Ashford Clinical Commissioning Group
Ashford Clinical Commissioning Group
Health & Demographic Profile
2014
Contributors;
Dr Faiza Khan Consultant in Public Health Kent County Council
Jack Baxter Public Health Information Officer Kent & Medway Public Health Observatory Contents Summary of Findings ...... 3 Links to other useful documents/ plans ...... 3 Introduction ...... 5 Geography ...... 6 Demography ...... 10 Population Breakdowns ...... 10 Population Projections ...... 11 Population Distribution Maps- ONS 2013 Mid-year estimates ...... 13 Health Inequalities ...... 21 Indices of Multiple Deprivation (IMD) 2010 ...... 23 Children ...... 30 Life Expectancy from Birth ...... 30 Infant Mortality ...... 33 General Fertility Rate ...... 35 Low Birth Weight ...... 36 Breastfeeding ...... 36 Children’s Centres ...... 37 Child Wellbeing Index 2009 ...... 39 Immunisation & Vaccination ...... 41 National Child Measurement Programme (NCMP) ...... 44 Child and Adolescent Mental Health Services ...... 45 Sexual Health ...... 48 Older People ...... 50 Chronic Diseases ...... 51 Risk Factors for Chronic Diseases ...... 51 Smoking Prevalence ...... 51 Adult Obesity Prevalence ...... 52 Alcohol Misuse ...... 54 Ashford LAPE Profile (2012 Update) ...... 56 Chronic Disease Patterns ...... 58 King’s Fund 10 Priorities for Commissioners ...... 58 Long Term Conditions ...... 59 Cancer Registrations ...... 59 Quality Outcomes Framework (QOF) ...... 62 Diabetes ...... 63 Coronary Heart Disease ...... 67 Stroke or Transient Ischaemic Attacks ...... 71 Hypertension ...... 75 Chronic Obstructive Pulmonary Disorder (COPD) ...... 79 Mental Health ...... 83 Dementia ...... 83 Page | 2
Mental Illness Needs Index 2000 ...... 85 Falls ...... 90 Hospital Activity: A&E Attendances and Admissions ...... 95 Ashford CCG A&E Attendance Rates ...... 95 Emergency admission rates in Ashford, 2012/13 ...... 109 Elective admission rates in Ashford for older people, 2012/13 ...... 123 Outpatient attendance rates in Ashford for older people, 2012/13...... 127
Links to other useful documents/ plans Healthy Lives, Healthy People: Our strategy for public health in England https://www.gov.uk/government/publications/healthy-lives-healthy-people-our-strategy-for-public- health-in-england Kent Joint Strategic Needs Assessment 13/14 Update http://www.kmpho.nhs.uk/jsna/ Kent Alcohol Strategy 2014-2016 http://www.kmpho.nhs.uk/EasysiteWeb/getresource.axd?AssetID=379439&type=full&servicetype=Att achment Ashford Borough Council corporate plan 2013-2015 http://www.ashford.gov.uk/focus-2013-15-corporate-plan Ashford CCG plans, reports and strategies http://www.ashfordccg.nhs.uk/about-us/our-plans-reports-and-strategies/ NHS England five year forward view http://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf Public Health England marketing strategy: 2014 to 2017 https://www.gov.uk/government/publications/public-health-england-marketing-strategy-2014-to-2017
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Summary of Findings 1. The area which comprises the CCG is made up of 35 electoral wards. 2. The CCG has a total of 14 practices with 3 branch practices. 3. It has a total registered population of 64,457 females and 61,943 males as of 31/12/2014. 4. Ashford CCG has a lower proportion of registered patients aged 65+ and 85+ compared to the Kent average. 5. The most deprived areas are mainly central to the area in Downs West, Norman, Bockhanger, Stanhope, Beaver, Victoria and Aylesford Green wards. 6. Ashford has no GP practices that serve patients in the 20%-40% most deprived areas nationally. 7. Ashford CCG has the highest life expectancy from birth of all Kent CCG’s at 82.5 years. 8. Ashford has the third lowest infant mortality rate of all the CCGs in Kent for 2011-2013. 9. Ashford has a higher General Fertility Rate than Kent for the period 2009-2013. 10. Ashford has a lower percentage of babies born with a low birth weight compared to Kent and England. 11. It has a 6-8 week breastfeeding prevalence of 36.8% with a coverage of 75.5% for 2013/14. 12. It has a total of 6 Children’s Centres. 13. There are a number of practices failing to reach the minimum target of 90% immunisation for vaccinations in Ashford practices at quarter 2 in 2014/15. 14. Ashford has the lowest admission rate in 2013/14 of all Kent CCGs for deliberate and unintentional injuries for 0-19 year olds. 15. There is a high prevalence of obesity for Year R & 6 children in Aylesford Green and Stanhope wards. 16. Ashford has a lower teenage conception rate than Kent for the year 2012. 17. Ashford has the highest life expectancy once you reach the age of 65 of all Kent CCGs at 20.7 years for the period 2009-2013. 18. Approximately 22.7% of adults in Ashford borough are obese compared to 21.2% in Kent and 23% in England (Active People Survey 2012). 19. Ashford has held a significantly lower admission rate due to alcohol-specific admissions compared to Kent since 2006/07 for all ages. 20. Alcohol specific admission rates for the under 20’s have presented a significant downward trend since 2006/07 in Ashford CCG, falling significantly lower than the rate for Kent since 2011/12. 21. The crude cancer registration rate in Ashford CCG is lower than Kent for the period 2008-2012. 22. The prevalence of diabetes in Ashford CCG practices is 6.1%, compared to 5% in Kent. 23. Both elective and emergency admissions rates due to diabetes have increased year on year in Ashford and Kent since 2006/07. 24. There is a prevalence of 3.1% for Coronary Heart Disease in Ashford CCG which is similar to Kent but lower than England (3.3%), there are potentially 1,179 patients undiagnosed. 25. Emergency admission rates for CHD have plateaued since 2010/11 and remain higher than elective admission rates for the condition in Ashford and Kent. 26. The prevalence of Stroke in Ashford CCG is 1.8% compared to 1.7% for Kent and England, there are potentially 31 patients who could have the condition but are unaware. 27. Ashford has held a slightly higher emergency admission rate than Kent due to a Stroke since 2006/07; elective rates for the condition have also risen above Kent since 2010/11. 28. The prevalence of Hypertension in Ashford CCG is 14.1% compared to 14.4% in Kent and 13.7% in England, there are potentially 11,369 patients who are unaware they have the condition. 29. Age-standardised admission rates for Hypertension have seen a year on year increase both electively and as an emergency in Kent and Ashford CCG. 30. The prevalence of COPD in Ashford is 1.6% compared to 1.8% in Kent and England, there is a potential 815 patients who are unaware they have the condition in the CCG. 31. COPD admission rates have also seen a year on year increase in Ashford and Kent with Ashford remaining lower than Kent since 2006/07 for both elective and emergency admissions. 32. Emergency admission rates due to dementia have remained below those of Kent in Ashford CCG since 2006/07. 33. Emergency admission rates as a result of a fall have remained lower than Kent in Ashford CCG since 2006/07. Page | 4
Introduction
NHS Ashford CCG was created in 2012 and became fully operational on 1 April 2013. It has a total GP registered population of 126,400 as of 31/12/2014; whereas the total resident population equalled 121,723 in 2013 (ONS mid-year estimates)
The CCG is responsible for commissioning the following services
Urgent and emergency care (including 111, Accident & Emergency and ambulance services) Out-of-hours GP services Planned hospital care (operations and other treatments that can be planned in advance) Community health services (such as community nurses, speech and language therapy, continence services, wheelchair services, and home oxygen services) Rehabilitation services (for example, physiotherapy after an accident or stroke) Maternity and new-born services (excluding neonatal intensive care) Children’s healthcare services (mental and physical health) Services for people with learning disabilities Mental health services (including psychological therapies) Infertility services Continuing healthcare Medication
The CCG does not have responsibility for health improvement services (such as sexual health, stop smoking services or healthy weight services) or commissioning primary care (GP surgeries, dentists, pharmacies and optometrists) or specialised health services.
