Dr C D Lenton & Partners Also known as Ashfield Surgery

Updated 21 December 2017

Dr AP Blight & Partner (also known as Ashfield Surgery) is located in Sutton Coldfield, Birmingham. The practice is situated in a multipurpose modern built building, providing NHS services to the local community.

Based on data available from Public Health England, the levels of deprivation in the area served by Dr AP Blight & Partner showed the practice is located in a less deprived area than national averages, ranked at eight out of 10, with 10 being the least deprived. (Deprivation covers a broad range of issues and refers to unmet needs caused by a lack of resources of all kinds, not just financial). The practice serves a higher than average patient population aged between 45 to 89. The number of patients aged zero to 39 is below local and national averages. Based on data available from Public Health England, the Ethnicity estimate is 2% Mixed, 6% Asian and 2% Black.

The patient list is 16,028 of various ages registered and cared for at the practice. Services to patients are provided under a General Medical Services (GMS) contract with the Birmingham Cross City Clinical Commissioning Group (CCG). GMS is a contract between general practices and the CCG for delivering primary care services to local communities.

The surgery has expanded its contracted obligations to provide local incentive schemes to patients. Local incentive schemes are above the contractual requirement of the practice and are commissioned in order to improve the range of services available to patients. The practice supports a local nursing home and carries out a daily visit to review patients; full reviews of records were carried out monthly.

On-site parking is available with designated parking for cyclists and patients who display a disabled blue badge. The surgery has automatic entrance doors and is accessible to patients using a wheelchair and push chairs.

The practice is a training practice for doctors and fifth year medical students. The practice also supports the Ministry of Defence in the training of doctors. They facilitate GP registrars (doctors in training) on a six month rotation. The practice runs the vasectomy service for patients registered with practices in Birmingham Cross City Clinical Commissioning Group and Solihull Clinical Commissioning Group.

Practice staffing comprises of six GP partners (3 male and 3 female), three salaried GPs (two male and one female), five practice nurses’ one nurse practitioner, one advanced wound care specialist nurse, a health care assistant and a phlebotomist. The non-clinical team consists of one practice manager, a deputy practice manager and a team of administrators, secretaries and receptionists.

The practice is open between 8.15am and 8pm Mondays and Wednesdays, 8.15am to 6.30pm Tuesdays, Thursdays and Fridays. Extended hours are from 6.30pm to 8pm Mondays and Wednesdays. Telephone consultations are also available and home visits for patients who are unable to attend the surgery. The practice had a messaging service for patients to remind them of their appointment times.

GP consulting hours are from 8.15am to 6.30pm Mondays to Fridays. Extended consulting hours are available on Mondays and Wednesdays from 6.30pm to 8pm.

The practice has opted out of providing cover to patients in their out of hours period. During this time, services are provided by Birmingham and District General Practitioner Emergency Rooms (BADGER) medical services.

Updated 21 December 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr AP Blight & Partners (also known as Ashfield Surgery) on 25 August 2016. The overall rating for the practice was good; however, the practice was rated as requires improvement for providing well-led services. The full comprehensive report on the August 2016 inspection can be found by selecting the ‘all reports’ link for Dr AP Blight & Partners on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 20 November 2017 to confirm that the practice had carried out their plan to make improvements in relation to prevention and control of infections, encouraging the uptake of health checks and improving support available for non-clinical staff that we identified in our previous inspection on 25 August 2016.

This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice continues to be rated as good.

Our key findings were as follows:

• Infection Prevention and Control (IPC) procedures had improved since our previous inspection. Documentations provided by the practice showed that cleaning schedules were being completed which provided clear evidence that specific cleaning tasks relating to the clinical rooms had been carried out.

• Data from the 2016/17 Quality Outcomes Framework (QOF) showed improvement in the completion of various health checks. For example, since our previous inspection the number of patients diagnosed with dementia who had their care reviewed in a face-to-face consultation had increased from 63% to 85%, and was comparable to the Clinical Commissioning Group (CCG) average of 85% and national average of 84%. Members of the management team explained that since our previous inspection the practice had improved the clinical system template to ensure more accurate recording for dementia reviews.

