Ashfields Primary Care Centre

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We assessed all the quality statement in this key question. At our last assessment, we rated this key question as outstanding. The rating is now good following this assessment with a quality statement rated as outstanding.

The provider understood their patient population and they identified and made changes to improve their service where required. The service provided person centred care and treatment whereby people’s individual needs and wishes were respected and acted upon. People who used the service provided positive feedback with regards to their ability to access care and treatment. CQC received feedback from 352 patients and 92% reported positive experiences with feedback indicating satisfaction with care and treatment, access and interactions with staff. Responses to the GP National Patient Survey for access showed the practice was either above or in-line with local and national averages. People were able to access the service readily and in a way that met their needs. Clinicians were available to see people on-the-day for urgent appointment requests. Staff were trained to direct people to the most appropriate service to meet their needs. Leaders proactively sought ways to address any barriers to improving people’s experience and outcomes. People who used the service were supported to make decisions about their future care.

This service scored 86 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We found evidence of outstanding practice for this quality statement. The provider understood the needs of the patient population. They provided services to meet these needs and collaborated with the PCN to offer services to the wider community so that patients could be seen at the practice rather than secondary care. These services included minor surgery, a deep vein thrombosis service, virtual dermatology and a musculoskeletal service. The provider delivered other services from their premises such as an ultrasound and phlebotomy service to improve access and reduce delays in diagnosis and treatment. Patients across the PCN could be referred to a gynaecologist (independently employed practitioner) for support with issues such as menopause. This service was introduced to provide accessible, timely specialist-led menopause support for patients. A Community Heart Failure Service run by a clinician from the PCN and integrated with secondary care was established to improve the quality of care for patients with chronic heart failure across South Cheshire and Vale Royal. This project involved clinicians from and included patients from Ashfields Primary Care Centre. The aim was to reduce unplanned admissions, reduce heart failure mortality and increase patients’ quality of life. The care coordination team supported patients who may need additional help to access services at the practice and in the wider community. They carried out welfare checks of patients, worked with patients to provide individualised support and advertised services across the patient population and wider community to improve patient healthcare and well-being. Feedback from the National GP Patient Survey showed 94% of patients (compared to 91% nationally) reported they were involved in decisions about their care and treatment and 96% of patients (compared to 90% nationally) reported that their needs were met.

Feedback from people who used the service in the National GP Patient survey showed that 95% of respondents felt the healthcare professional they saw had all the information they needed about them during their last general practice appointment. The practice worked in partnership with other services to meet the needs of its patient population and community, for example, a phlebotomy service was delivered from the premises improving convenience for patients and reducing delays in diagnosis and treatment. The provider supported people living in local care homes with named clinicians, care coordinators and prescription clerks to support continuity of care for people.The practice worked in partnership with other services and independently to meet the needs of its patient population and community, for example, a phlebotomy service, community heart failure, vasectomy, minor surgery, DVT and menopause clinic were delivered from the premises improving convenience for patients and reducing delays in diagnosis and treatment. Dedicated clinics for asylum seekers were also provided so that they could receive continuity of care by seeing the same GPs and Nurses. They also had a dedicated Care Coordinator who supported them with registrations, documentation, information and access.

Staff communicated and provided information in a way that helped people to understand their care. People’s individual needs to have information in an accessible way were identified, recorded, highlighted and shared. Information was tailored to meet peoples specific needs, for example through the use of interpreting and translation services for people who did not speak English as a first language and supporting people who had difficulty with reading, writing or using digital services. People were provided with sufficient information about their health and treatment options for them to make an informed decision. The practice website contained NHS information about health conditions and support services that people could use. Staff had received training on information governance. The provider had up to date policies to support information governance which included General Data Protection Regulation (GDPR). All staff had completed information governance training which included General Data Protection Regulation (GDPR). The care-coordinator team facilitated information sharing for patients about local organisations for patients. They had hosted 120 engagement events at the practice within 14 months enabling patients to receive information about a number of community services providing support such as mental health, disability, carers, dementia and stroke awareness. Information about volunteering was also provided to encourage young people to become involved in the community.The team had attended local events like Armed Forces Day and a Transport Festival to give people information about the services provided. Groups were held for patients with a learning disability and people affected by dementia to give advice and guidance.