Ashford CCGs mission is to improve the health and well-being of the population of Ashford by successfully engaging local GPs to lead their work and by working in partnership with patients, Ashford Borough Council, Public Health and other key stakeholders, to develop plans to improve outcomes.
Ashford CCG values
Listen: listening to patients, being responsive and ensuring their thoughts and needs shape the Group's commissioning decisions and striving to ensure all patients have the best possible experience of the NHS.
Collaborate: Best healthcare is delivered when working together – clinicians, patients, stakeholders and all sections of the community. The Group will work as one with its stakeholders within the Area and partner Clinical Commissioning Groups across the East Kent Federation so that the Group becomes recognised as a confident organisation that listens, learns and delivers.
Be open to change: As the needs of patients change and new treatments develop the Group will strive to make sure it always commissions high quality and value for money services.
Be realistic about the challenge ahead: The Group knows that with the increasing demands on services it needs to deliver sustainable services within the limits of its financial resources. The Group will be open and honest with all its patients and stakeholders and work closely with them to prioritise the Group's commissioning decisions.
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Geography Figure 1- Kent & Medway district authorities with CCG outlines.
There are eight Clinical Commissioning Groups in the Kent & Medway area and thirteen districts. Page | 6
Figure 2- Electoral Wards within Ashford CCG
Page | 7 There are 35 electoral wards that make up the Ashford CCG area; they are also coterminous with the Ashford district borough.
Figure 3- Approximate location of GP Practices in Ashford CCG
There are 14 GP practices in Ashford CCG area. Majority of the practices are located south and south east of A251 and A28 with only two practices in the north and north-west of these roads. Page | 8
Table 1- Key to Figure 3
*Letter suffix (e.g. 2a) denotes a Branch practice of a partnership group (see below). Practice Community Key PartnershipName PracticeName Code Network 1 G82049 Dr MOHAMMED YI Hollington Surgery North 2 G82050 South SYDENHAM HOUSE MED C AT & P Sydenham House Medical Centre 2a G82050 South 3 G82053 FRONT ROAD SURGERY AT & Par Woodchurch Surgery Rural 4 G82080 Dr COONEY JA & Partners The Willesborough Health Centre North 5 G82087 NEW HAYESBANK SURG A & Part New Hayesbank Surgery North 6 G82094 THE CHARING SURGERY A & Par The Charing Surgery North 7 G82114 IVY COURT SURGERY A & Partn Ivy Court Surgery Rural 8 G82142 WYE SURGERY A & Partners Wye Surgery North 9 G82186 Rural HAMSTREET SURGERY AT & Part Hamstreet Surgery 9a G82186 Rural 10 G82658 Dr DEL BIANCO G & Partner Sellinge Surgery North 11 G82688 South Dr SETTY MVS & Partner Singleton Surgery 11a G82688 South 12 G82712 Dr THOMAS A Singleton Medical Centre South 13 G82730 Dr KELLY JC & Partners Kingsnorth Medical Practice South 14 G82735 SOUTH ASHFORD MEDICS AT & P South Ashford Medics South 1 Practice has now closed in Ashford CCG G82748 has now closed and patient list has merged with G82050- Sydenham House Medical Centre.
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Demography Population Breakdowns Figure 4-
The total registered population for Ashford CCG at 31/12/2014 was 126,400 compared to a resident population of 121,723. Overall Ashford broadly presents a similar proportional representation for each age band compared to Kent, however there are a few slight differences between the two with Ashford presenting a higher proportion of 0-14 and 40-49 year old females and 5-19 and 40-54 year old males. Whereas in both genders there is a slightly smaller representation of 20-24s, 55-64s and those aged 70+. Page | 10
Population Projections Figure 5- Population projections - Males
The predicted trends for males aged 65+ and 85+ are what you’d expect as they’re showing a gradual increase in numbers over the next 24 years and a massive percentage increase of 83.5% and 250% respectively. This will require innovative service planning for the future in order to cope with the needs and demands of the older population; approximately one quarter of the Ashford CCG male population will be aged over 65 by 2037 whereas the population of 16-64s (working age) will only make up just over half of the total population (55.4%) despite having a percentage increase of 10.2% between 2013 and 2037. The 0-4 age group is set to rise 7.3% over this time and 5-19s by 13.9% in the same period however as with the 16-64s their proportional representation of the total population will be decreasing while the 65+ age group is inflated as a result of the baby boom after the Second World War.
Male Population Projection % of total population Age Predicted Difference from % Increase 2013 2017 2021 2025 2029 2033 2037 Group 2013-2037 (thousands) from 2013 0-4 0.29 7.3% 6.7% 6.7% 6.6% 6.3% 6.1% 5.9% 5.8% 5-19 1.63 13.9% 19.9% 19.3% 19.2% 19.4% 19.2% 18.8% 18.3% 16-64 3.70 10.2% 61.7% 60.5% 59.5% 58.6% 57.3% 56.1% 55.4% 65+ 8.32 83.5% 16.9% 18.3% 19.2% 20.4% 22.1% 23.9% 25.1% 85+ 2.52 250.0% 1.7% 2.1% 2.4% 2.8% 3.4% 4.4% 4.8% All of these projections are published by the Office for National Statistics and are available at: http://www.ons.gov.uk/ons/rel/snpp/sub-national-population-projections/2012-based-projections/rft- open-population-ccg.zip
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Figure 6- Population projections - Females
The projected female population for Ashford CCG follows the same pattern as males with the exception of a couple of small differences; the 65+ population has already overtaken the number of 5-19 year olds whereas with males this isn’t due to happen until 2021. A similar overlap occurs between the 0-4s and 85+ in the year 2033 whereas males are not expected to until after 2037 based on current trends. The large increase in the 65+ age group is likely to be the same across the whole of England due to the aforementioned baby boom after the Second World War (anyone born between 1945 and 1950 will all be 65 by the year 2015) this helps explain why the percentage increase and proportional representation of the total population are significantly higher in these age groups compared to the younger age bands, it is also connected to the fact people are living longer, healthier lives as well as fewer babies being born each year.
