Ashfields Primary Care Centre

Updated 23 June 2016

Ashfields Primary Care Centre is based in a purpose built facility in the centre of the village of Sandbach and close to local amenities. The practice is based in a less deprived area when compared to other practices nationally. The male life expectancy for the area is 80 years compared with the CCG averages of 79 years and the National average of 79 years. The female life expectancy for the area is 83 years compared with the CCG averages of 83 years and the National average of 82 years. There were 23,043 patients on the practice list at the time of inspection.

The practice has 12 GP partners, four salaried GPs and one trainee GP. The practice has eight practice nurses, two research nurses, two pharmacists, four healthcare assistants (HCA), a practice manager, a deputy practice manager, reception and administration staff. The practice is a training practice for General Practitioner registrars. It is also a teaching practice hosting medical students on placement.

The practice is open Monday to Friday from 8.00am to 6.30pm. Extended hours were available on Mondays to Friday from 7am to 8am and 6.30pm to 8pm on Mondays also some Saturday mornings from 9am to 11am. Patients requiring GP services outside of normal working hours are referred on to the local out of hour’s provider N.E.W. operated by the East Cheshire Trust.

The practice has a Personal Medical Services (PMS) contract. In addition the practice carries out enhanced services such as health assessments for patients with learning disabilities and flu and shingles vaccinations.

Updated 23 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Ashfields Primary Care Centre on 26 April 2016. Overall the practice is rated as good.

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

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• The practice implemented suggestions for improvements and made changes to the way it delivered services. This was done as a consequence of feedback from patients and from the patient participation group, for example the introduction, training and ongoing review of an electronic appointment check in system and supporting patients through a variety of clinics.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on. The leadership team displayed innovation and continually strived to improve service to patients.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw three area of outstanding practice:

• The practice had found innovative ways to respond to patient needs, including introducing consultant led clinics normally held at hospitals, for example vasectomy and general surgery. Other clinics made available at the practice included, neurology, dermatology, ophthalmology, audiology, mental health and memory. National and self-initiated surveys showed extremely high levels of patient satisfaction due to these Initiatives.

• The practice had listened to patients via the patient participation group (PPG) and individual requests resulting in the introduction of a self-referral system for physiotherapy. Audit confirmed that this had led to a reduction in the prescribing of Analgesia, less GP time conducting referrals, speedier treatments and increased patient satisfaction.

• The practice surveyed the requirements for patients presenting at reception and found 28% of them had medication queries, so had increased pharmacist capacity to respond to this need.

The areas where the provider should make improvement are:

• To ensure that all relevant staff are aware of safety alerts and any action needing to be taken as a result.

• Implement a more effective approach to recording and retaining recruitment information

• Review security arrangements in relation to public access to non-public areas

• Record verbal complaints

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 23 June 2016

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• The practice was performing comparably to the local and national averages for patients with diabetes, The percentage of patients with diabetes, on the register, in whom the last blood

pressure reading (measured in the preceding 12 months) is 140/80 mmHg or less

(01/04/2014 to 31/03/2015) was 79.5% compared to a national figure of 78% and a CCG figure of 81.4%

• Longer appointments and home visits were available when needed. Visits to local care homes were scheduled weekly by a nominated GP to ensure continuity of care.

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.

Updated 23 June 2016

The practice is rated as good 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. Immunisation rates were relatively high for all standard childhood immunisations.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• The practice was performing comparably to the local and national averages for cervical screening, data showed that the percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years (01/04/2014 to 31/03/2015) was 80.6% compared with 81.8 nationally and 82% within the CCG.

• Appointments were available outside of school hours and the premises were suitable for children and babies. Baby clinic were held on a regular basis.

• We saw positive examples of joint working with school nurses and health visitors.

Updated 23 June 2016

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

• 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.

• A lift was provided for people needing wheelchair access and wheelchairs were provided by the practice. A hearing loop was available for those patients who required one.

Updated 23 June 2016

The practice is rated as good 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. Extended hours were available on Mondays to Friday from 7am to 8am and 6.30pm to 8pm on Mondays also some Saturday mornings from 9am to 11am.The practice is currently trialling pre bookable lunchtime telephone consultation with GPs.

• 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.

Updated 23 June 2016

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

• 89.7% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average.

• 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.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

• Health care assistants are trained to be “dementia friends”, most non clinical staff had attended this training and it forms part of the practice’s induction programme.

Updated 23 June 2016

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

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability. The practice provided dedicated appointments for patients residing a local bail hostel and had found that using text message as a form of contact for travellers was effective.

• 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.