice is currently happy to supply and administer your travel vaccinations free of charge (even though we are entitled to give you a prescription and charge for travel related vaccinations). This is because we believe we owe you the best of health care, whether home or abroad.

However, there are some vaccines that we will have to give you a private prescription for and you will need to bear the cost of the vaccine yourselves. We are still happy to issue prescriptions to you free of charge, but you will need to pay at the chemist. These include:

Some malaria prophylaxis (tablets) can be bought "Over The Counter" (OTC), but others need a private prescription (which can be expensive), but better to take malaria prophylaxis than return home with malaria!

Minor Operations:

Minor Operations include a range of minor procedures including: Aspiration, cryotherapy, cautery, curettage, excision, incision, injection, biopsy and avulsion. If that list hasn't put you off read on!

They are usually performed by Dr. Bull on a Wednesday afternoon in one of the treatment rooms, but sometimes injections are performed in normal surgery if the condition has already been diagnosed & assessed as appropriate. 

Appointments are usually 5' for cryotherapy, 15' for injections and 30' for cutting procedures. All appointments should be made on the instruction of, or with the prior consent of, one of the GPs.

Enhanced Services:

These consist of services which are over and above the usual GP services, and represent additional quality markers of a good practice. Enhanced Services include:

Access:

Government (DoH) targets are that patients should be able to see a member of the Primary Healthcare Team within 1 working day and a GP (not necessarily the GP of your choice) within 2 working days.

At this Practice, all requests for same day appointments are "triaged": Some matters can be easily sorted on the telephone; some are assessed by the Practice Nurse in person; others need to be seen by the GP.

All requests are dealt with on the day.

The Practice offers influenza vaccinations to all patients in the ≥65 year age group, or who fall into one of the "at risk" groups. For more detail regarding the Practice policy in this area, click here.

Immunizations are available from September through March each year, although the bulk of immunizations take place in November for logistical reasons (delivery, etc).

In addition, we offer Pneumococcal vaccination to all who fall into the "at-risk" groups.

The Practice offers an anticoagulant service for the growing number of patients that are taking warfarin (either short-term or lifelong treatment). See our Anticoagulation Protocol.

The Practice has experimented in the past with Near Patient Testing (NPT), i.e. patient's blood taken and processed at the surgery, with an immediate result & management plan for the patient. Although this service proved very popular with patients, we had concerns Re. quality assurance (QA) and abandoned this approach until the QA aspects might be improved.

Since then, we have sent blood to the laboratory and processed results later that day, telephoning patients with the management plan. This approach works well.

However, the QA concerns have been addressed and there are now plans afoot to reintroduce NPT later this year: Watch this space!

The Practice fits a range of IUCDs (coils). In order to have an IUCD fitted, please first discuss your contraceptive needs with either a GP or Practice Nurse.

Coil fittings require a 20' appointment with Dr. Turner in one of the Obs & Gynae clinic sessions on Tuesday mornings.

For more information on IUCDs and other family planning methods, see the practice Family Planning protocols.

The Practice now offers a Minor Injuries service. Typically, many injuries have been diverted to A&E, but now the Practice wishes to offer this service to our Patients. We have organized our work schedules so that nobody need wait long and we hope that a local service will prove both convenient & popular.

The following list gives guidance on the types of injuries and circumstances that lead to the use of Minor Injury Services but is not comprehensive:

However, if your injury is too serious, you will be directed to A&E for your own safety & wellbeing.

The Practice is now able to offer a full GUM (Genito-Urinary Medicine) clinic throughout the week in the usual PN or GP appointment slots (in order to maintain discretion for our patients).

Traditionally, patients have been directed to GUM services at either CNDRH or RHH, but with appointment waits exceeding a number of weeks, this is obviously unsatisfactory.

Following a history and examination, a full complement of swabs/samples are taken and sent to the laboratory. Obvious infections are treated immediately, but the swab results provide a definitive diagnosis, and further treatment may be started at review 1 week later.

Patients are advised to abstain completely from sexual intercourse until the "all clear" is given. This may be at the 1 week review if there is no infection demonstrated.

If, however, infection (STD: Sexually Transmitted Infection) has been demonstrated & treatment required, repeat swabs will be necessary after the treatment, and only when the results of these are negative, will the "all clear" be given. To engage in sexual intercourse before the "all clear" simply exposes both others, and yourself, to potential infection.

It is also vital that "contact tracing" takes place: This means that you inform all your sexual partners (last 12 months) and advise them to seek medical advice (via their GP or local GUM clinic). STDs can frequently be asymptomatic, which means that one wouldn't know unless  tested!