Female Population Projection % of total population Age Predicted Difference from % Increase 2013 2017 2021 2025 2029 2033 2037 Group 2013-2037 (thousands) from 2013 0-4 0.25 6.5% 6.3% 6.2% 6.1% 5.9% 5.7% 5.5% 5.5% 5-19 1.81 16.0% 18.1% 17.9% 17.9% 18.1% 18.0% 17.7% 17.3% 16-64 3.04 8.0% 60.7% 59.6% 58.4% 57.4% 56.1% 54.8% 53.8% 65+ 8.98 73.5% 19.5% 20.8% 21.7% 22.9% 24.6% 26.5% 27.8% 85+ 2.90 152.0% 3.1% 3.3% 3.5% 3.9% 4.6% 5.8% 6.3%
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Population Distribution Maps- ONS 2013 Mid-year estimates Figure 7- Population Distribution 0-4s
Top 5 highest wards 1 Victoria (534) 2 Godinton (489) 3 Stanhope (476) 4 Park Farm South (435) 5 Beaver (396)
Bottom 5 lowest wards 31 Rolvenden and Tenterden West (96) 32 St Michaels (90) 33 Kennington (86) 34 Tenterden North (84) 35 Charing (75)
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Figure 8- Population Distribution 0-19s
Top 5 highest wards 1 Godinton (1935) 2 Victoria (1700) 3 Park Farm South (1680) 4 Stanhope (1551) 5 Beaver (1545)
Bottom 5 lowest wards 31 Wye (498) 32 Rolvenden and Tenterden West (493) 33 Kennington (468) 34 Tenterden North (392) 35 Charing (374)
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Figure 9- Population Distribution 16-64s
Top 5 highest wards 1 Godinton (4443) 2 Victoria (3880) 3 Beaver (3544) 4 Stour (3280) 5 Park Farm South (3229)
Bottom 5 lowest wards 31 St Michaels (1313) 32 Charing (1307) 33 Tenterden South (1304) 34 Wye (1274) 35 Tenterden North (1115)
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Figure 10- Population Distribution 65+
Top 5 highest wards 1 Weald South (1448) 2 Saxon Shore (1194) 3 Weald Central (1139) 4 North Willesborough (1069) 5 Beaver (1009)
Bottom 5 lowest wards 31 Norman (386) 32 South Willesborough (316) 33 Washford (314) 34 Stanhope (252) 35 Park Farm North (156)
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Figure 11- Population Distribution 85+
Top 5 highest wards 1 Weald South (191) 2 Stour (186) 3 Tenterden North (155) 4 North Willesborough (154) 5 Tenterden South (144)
Bottom 5 lowest wards 31 South Willesborough (33) 32 Norman (30) 33 Washford (22) 34 Park Farm North (18) 35 Stanhope (15)
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Figure 12- Population Density
Top 5 highest wards 1 Stanhope (70.2) 2 Park Farm South (62.3) 3 Beaver (50.8) 4 Aylesford Green (46.2) 5 Little Burton Farm (45.1)
Bottom 5 lowest wards 31 Saxon Shore (0.7) 32 Downs West (0.7) 33 Rolvenden and Tenterden West (0.6) 34 Downs North (0.5) 35 Isle of Oxney (0.5)
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Figure 13- Proportion of CCG registered practice populations aged 65+ and 85+
Ashford CCG has a lower proportion of registered patients aged 65+ and 85+ compared to the Kent average. These proportions represent the percentage of patients that make up their total registered population. As you can see from the chart Ashford has the third lowest proportion of 65+ and 85+ year olds out of all 7 of Kent’s CCGs Page | 19
Figure 14- Ethnicity in Ashford CCG and Borough (Census Based) - Broad Ethnic Groups (excluding White)
The wards with the highest percentage of people of Asian ethnicity are Victoria, Stour, Godinton and Stanhope. Those with the highest percentage of Black ethnicity are South Willesborough, Park Farm North and Little Burton Farm. Page | 20
Health Inequalities The Health and Social Care Act 2012 now places a new statutory duty on health services to reduce inequalities in health. Demonstrating this intention is also a requirement of CCGs for the purposes of authorisation by the NHS National Commissioning Board. Inequalities-in-health is primarily a socio-economic relationship. The poorer people are, the greater the likelihood of early onset disability, chronic disease and a shorter life span. In contrast, those who are of a higher status are expected to have a much greater disability-free life span and live a lot longer. People with low socio-economic status are at greater risk of behaviours causing ill health. They will have higher smoking rates, a poorer diet; have less opportunity to take part in social activities and poorer mental health. Whilst it is undeniable that individual behaviour is a significant driver of ill health, it is wrong to attribute all causes of premature poor health and early death to personal behaviour. If such behaviour was eliminated, people with the lowest socio-economic status would certainly live longer, but would continue to die prematurely relative to the mainstream society. Addressing health inequalities as a strategic response requires CCGs to commit to partnership working with other statutory agencies whose capacity to address the wider determinants of health is core to their purpose. Accordingly Ashford CCG must support the actions of Kents’ Public Health Team, working with local authorities to address the root causes of disadvantages in society, whether through the Kent Health Inequalities Strategy, through Ashford Borough Council’s Corporate Plan or through the work of Local Children’s Trusts. In addition the British Medical Association through the Presidency of Professor Sir Michael Marmot has identified a range of actions that doctors can implement directly.
Doctors can help by intervening with individual patients, their families and contacts, using clinical tools including social prescribing and brief interventions. They can work within communities, for example, by commissioning measures including health promotion and ill-health prevention that will affect changes to the social determinants and are effective in the whole community including those who are traditionally hard to reach; such as gypsy and traveller communities.
Doctors can use evidence and influence to have a positive impact on health inequalities. Doctors can use their position and their expertise to advocate for change to areas outside traditional medical areas and to promote the generation of research, especially on the efficacy of prevention measures.