Feedback from people who used the service was reviewed and used to support service improvement. Feedback from the Patient Participation Group (PPG) indicated that changes had been made to the service as a result of listening to people’s views. For example, changes had been made to the appointment system. Patients responded very positively in the annual National GP patient survey for questions related to the healthcare professional being good or very good at listening to them and involving them as much as they wanted in decisions about their care. The provider monitored patient views through a variety of sources, including through the Friends and Family Test. They produced a monthly report for patients of the results of this feedback and actions to improve services. NHS Friends and Family Test results for November 2024 – January 2025 showed there had been 1,913 responses with 95% being extremely likely or likely to recommend the service. Information was available at the service and online so that people knew how to give feedback about their experiences of care and support, including how to make a complaint. We reviewed a sample of 3 complaints. These had been responded to appropriately. Duty of candour was evident in responses to complaints. There was a process for learning from complaints and sharing any actions needed across the whole staff team. Staff were knowledgeable about the complaint process and how to support patients to make a complaint. However, some staff told us that they were not always notified about complaints and the outcome. This was brought to the attention of the provider.

People could access care, support and treatment when they needed it and in a way that reflected their needs. Staff treated people equally and without discrimination. Digital flags were used within the care records system to highlight any specific individual needs, such as the requirement for longer appointments or for a translator to be present. Staff told us they provided opportunities and support for different groups of the patient population to overcome health inequalities. There was information available to support people to understand how to access the service. Appointments were available outside of school and usual working hours. People could access appointments online, over the phone and in person. There were systems and processes in place to prioritise people presenting with the highest need. Longer appointments were available to support the needs of patients. There was a process to promote continuity of care. The premises were accessible for people who were physically disabled. Treatment rooms were available on the ground floor and an automatic door was provided to the entrance. The percentage of respondents in the National GP Patient Survey who responded positively to their overall experience of contacting the practice was 81% (compared to 67% nationally) and 75% of respondents (compared to 66% nationally) felt they waited about the right amount of time for their last appointment. The provider monitored access to ensure it continued to meet patients needs and introduced changes to improve access in accordance with the findings.

Leaders proactively sought ways to address any barriers to equity in people’s experience and outcomes. The provider had processes to ensure people could register at the practice, including those in vulnerable circumstances such as homeless people and Travellers. Staff understood the importance of providing an inclusive approach to care and made adjustments to promote this. For example, the provider had provided an outreach service to asylum seeking patients. The provider had campaigned to improve transport for these patients due to the location of their accommodation and as a result improvements had been made. This group of patients were now able to travel to a dedicated clinic at the practice, with translation services available and they had the support of a care co-ordinator for health and social care issues. . The provider had supported 410 asylum seekers in the last year. The provider also worked with other groups of people to promote fair access. For example, they provided group sessions for people with a learning disability to explain breast screening. Reached out to young carers and the LGBTQ+ community to identify any obstacles to access and identify the support needed from the practice. The systems in place for sharing information about a range of community services also promoted equitable access for people.The provider had worked with the Integrated Care Board (ICB) to ensure these patients were vaccinated. Available data showed that people experienced similar to or better outcomes for care and treatment when compared to services locally and nationally. The results of the National GP patient survey showed that 96% of respondents felt their needs were met during their last general practice appointment and 89% described their overall experience of the practice as good.

People who used the service were provided with information to make informed decisions about their current and future care and treatment and supported to plan for these. Our records review showed people were supported to consider their wishes for their end-of-life care, including cardiopulmonary resuscitation. This information was shared with other services when necessary. Staff told us they attended multi-disciplinary meetings to discuss supporting people receiving end of life care.