The Practice is now working in conjunction with the Community Alcohol Team to offer extended work with those suffering with alcohol dependence.

If you think you might be drinking too much, come and discuss this with one of the GPs. If you have problems with alcohol, why not seek help? Please make a 20' appointment with Dr. Bull.

The Practice is pleased to announce that we will be running a Dronfield & Locality drug misuse clinic on a Wednesday afternoon between 2:30 - 3:30pm, in conjunction with North Derbyshire Community Drugs Team (CDT).

This clinic is only by referral by the CDT, usually from a specialist (GPSI or Consultant) clinic, and is for those who are reasonably stable on methadone.

If you have a drug misuse problem, please see one of the GPs (preferably Dr. Bull) who will refer you to the Community Drugs Team at West Bars, Chesterfield for further assessment and referral into a specialist clinic, or if appropriate, direct into the Dronfield & Locality clinic.

Patients with rheumatoid or other types of inflammatory joint disease are often on powerful and potentially toxic drugs to help control their condition. These drugs can only be prescribed within a system for close monitoring of blood and other tests.

The Practice has been offering a "shared-Care" scheme with the hospital for a few years now, in which the Specialist initiates medication, and when stable, the patient is then passed to the Practice to continue prescribing/monitoring on a monthly basis.

This is more convenient for patients and frees the Specialist up to see other patients. Patients are seen 6-12 monthly by the Specialist, or at the request of the Practice when monitoring indicates all is not so well.

Depression:

The Practice also offers extended care for those with Depression. In addition to antidepressants (the usual care for major Depressive illness), the practice offers close GP supervision, counselling (Practice counsellor) and a validated scoring system (MADRS) that allows the GP to assess progress more accurately, and monitor for relapse.

Private Services:

Note: All private services are funded by the patient (or rarely, by a third party). Please refer to our list of published private fees. Fees are payable on collection (or if to be posted to a third party, on deposit).

Notes & letters:

The GPs are called on to issue and sign a variety of notes and letters for patients' affairs. These may be issued during consultations, or requests may be left with reception.

(It is worth pointing out that not all requests can be entertained according to the circumstances. GPs will discuss matters with patients where it is unclear whether a note or letter can be issued.)

Various forms:

GPs are asked to complete various forms on behalf of their patients (e.g. Passport applications; disabled driver badges, insurance forms for holiday cancellation, etc, etc.).

These are generally best left with Reception, and the GPs will usually process these within 3 working days (taking into account that each GP does not work every day).

Completed forms will be available for collection from Reception unless an SAE is supplied.

Insurance reports:

These arrive directly from the insurance company acting on your behalf. They contain a section where you have signed giving consent to release of all relevant information to the Medical Officer of that insurance company. Without that consent, not report is released.

You are also asked to state whether you wish to see the report before it is sent to the insurance company, in accordance with the Access To Medical Records Act, 1989.

If you indicate "no", the report is sent immediately on completion, but is stored electronically on your health record should you wish to access it at a later date. We are obliged to keep the report for 6 months, but we store them permanently.

If you indicate "yes", the report is held for 21 days from completion. At this time you will be contacted by the Practice, and you can arrange an appointment with the GP responsible to review the report and ask any questions.

You also have the opportunity to correct any mistakes in your health record/report (although where GP and Patient disagree, both accounts are included).

You also have the right to request that certain data is withheld, and this will be deleted from the report. However, GPs must indicate to the insurance company where this has occurred, and the insurance company is entitled to deduce whatsoever and weight your premium accordingly.

If you do not make an appointment within 21 days, the report is sent to the insurance company, but you still have access to the report for the next 6 months (indefinitely as our patient).

Payment is made direct to the Practice by the insurance company, and this is usually recouped through your premiums.

Medicals:

Medicals are required most commonly for:-

Patients are usually directed to make an appointment with the GP by the requesting authority. Appointments should be made for 30 minutes (except adoption/fostering medicals which should be 45'). The Practice endeavours to fit these in on Tuesdays or Wednesdays.

Medicals are quite expensive, and patients are advised to check the Private Fees webpage. (In the case of Adoption/Fostering and insurance medicals, payment is by the third party.)

Department of Work & Pensions (DWP):

Patients claiming a variety of benefits & allowances have also signed consent (often unbeknown to them ... hidden in the small print somewhere!) for the DWP to request medical reports from the GP.

Some of these (usually those asking statements of fact) are part of our "Terms of Service" (and are therefore part of our NHS work); but others (usually those asking for opinions or prognoses) are private work. The DWP pays the private fees for these.

Patients are usually not aware that reports have been requested and sent, but usually these reports determine whether a patient is called for a review/medical examination or their benefit/allowance simply continued.

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