Source: BMA Publications 2011
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Figure 15- Outline of the HINST Intervention Model
National SupportTeam)
HINST(Health Inequalities
Bentley (2007) C SystematicallyAddressing InequalitiesHealth
Source: The direct actions that clinical services need to focus upon include:
A) Partnership, vision and strategy, leadership and engagement This requires ‘seamless’ partnership working between local authorities and CCGs. The CCG has a statutory duty to collaborate with social services. Public Health has a major leadership role but cannot deliver on its own. There is a need for a detailed strategy or action plan which shows how local inequality targets can be achieved. B) Systematic and scaled interventions by frontline services Primary care services will need to play a central role requiring organisational capacity to be addressed by some practices if they are to work more effectively on this agenda. There is a need for training systematically to ensure effective brief interventions, referral pathways, and performance monitoring which should at least cover smoking, alcohol problems and obesity. C) Systematic community engagement The CCG and local authorities should have joint systems for reaching vulnerable patients at highest risk who may be demotivated and not in meaningful contact with services. Such systems should be of sufficient scale to make a difference. A comprehensive engagement system is needed to interact not only with community groups but also with socially excluded individuals and families, e.g. through health trainers. D) Frontline service engagement with the community Many local areas have large portions of the population that are seldom seen, seldom heard. This can be addressed through the systematic use of practice registers and outreach staff to draw people in to services. Outreach strategies need to be targeted and scaled up appropriately in order to have impact across whole communities. The NHS workforce needs to be integrated effectively. The voluntary sector has great potential to bridge across from service into community provided that that sector is supported to develop its infrastructure to function at a strategic level.
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Indices of Multiple Deprivation (IMD) 2010 Figure 16- Deprivation- IMD Score Overall
Summary of IMD
There is due to be an update to this in summer 2015.
The English Indices of Deprivation 2010 use 38 separate indicators, organised across seven distinct domains of deprivation which can be combined using appropriate weights, to calculate the Index of Multiple Deprivation 2010 (IMD 2010).
This is an overall measure of multiple deprivations experienced by people living in an area and is calculated for every Lower layer Super Output Area (LSOA) in England.
The IMD 2010 can be used to rank every LSOA in England according to their relative level of deprivation.
Source: https://www.gov.uk/government/uplo ads/system/uploads/attachment_dat a/file/6871/1871208.pdf
This analysis describes the distribution of residents of the Ashford CCG area by reference to their socio-economic status. The majority of the most deprived LSOAs are found centrally in the Downs West, Norman, Bockhanger, Stanhope, Beaver, Victoria and Aylesford Green wards. The least deprived LSOAs are found in St Michaels, Kennington, Highfield, Park Farm North and Park Farm South wards. Page | 23
Figure 17- Income Deprivation
Income Deprivation Domain
This domain measures the proportion of the population in an area experiencing deprivation related to low income. A combined count of income deprived individuals per LSOA is calculated by summing the following five indicators; Adults and children who are; In income support families. In income-based jobseekers allowance families. In pension credit (Guarantee) families. In child tax-credit families whose collective income is below 60% of the median before housing costs. -And Asylum seekers in England in receipt of subsistence support, accommodation support or both.
The wards which are the most deprived in terms of their income are very similar to those highlighted for their overall IMD Score. Wye ward presents 1 LSOA in the least deprived and 1 in the most deprived as does Downs West which contributes to health inequalities. The most deprived areas are found in the following wards; Aylesford Green, Beaver, Bybrook, Bockhanger, Norman, Stanhope and Victoria. The least deprived areas are in Godinton, Kennington, Highfield, Saxon Shore and Park Farm North and South wards.
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Figure 18- Employment Domain
Employment Domain
This domain measures employment deprivation in an area conceptualised as involuntary exclusion of the working age population from the labour market.
A combined count of employment deprived individuals per LSOA is calculated by summing seven indicators.
Please follow the link on page 23 for a more detailed insight into how this is calculated.
The most deprived areas based on the employment domain are almost exactly the same as the overall IMD score with 1 LSOA in Godinton replacing one in Norman ward as the only difference. The least deprived areas are in Saxon Shore, Wye, Park Farm North and South and Godinton, which is made up of the 20% most and least, deprived LSOAs and indicates there is stark presence of health inequalities.
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Figure 19- IDACI
Income Deprivation Affecting
Children Index
In addition to the income deprivation index (Figure 17) there are two supplementary indices also produced;
Income Deprivation Affecting Children Index Income Deprivation Affecting Older People Index.
The IDACI represents the proportion of children aged 0-15 living in income deprived households .
The picture for IDACI highlights all the usual suspects for the most deprived areas but presents a slightly different outlay for the least deprived areas, which includes Highfield, North Willesborough, Biddendden,Tenterden South and parts of Park Farm North and South.
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Figure 20- IDAOPI
Income Deprivation Affecting Older People Index
The IDAOPI represents the proportion of older people aged 60 and over living in income deprived households respectively.
For a more in depth definition of any of these indicators please follow the link below.
Source: https://www.gov.uk/governmen t/uploads/system/uploads/attac hment_data/file/6871/1871208. pdf
The prime measure here is the extent to which there are sufficient concentrations of older people whose primary dependency is upon state pensions alone. The lack of income in later years is a useful proxy for identifying people at greater risk of early onset chronic disease. Downs West and Wye contain LSOAs in the least and most deprived quintiles which presents priority areas regarding health inequalities. The most deprived areas lie within Aylesford Green, Beaver, Stanhope and Bockhanger wards. The least deprived areas are found in Highfield, Biddenden, Saxon Shore, Park Farm North, Tenterden South and Bybrook wards. Page | 27
Figure 21- Living Environment
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Living Environment Domain
This domain from the Index of Multiple Deprivation measures the physical and financial accessibility of housing and key local services. The indicators fall into two sub-domains: ‘geographical barriers’ which relate to the physical proximity of local services and ‘wider barriers’ which include issues relating to access to housing such as affordability. Seven indicators are combined to calculate this domain.
Wider barriers: • Household overcrowding – the proportion of households within an LSOA which are judged to have insufficient space to meet the household’s needs; • Homelessness – the rate of acceptances for housing assistance under the homelessness provisions of the 1996 Housing Act (at local authority district level); • Difficulty of access to owner-occupation (local authority district level) – proportion of households aged under 35 whose income means they are unable to afford to enter owner occupation.
Geographical barriers: • Road distance to a GP surgery; • Road distance to a supermarket or convenience store; • Road distance to a primary school’ • Road distance to a post office.
What therefore is being measured is the extent of spatial and service isolation and thus factors which may have some dilatory influence on positive mental health. This analysis offers a perspective that is counter to many of the other cartographic descriptions of deprivation but not all. Housing issues such as overcrowding and homelessness are both still found in all of the major centres of populations. On the other hand, the distance from location of basic services and amenities is also reflected in the extensive rural parts of the Ashford CCG area
Table 2- Practice Deprivation by IMD 2010 20% Most 40% Most Between 40% Most Deprived 40% Least 20% Least CCG Deprived Deprived & 40% Least Deprived Deprived Deprived NHS Ashford CCG 1 9 4 NHS Canterbury & Coastal CCG 10 11 1 NHS Dartford, Gravesham & Swanley CCG 3 12 12 7 NHS South Kent Coast CCG 1 11 10 9 NHS Swale CCG 4 3 8 5 NHS Thanet CCG 4 7 5 4 NHS West Kent CCG 1 3 27 31 Kent 9 25 49 77 43 Source: IMD 2010 by GP Practice Ashford CCG has no practices who serve patients that live in the 40% most deprived areas in England. It has 4 practices with patients who live in the 20% least deprived areas and 9 practices with patients who live in the 40% least deprived areas for the whole of England.