• The practice continued working with other health care professionals in the case management of vulnerable patients. Since our previous inspection, the practice improved the accuracy of their clinical records. Data provided by the practice showed that the number of patients on the practice learning disability register had reduced from 55 to 50 patients as of the 31/03/2017. Unverified data provided by the practice showed an increase in the number of annual learning disability health checks from 22 to 38 patients, (demonstrating an increase from 40% to 76%). Staff explained that they targeted patients during their annual Flu campaign to increase uptake. The practice also commenced dedicated GP time for more structured clinics which focused on this population group. Staff continued writing and calling patients inviting them in for their annual health check.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 November 2016

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and a structured annual 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. We saw evidence that meetings were held on a monthly basis.
• The practice offered a range of services to support the diagnosis and management of patients with long term conditions for example newly diagnosed diabetics. Group sessions for a maximum of 10 patients were held every two weeks and the practice had seen positive outcomes from the sessions with an improvement in the diabetic blood monitoring HbA1c test with 84% patients having a lower result of 7 or less. The practice attributed this to the positive effect the group sessions were having on advising patients on lifestyle changes.
• There were 957 patients on the asthma register and 75% of these patients had received a review in the past 12 months.

Updated 23 November 2016

• 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.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses. The midwife provided antenatal care every week at the practice.
• Childhood immunisation rates for under two year olds ranged from 83% to 98% compared to the CCG averages which ranged from 80% to 95%. Immunisation rates for five year olds were ranged from 81% to 99% compared to the CCG average of 87% to 96%.
• There were policies, procedures and contact numbers to support and guide staff should they have any safeguarding concerns about children.
• The practice’s uptake for the cervical screening programme was 80% which was in line with the national average of 82%.
• The practice was part of the Badger umbrella service for sexual health which had been commissioned by NHS Public Health England. This included contraception advice and counselling and treatment of sexually transmitted diseases.
• The practice offered an advanced contraceptive and sexual health service (CASH) twice a week to the local population.
• A weekly vasectomy clinic was offered. This was a two part service, with a counselling service being offered by one of the GPs to support the patients through the process and a consultant urologist to carry out the procedure.

Updated 23 November 2016

• The practice offered proactive, personalised care to meet the needs of the older people in its population. Care plans were in place for those at risk of unplanned admissions.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs. This included blood tests and vaccinations for those patients who were housebound.
• The premises were accessible to patients with mobility difficulties. A ramp and designated car parking spaces were in place.
• The practice had systems in place to identify and assess patients who were at high risk of admission to hospital. Patients who were discharged from hospital were reviewed to establish the reason for admission and care plans were updated.
• The practice worked closely with multi-disciplinary teams so patient’s conditions could be safely managed in the community.
• The practice support pharmacist carried out medicine reviews and held regular meetings with the GPs to discuss patient’s needs.
• The practice supports a local nursing home and carries out a daily visit to review patients.
• All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met.

Updated 23 November 2016

• 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 reflects the needs for this age group. The health care assistant had completed the course for stop smoking and this service was offered at the practice.
• The practice provided a health check to all new patients and carried out routine NHS health checks for patients aged 40-74 years.
• The practice offered a choice of extended hours to suit their working age population, with later evening appointments available two days a week. Results from the national GP survey in July 2016 showed 75% of patients were satisfied with the surgery’s opening hours which was higher than the local average of 74% and the national average of 76%.

Updated 23 November 2016

• 63% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was lower than the national average of 84%.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• 94% of patients on the practice’s mental health register had had their care plans reviewed in the last 12 months, which was higher than the national average of 88%.
• Results from the Quality and Outcomes Framework (QOF) showed the practice had achieved 99.8% in mental health related indicators, which was higher than the national average of 92.8%
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 23 November 2016

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability and regularly worked with other health care professionals in the case management of vulnerable patients.
• The practice offered longer appointments and annual health checks for people with a learning disability. Following the inspection, the practice ran searches on their clinical system and we saw evidence that there were 55 patients on the learning disability register; between the period August 2015 to August 2016, 22 had received their annual health checks. The practice did send reminders to the patients of their appointments and was actively trying to increase the number of patients attending health checks.
• The practice informed vulnerable patients about how to access various support groups and voluntary organisations and held meetings with the district nurses and community teams every month
• 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. We saw evidence of monthly meetings with the health visitor to discuss vulnerable children.
• The practice’s computer system alerted GPs if a patient was also a carer. There were 408 patients on the practices register for carers; this was 3% of the practice list.