Ashley Surgery

Updated 26 January 2017

Ashley Surgery is registered with the Care Quality Commission (CQC) as a partnership provider in Market Drayton, Shropshire. The practice holds a General Medical Services (GMS) contract with NHS England. A GMS contract is a contract between NHS England and general practices for delivering general medical services and is the commonest form of GP contract. The practice is a training practice for GP registrars and medical students to gain experience, knowledge and higher qualifications in general practice and family medicine.

The practice area is one of low deprivation when compared with the national and local Clinical Commissioning Group (CCG) area. At the time of our inspection the practice had 3989 patients. Demographically there is a higher proportion of patients aged over 65 (26%) and 75 (10%) when compared with the national averages of 17% and 8% respectively. There is a lower proportion of younger patients. The percentage of patients with a long-standing health condition is 63% which is above the CCG average of 57% and national average of 54%. This could mean increased demand for GP services.

The practice is open between 8am and 6pm Monday to Friday except Thursday afternoons when it closes at 1pm. It provides extended opening hours until 8pm on a Tuesday. Patients can book appointments up to six weeks in advance. At 12.30pm, Monday to Friday, the practice offers a sit and wait surgery for under five years old. The practice does not routinely provide an out-of-hours service to their own patients but patients are directed to the out of hours service, Staffordshire Doctors Urgent Care when the practice is closed.

The practice staffing comprises of:

• Two male GP partners

• A female locum GP

• A female GP Registrar

• A female nurse practitioner

• Three female practice nurses

• A female health care assistant (HCA)

• A practice manager

• An assistant practice manager

• A team of administrative staff working a range of hours

• Three dispensary staff

The practice provides a number of specialist clinics and services. For example long-term condition management including asthma, diabetes and high blood pressure. It also offers services for family planning, childhood immunisations, travel vaccinations and phlebotomy (the taking of blood from a vein for diagnostic purposes).

Updated 26 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Ashley Surgery on 16 November 2016. Overall the practice is rated as outstanding.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.

• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example, a member of staff had completed the ‘Walk Leader’ training and set up a monthly ‘Walking for Health’ group to reduce social isolation. In collaboration with the health visiting service, there were plans to start a pram walk for rurally isolated new mothers.

• Feedback from patients about their care was consistently positive.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example, a practice nurse studying for a diploma in frailty worked with Age UK North Staffordshire to provide the Senior Plus service, providing extra support to older patients to help them to continue to live independently at home.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example, to overcome problems for older adults living in a rural community in accessing phlebotomy services, the practice provided a blood test monitoring service for patients on a long-term medicine used to prevent the formation of blood clots.

• The practice had good facilities and was well equipped to treat patients and meet their needs.

• 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.

• There was a clear leadership structure and staff felt supported by the management.

• The practice had strong and visible clinical and managerial leadership and governance arrangements.

We saw two areas of outstanding practice:

• The practice was proactive and effective in reducing the number of emergency hospital admissions and A&E attendances for all population groups. Comparison of data for 2014/15 and 2015/16 demonstrated an ongoing downward trend in the number of A&E admissions.

• A health care assistant (HCA) at the practice offered smoking cessation support for patients. A 74% smoking cessation rate had been achieved at four weeks with a 56% cessation rate at 12 weeks. Due to the effectiveness of this service, the HCA had been presented with an award from the ‘Time to Quit NHS Stop Smoking Service’ for the ‘Most Consistent Quit Smoking Advisor’ in North Staffordshire for 2014/15.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 January 2017

The practice is rated as outstanding 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.

• Performance for diabetes in all five related indicators was above the Clinical Commissioning Group (CCG) and national averages. For example, the percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) was 140/80 mmHg or less was 90% which was higher than the CCG average of 77% and the national average of 78%.

• 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.

• The practice provided a blood test monitoring service for patients on a long-term medicine used to prevent the formation of blood clots.

• The practice used a text messaging system that sent patients with long-term conditions such as high blood pressure reminders and health tips tailored to their individual needs.