The GP Practice IMD is estimated by taking a weighted average of the IMD scores for each LSOA in which a given practice has patients registered. The weights are the % of the practice's registrations in each LSOA.
The GP Practice IMD scores are provided by the Public Health Observatories on behalf of the Department of Health
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Children Life Expectancy from Birth Figure 22- Life Expectancy from birth by CCG in Kent
The Ashford CCG area has a life expectancy of 82.5 years making it the highest of all the Kent CCGS and significantly higher than the Kent & England averages; Kent (81.5) England (81.1). However it should be noted that the England value is for the period 2010-2012 and is the midpoint of the male and female life expectancy as data for both sexes is not produced, unfortunately 5-year data for LE isn’t produced nationally so a three year average is the best available as a comparator. The highest life expectancy from birth is in Weald North ward at 87.7 years, there are 25 wards in Ashford CCG with a significantly higher life expectancy compared to Kent and 6 wards are significantly worse than the England average. The ward with the lowest life expectancy is Aylesford Green at 79.1 years; 2.4 years lower than the Kent average.
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Figure 23- Life expectancy from birth by Ward in Ashford CCG, 2009-2013
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Figure 23.1- Map of Life expectancy from birth by Ward in Ashford CCG, 2009-2013
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Infant Mortality Figure 24- Infant Mortality Trend 2006-2013
The infant mortality trend for Ashford CCG fluctuated between 2006 and 2008 and presented a consistent downward trend from 2008-2012 taking it well below the Kent and England rate until 2013 where it jumped back up to 5.1 per 1,000 live births, the same rate as in 2006. Page | 33
Figure 25- Infant Mortality rate by CCG, 2011-2013
Ashford CCG had the third lowest infant mortality rate of all the CCGs in Kent for the period 2011-2013 and was also lower than the rate for Kent and England.
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General Fertility Rate Figure 26- GFR 2009-2013 by Electoral Ward
The general fertility rate for Ashford CCG is slightly higher than the Kent rate. The wards with the highest fertility rates are Stanhope, Singleton South, Great Chart with Singleton North, Aylesford Green and Victoria Wards. The wards with the lowest rates are Saxon Shore, Weald North, Weald Central, Kennington and St Michaels wards. Figure 27- GFR 2009-2013 Map
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Low Birth Weight Figure 28- Percentage of low birth weight (<2500g) babies born by electoral ward 2011-2013.
The Ashford area has a lower percentage of babies born weighing less than 2500 grams compared to Kent and England, however the following wards present higher figures than the national and county comparators; Kennington, Highfield, Tenterden North and Rolvenden & Tenterden West wards. Figure 29- LBW Babies Born 2011-2013 Map
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Breastfeeding Table 3- 6-8 Week breast feeding status 2013/14 Number of Number of Number of Number of Infants Number of Prevalence Coverage Clinical Commissioning Groups Breastfed Part Breastfed Infants Not where status is Maternities % % Infants Infants Breastfed unknown Ashford 1,447 371 161 561 354 36.8% 75.5% Canterbury & Coastal 1,870 611 230 717 312 45.0% 83.3% Dartford, Gravesham & Swanley 3,321 763 459 1,531 568 36.8% 82.9% South Kent Coast 2,079 481 220 882 496 33.7% 76.1% Swale 1,444 255 115 648 426 25.6% 70.5% Thanet 1,617 296 135 712 474 26.7% 70.7% West Kent 5,333 1,867 676 1,938 852 47.7% 84.0% Kent 17,111 4,644 1,996 6,989 3,482 38.8% 79.7% Source: Child Health Computer Table three shows the breastfeeding prevalence and coverage for all CCGs in Kent for the 2013/14 financial year. Ashford CCG had a breastfeeding prevalence of 36.8% and a coverage of 75.5% which denotes the percentage of the population where the breastfeeding status is known, there were 354 cases where there had not been a 6-8 week check recorded for new-borns. Ashford performed slightly worse than Kent for 2013/14 with Kent recording a prevalence of 38.8% and a coverage of 79.7% for the year. Children’s Centres The monitoring of child health is in accordance with the national Healthy Child programme. This programme is conceived in two parts: birth to age five and five to 19. There is internationally-based evidence to show that over the life course, a person’s health is fundamentally influenced by influences in the first few months of life and a child’s early years (0-3). The delivery of this programme falls significantly to the role of the health visitor working in conjunction with a range of providers of children’s services. In recent years there has been a transformation of early year’s provision through the establishment of children’s centres with a view that primary childcare is not something which should be medicalised. The current policy of the Government is to re-build the profession of health visitors and expand their numbers. Locally the importance of health visitors has been consistently recognised and in the short term the delivery of the health visitor programme will fall to the NHS Commissioning Board and, at the completion of the programme (2015) the commissioning of these services will be transferred to local authorities re-confirming a historic position (pre-1974). Health visitor practise is seen to be crucial in the context of the role of children’s centres and thus health visitors will primarily be based in such centres. It is essential that there is effective liaison between health visitors, children’s centres and primary care teams and therefore a requirement that each practice has a named health visitor
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Figure 30- Approximate location of children’s’ centres
Key Children's Centre Name 1 The Willow Children's Centre 2 Ray Allen Children's Centre 3 Waterside Children's Centre 4 Sure Steps Children's Centre (Phoenix) 5 Bluebells Children's Centre (Hothfield) 6 Little Explorers Children's Centre
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Child Wellbeing Index 2009 Figure 31- Health & Disability Score
This is a mapped overall summary of children’s health drawn from a specific field of children’s indicators of wellbeing based on a variant of the Index of Multiple Deprivation as published in 2007. It covers for this purpose:
• All emergency admissions to hospital for children aged 0-18 as a proportion of all children aged 0-18 in each LSOA. (Source: Hospital Episode Statistics for England, 2005/6); • All outpatient hospital attendances for children aged 0-18 as a proportion of all children aged 0-18 in each LSOA. (Source: Hospital Episode Statistics for England, 2005/6); • The proportion of children aged 0-16 receiving Disabled Living Allowance. (Source: DWP, 2005).
Particular attention should be drawn to a greater proportion of children with poor health and disability found in the Godinton, Victoria, Norman, Weald East, Washford and Stanhope wards.
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Figure 32- Material Well-being Score – Child well-being Index 2009 This map describes material wellbeing for children as analysed by a variant of the Index of Multiple Deprivation 2007.
Particular note should be taken of the southern LSOA in Downs West ward which presents LSOAs in the best and worst quintile for the Material Well- being score. Other areas in the worst quintile are Stour, Norman, Victoria and Stanhope wards.
Children born into poverty are more likely to:
• Die in the first year of life; • Be born small, or born early, or both; • Be bottle fed; • Die from an accident in childhood; • Smoke and/ or have a parent who smokes; • Have poor nutrition; • Become a lone parent; • Have or father children younger; • Suffer from mental health problems; • Die in an accident; • Die younger.
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Immunisation & Vaccination Figure 33- 2014/2015 Quarter 2 Practice level vaccinations to 1st birthday
# children reaching Up to 1st Birthday GP Practice Practice Name 1st birthday during DTaP/IPV/Hib MenC PCV Key WHO Targets Code Quarter 2 # Vaccinated % Uptake # Vaccinated % Uptake # Vaccinated % Uptake > 95% G82049 Hollington Surgery 6 6 100.0% 6 100.0% 6 100.0% 90% - 95% G82050 Sydenham House Medical Centre 47 46 97.9% 46 97.9% 46 97.9% G82053 Woodchurch Surgery 6 6 100.0% 6 100.0% 6 100.0% < 90% G82080 The Willesborough Health Centre 52 51 98.1% 52 100.0% 51 98.1% G82087 New Hayesbank Surgery 43 40 93.0% 41 95.3% 41 95.3% G82094 The Charing Surgery 20 18 90.0% 19 95.0% 18 90.0% G82114 Ivy Court Surgery 17 16 94.1% 16 94.1% 16 94.1% G82142 Wye Surgery 23 20 87.0% 20 87.0% 20 87.0% G82186 Hamstreet Surgery 11 10 90.9% 10 90.9% 10 90.9% G82658 Sellinge Surgery 9 8 88.9% 9 100.0% 9 100.0% G82688 Singleton Surgery 12 11 91.7% 11 91.7% 11 91.7% G82712 Singleton Medical Centre 15 13 86.7% 15 100.0% 13 86.7% G82730 Kingsnorth Medical Practice 36 34 94.4% 34 94.4% 34 94.4% G82735 South Ashford Medics 32 30 93.8% 31 96.9% 30 93.8% G82748 Musgrove Park Medical Centre 24 20 83.3% 22 91.7% 20 83.3% Ashford CCG 353 329 93.2% 338 95.8% 331 93.8% Kent 4394 3870 88.1% 4114 93.6% 3914 89.1% Source: Child Health Computer Figure 34- 2014/2015 Quarter 2 Practice level vaccinations to 2nd birthday
# children reaching Up to 2nd Birthday Primaries Up to 2nd Birthday Boosters GP Practice Practice Name 2nd birthday during DTaP/IPV/Hib MMR MenC Infant Hib/MenC PCV Code Quarter 2 # Vaccinated % Uptake # Vaccinated % Uptake # Vaccinated % Uptake # Vaccinated % Uptake # Vaccinated % Uptake G82049 Hollington Surgery 3 3 100.0% 3 100.0% 3 100.0% 3 100.0% 3 100.0% G82050 Sydenham House Medical Centre 49 48 98.0% 45 91.8% 45 91.8% 45 91.8% 42 85.7% G82053 Woodchurch Surgery 12 11 91.7% 10 83.3% 11 91.7% 10 83.3% 9 75.0% G82080 The Willesborough Health Centre 52 50 96.2% 45 86.5% 48 92.3% 45 86.5% 43 82.7% G82087 New Hayesbank Surgery 66 65 98.5% 60 90.9% 63 95.5% 61 92.4% 60 90.9% G82094 The Charing Surgery 21 20 95.2% 17 81.0% 18 85.7% 18 85.7% 18 85.7% G82114 Ivy Court Surgery 33 32 97.0% 28 84.8% 32 97.0% 27 81.8% 28 84.8% G82142 Wye Surgery 14 14 100.0% 13 92.9% 13 92.9% 13 92.9% 13 92.9% G82186 Hamstreet Surgery 21 20 95.2% 20 95.2% 20 95.2% 20 95.2% 20 95.2% G82658 Sellinge Surgery 8 8 100.0% 8 100.0% 8 100.0% 8 100.0% 7 87.5% G82688 Singleton Surgery 27 26 96.3% 25 92.6% 26 96.3% 25 92.6% 25 92.6% G82712 Singleton Medical Centre 14 14 100.0% 13 92.9% 14 100.0% 14 100.0% 14 100.0% G82730 Kingsnorth Medical Practice 42 40 95.2% 39 92.9% 41 97.6% 41 97.6% 41 97.6% G82735 South Ashford Medics 42 38 90.5% 33 78.6% 38 90.5% 33 78.6% 27 64.3% G82748 Musgrove Park Medical Centre 18 18 100.0% 12 66.7% 18 100.0% 12 66.7% 12 66.7% Ashford CCG 422 407 96.4% 371 87.9% 398 94.3% 375 88.9% 362 85.8% Kent 4625 4323 93.5% 4069 88.0% 4291 92.8% 4094 88.5% 3891 84.1%
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Figure 35- 2014/2015 Quarter 2 - Practice level vaccinations to 5th birthday
# children reaching Up to 5th Birthday Primaries GP Practice Practice Name 5th birthday during DT/Pol MMR Hib MenC Pertussis PCV Code Quarter 2 # Vaccinated % Uptake # Vaccinated % Uptake # Vaccinated % Uptake # Vaccinated % Uptake # Vaccinated % Uptake # Vaccinated % Uptake G82049 Hollington Surgery 12 12 100.0% 12 100.0% 12 100.0% 12 100.0% 12 100.0% 12 100.0% G82050 Sydenham House Medical Centre 62 55 88.7% 57 91.9% 55 88.7% 54 87.1% 55 88.7% 54 87.1% G82053 Woodchurch Surgery 8 8 100.0% 7 87.5% 8 100.0% 8 100.0% 8 100.0% 8 100.0% G82080 The Willesborough Health Centre 41 40 97.6% 39 95.1% 40 97.6% 39 95.1% 40 97.6% 40 97.6% G82087 New Hayesbank Surgery 47 47 100.0% 47 100.0% 47 100.0% 46 97.9% 47 100.0% 46 97.9% G82094 The Charing Surgery 23 23 100.0% 22 95.7% 23 100.0% 22 95.7% 23 100.0% 21 91.3% G82114 Ivy Court Surgery 36 34 94.4% 34 94.4% 34 94.4% 33 91.7% 34 94.4% 34 94.4% G82142 Wye Surgery 38 37 97.4% 37 97.4% 37 97.4% 36 94.7% 37 97.4% 36 94.7% G82186 Hamstreet Surgery 17 17 100.0% 17 100.0% 17 100.0% 17 100.0% 17 100.0% 17 100.0% G82658 Sellinge Surgery 12 12 100.0% 11 91.7% 12 100.0% 12 100.0% 12 100.0% 12 100.0% G82688 Singleton Surgery 16 16 100.0% 16 100.0% 16 100.0% 16 100.0% 16 100.0% 16 100.0% G82712 Singleton Medical Centre 7 6 85.7% 6 85.7% 6 85.7% 6 85.7% 6 85.7% 6 85.7% G82730 Kingsnorth Medical Practice 32 31 96.9% 30 93.8% 31 96.9% 31 96.9% 31 96.9% 31 96.9% G82735 South Ashford Medics 46 43 93.5% 43 