• Data for 2014/15 demonstrated that emergency admissions for chronic obstructive pulmonary disease per 100 patients on the disease register was four. This was seven patients per 100 lower than the CCG average of 11.

• Care plans for some long-term conditions such as diabetes were not always dated.

Updated 26 January 2017

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

• There were systems in place to identify children and young people who had a high number of A&E attendances.

• Immunisation rates were high for all standard childhood immunisations.

• Children and young people were treated in an age-appropriate way.

• The practice’s uptake for the cervical screening programme was 82%, which was comparable to the CCG and national averages of 82%.

• 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 and health visitors.

• Same day appointments were available for children and young people. At 12.30pm Monday to Friday, the practice offered a daily sit and wait surgery for under five year olds to provide parents with rapid and continuous access to appointments for young children.

• Data for 2014/15 demonstrated that emergency admissions for children with a lower respiratory tract infection per 1000 patients was three. This was below the CCG average of five patients per 1000 population.

• The practice was working with the local health visiting service to establish a pram walk for rurally isolated new mothers. 

Updated 26 January 2017

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

• The practice provided care and treatment to a higher proportion of patients aged over 65 (26%) and 75 (10%) when compared with the national averages of 17% and 8% respectively. This could mean increased demand for GP services.

• To meet the needs of this population group, a practice nurse was supported to undertake a diploma in frailty.

• The practice proactively worked with Age UK North Staffordshire to provide the Senior Plus service. The service provided extra support to older patients to help them to continue to live independently at home.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• Home visits were available for older patients and patients who had clinical needs which resulted in difficulty attending the practice.

• To overcome some of the barriers for older adults living in a rural community in accessing phlebotomy services, the practice provided a blood test monitoring service for patients on a long-term medicine used to prevent the formation of blood clots.

• The practice had hosted an awareness week and a Macmillan afternoon tea and wellbeing event for partner organisations such as Age UK, the Beth Johnson Foundation and Healthwatch to promote alternative services available for patients.

Updated 26 January 2017

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 reflects the needs for this age group.

• Extended opening hours were available until 8pm on Tuesdays and Saturday flu clinics were provided for the working age people. Telephone consultations were also available for working age people.

Updated 26 January 2017

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

• The percentage of patients with a diagnosed mental health condition who had a comprehensive, agreed care plan documented in their record, in the preceding 12 months was 100%. This was above the CCG and national averages of 89%.

• Eight-one per cent of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months. This was comparable with the CCG average of 87% and national average of 84% however their exception reporting rate of 4% was below the CCG average of 9% and the national average of 7% meaning more patients had been included.

• 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.

• All staff had received dementia friendly training and had a good understanding of how to support patients with mental health needs and dementia.

• A community psychiatric nurse (CPN) visited the practice weekly to provide a counselling service to patients experiencing poor mental health.

Updated 26 January 2017

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

• The practice held a register of patients living in vulnerable circumstances including 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. For example, the Integrated Local Care Team (ILCT), a team that included health and social care professionals and the palliative care team.

• The practice was proactive in informing vulnerable patients about how to access various support groups and voluntary organisations. For example, the practice had hosted an awareness week and a Macmillan afternoon tea and wellbeing event for partner organisations such as Age UK, the Beth Johnson Foundation and Healthwatch to promote alternative services available for patients.

• The practice ran a Carers Awareness month throughout August 2016 to identify patients who were carers and to offer support. Consequently, the practice had identified 151 patients as carers (4% of the practice list). The practice was in the process of arranging regular meetings for carers to meet at the practice with the North Staffordshire Carers Association.

• 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.

• A monthly ‘Walking for Health’ group had been established at the practice to reduce social isolation.

• The practice used a risk stratification tool and their knowledge of patients to identify and support their 2% most vulnerable patients. These patients were supported through care plans and a practice nurse worked with Age UK North Staffordshire to provide the Senior Plus service.