93.5% 43 93.5% 41 89.1% 43 93.5% 43 93.5% G82748 Musgrove Park Medical Centre 3 3 100.0% 2 66.7% 3 100.0% 3 100.0% 3 100.0% 3 100.0% Ashford CCG 400 384 96.0% 380 95.0% 384 96.0% 376 94.0% 384 96.0% 379 94.8% Kent 4752 4526 95.2% 4464 93.9% 4529 95.3% 4442 93.5% 4529 95.3% 4463 93.9%
# children reaching Up to 5th Birthday Boosters GP Practice Practice Name 5th birthday during DTaP/IPV Hib/MenC MMR PCV Code Quarter 2 # Vaccinated % Uptake # Vaccinated % Uptake # Vaccinated % Uptake # Vaccinated % Uptake G82049 Hollington Surgery 12 12 100.0% 12 100.0% 12 100.0% 11 91.7% G82050 Sydenham House Medical Centre 62 45 72.6% 55 88.7% 45 72.6% 52 83.9% Key WHO Targets G82053 Woodchurch Surgery 8 8 100.0% 8 100.0% 7 87.5% 7 87.5% G82080 The Willesborough Health Centre 41 21 51.2% 39 95.1% 21 51.2% 36 87.8% > 95% G82087 New Hayesbank Surgery 47 44 93.6% 46 97.9% 44 93.6% 46 97.9% 90% - 95% G82094 The Charing Surgery 23 18 78.3% 22 95.7% 18 78.3% 18 78.3% G82114 Ivy Court Surgery 36 32 88.9% 34 94.4% 31 86.1% 34 94.4% < 90% G82142 Wye Surgery 38 29 76.3% 37 97.4% 28 73.7% 35 92.1% G82186 Hamstreet Surgery 17 16 94.1% 17 100.0% 16 94.1% 17 100.0% G82658 Sellinge Surgery 12 9 75.0% 12 100.0% 9 75.0% 11 91.7% G82688 Singleton Surgery 16 16 100.0% 16 100.0% 15 93.8% 16 100.0% G82712 Singleton Medical Centre 7 6 85.7% 6 85.7% 6 85.7% 6 85.7% G82730 Kingsnorth Medical Practice 32 25 78.1% 31 96.9% 24 75.0% 30 93.8% G82735 South Ashford Medics 46 34 73.9% 40 87.0% 34 73.9% 37 80.4% G82748 Musgrove Park Medical Centre 3 2 66.7% 2 66.7% 1 33.3% 1 33.3% Ashford CCG 400 317 79.3% 377 94.3% 311 77.8% 357 89.3% Kent 4752 3958 83.3% 4372 92.0% 3910 82.3% 4241 89.2% Source: Child Health Computer
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National Childhood Immunisation Programme The national Childhood Immunisation programme is an essential part of protecting children’s health. Low vaccine up-take puts children at risk. The right to be offered immunisation is enshrined in the NHS Constitution. Lower than acceptable levels of immunisation in east Kent were reviewed by a National Support Team in 2010 that made 29 detailed recommendations. The strategic aim is: • To achieve herd immunity (95 %+) in the population through increased uptake of immunisation; • To ensure immunisation services are equitable and accessible; • To provide a high quality standardised immunisation service; • To ensure the implementation of NICE guidance relating to immunisation. Overall Ashford CCG practices perform better or similar to the Kent average, there are several GP practices which are failing to meet the 90% target rate set by WHO (World Health Organisation) which have been identified using the RAG rating (any practice failing to reach a 90% uptake in vaccinations will appear with a red background). *please note that Musgrove Park Medical Centre has now merged with G82050 (Sydenham House Medical Centre) but immunisation data was still published under Musgrove Park. The worst uptake rates are recorded for the 2nd birthday boosters and 5th birthday boosters with Ashford CCG achieving less than 90% in all but one of the immunisations (Hib/ MenC) this highlights the need to keep a focus on the implementation of effective immunisation after the child’s second birthday to help achieve optimal rates. Figure 36- Age-standardised admission rates for deliberate and unintentional injury for 0-19s
Ashford CCG has shown a steady downward trend since 2006/07 for hospital admissions due to deliberate self-harm and unintentional injuries and has always remained lower than the rate for Kent. Ashford also had the lowest admission rate of all the CCGs for 2013/14 at 101.3 per 10,000 0-19 year olds. The rate for Kent was 119.2 per 10,000 0-19s. Useful tip: if the orange error bars do not overlap then statistically they are significantly different, for example the 2013/14 Kent value is significantly lower than the 2006/07 value. Page | 43
National Child Measurement Programme (NCMP) Figure 36.5- NCMP Reception Year Obesity Prevalence 2012/13
Figure 36.51- NCMP Year 6 Obesity Prevalence 2012/13
The areas in Ashford CCG with the highest obesity prevalence are mainly in the central wards for year R and 6 children, there is a relationship between deprivation and high levels of obesity prevalence with Public Health England calculating a difference of 6% for year R children and 12.6% for 6 children between those who live in the least and most deprived areas across the whole of England. Norman, Stanhope and Aylesford Green wards all have high obesity prevalence in both year groups. Page | 44
Child and Adolescent Mental Health Services Figure 37- Age-specific 0-18s CAMHS contact rates 2010/11 Data.
Overall Ashford CCG had a contact rate of 21.7 per 1,000 for children and young people in contact with mental health services in 2010/11. The wards with the highest rates are Bockhanger, Stanhope, Park Farm North and Weald East.
The development of CAMHS began in 1995 when two key documents; ‘A Handbook on Child and Adolescent Mental Health’ and ‘Together We Stand’ laid the foundations for a four-tiered framework for the planning, commissioning and delivery of child and adolescents mental health services.
For more information please visit: (http://www.youngminds.org.uk/training_services/policy/policy_in_the_uk/camhs_policy_in_england)
The government published a mental health strategy in February 2011- ‘No Health Without Mental Health: a Cross-Government Outcomes Strategy for People of All Ages’
This strategy aims to improve mental health in all ages, and people from all backgrounds. It has six objectives:
1. More people will have good mental health 2. More people with mental health problems will recover 3. More people with mental health problems will have good physical health 4. More people will have a positive experience of care and support 5. Fewer people will suffer avoidable harm 6. Fewer people will experience stigma and discrimination
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Figure 38-
Figure 39- Graph of teenage conception rates by ward 2010-2012
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The Ashford district area is coterminous with the CCG boundary so the rate for the district can also be applied as a CCG rate. Overall Ashford had a higher teenage conception rate for the period 2010- 2012 (pooled data) compared to the 2012 data for Kent and England, unfortunately pooled data is not available for Kent and England. To protect confidentiality all counts and rates based on fewer than 5 occurrences have been suppressed. The areas with the highest rate of teenage conceptions in Ashford were Stanhope, Victoria and Norman wards; all of which are in the 20% most deprived quintile based on the IMD 2010. Figure 40- Teenage conception rates in Kent local authorities 2010 - 2012
The Ashford area has seen a welcome reduction in the rates of teenage pregnancy since the national programme commenced in1998. The national programme finished in 2011 but the Kent strategy is to reduce the rate of teenage conceptions in all districts to fewer than 40 per 1,000 young women under the age of 19 by 2015. Current figures provided by ONS displayed in the above chart show that most local authorities had already achieved this by 2010 with Shepway achieving this in 2011 and Thanet in 2012.
Successful reductions in teenage pregnancy rates are the result of a strategy that combines the availability of sexual health services with working on the wider determinants of good health – largely a partnership issue. Fundamentally the phenomenon of teenage pregnancy is a product of poor aspiration and self-regard amongst young people. The sustained downward trends in rates cannot be presumed to continue as the current national economic situation makes this a very difficult time for young people.
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Sexual Health The following charts have been created using data from the Sexual and Reproductive Health Profile data on the Public Health England website (http://fingertips.phe.org.uk/). Figure 41- Diagnosed HIV rate among persons aged 15 to 59 years by district, 2013
Figure 42- % of HIV diagnoses with CD4 count below 350mm³, 2011-2013
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Figure 43- Rate of diagnosed chlamydia for 15-24s, 2013
Ashford had the third highest rate of diagnosed HIV of all the districts in Kent at 1.46 per 1,000 15-59 year old, however this is still significantly lower than the rate for England and the South East. Ashford had the second lowest percentage of late HIV diagnoses in Kent based on the number of CD4 cells counted within 91 days of the diagnosis, CD4 cells are a type of white blood cell that help protect your body from illness, by measuring the count of these cells doctors are able to identify what stage the HIV infection has reached and whether or not the patient should have been identified earlier. The only district with a significantly lower percentage of late diagnoses compared to England, the South East and Kent is Dover district which indicates there is good management of the disease in that area. Ashford district had significantly lower rates of diagnosed chlamydia in all settings compared to England and was very similar to Kent as a whole at 1,572 per 100,000 people compared to 1,563 for Kent.
Here is a list of other sexual health indicators which are also available at district level from (http://fingertips.phe.org.uk/):
Rate of syphilis diagnoses per 100,000 population Rate of gonorrhoea diagnoses per 100,000 population Proportion of population aged 15 to 24 screened for chlamydia, measured separately in GUM and non-GUM settings (PHOF indicator 3.02ii) Rate of first episode genital warts diagnoses per 100,000 population Uptake of HIV testing among men who have sex with men (MSM) measured in GUM Uptake of HIV testing among women measured in GUM Uptake of HIV testing among men measured in GUM Pelvic inflammatory disease (PID) admissions Sexual offences (PHOF indicator) Page | 49
Older People As the population ages the need for health care increases as people are living longer and managing better with long term conditions The proportion of the Ashford CCG population aged 65+ is 18.1% with 2.3% over the age of 85. These are both lower than the averages for Kent at 19.3% and 2.6% respectively. Figure 44- Life Expectancy at 65 at ward level, 2009-2013
The population of Ashford CCG who reach 65 years can expect to live a further 20.7 years compared to 19.8 years for Kent. Ashford CCG has the highest life expectancy at 65+ of all CCGs for the years 2009-2013. There are 26 wards in the CCG with a life expectancy greater than that for Kent. Figure 44.1- Life Expectancy at 65 in Kent CCGs, 2009-2013
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Chronic Diseases Risk Factors for Chronic Diseases Smoking Prevalence Figure 45-
Figure 46- Smoking Prevalence by GP 2013/14 QOF data
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The prevalence estimates for smoking are calculated by dividing the number of people on the QOF smoking register in to the practice list size of 15+ year olds to give a percentage. The register figure does not represent all patients who smoke, but represents a count of patients noted as smoking within the last 12 months, who also have any or any combination of the following conditions: coronary heart disease, stroke/TIA, hypertension, diabetes, COPD, asthma. (A patient with more than one of these conditions is only counted once.) Approximately 29.1% of residents in Ashford are smokers compared to 29.6% of adults in the whole of England and 29.4% in Kent. For more accurate information on smoking and tobacco control there is a useful tool published by Public Health England to view areas by region/ PHE Centre and then broken down further by the following geographical levels: Primary Care Trust County/ Unitary Authority District/ Unitary Authority level. This is available at: http://www.tobaccoprofiles.info/
Adult Obesity Prevalence Figure 47-
These Lifestyle estimates were originally calculated by the office for national statistics at middle layer super output area level but have recently realigned this data to ward level. Unfortunately the 2006- 2008 data is still the most recent available and there is currently no indication of when a new release is likely to be published. The active people survey provides more recent information at a district level.
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Figure 48- Active People Survey 2012, Prevalence of different weight classes in Kent districts
The Active People Survey is a large telephone survey of sport and active recreation commissioned by Sport England. In January 2012 questions on height and weight were added to provide data for the adult excess weight indicator in the Public Health Outcomes Framework. The APS collects self-reported height and weight from adults aged 16 and over. Height and weight data have been adjusted at individual level to correct for the reporting bias in self-report data. The new data provide robust prevalence estimates and will allow local areas to monitor annual trends in excess weight prevalence among their adult population. The APS data displays nearly 1 in 4 adults (22.7%) in Ashford are obese compared to 1 in 5 in Kent (21.2%). As a county Kent has a lower prevalence of obese adults compared to the overall figure for England (23%).
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Alcohol Misuse Figure 49- Age-standardised admission rates for alcohol specific admissions in D.G.S CCG by sex, 2006/07 – 2013/14, all ages
Figure 50- Age-standardised alcohol-specific admission rates in Ashford CCG and Kent, 2006/07 – 2013/14, all ages
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Since 2006 there has been a steady increase in the rate of alcohol-specific admissions to hospital for all ages across the whole of Kent however despite the rate increasing in Ashford CCG it is significantly lower than the Kent rate; the steady upward trend highlights the need for closer monitoring in the coming years. There are nearly twice as many Male admissions compared to Females due to alcohol-specific conditions in both Kent and Ashford CCG. Figure 51- Under 20’s alcohol-specific admission rates, 2006/07 – 2013/14
The trend for under 20’s alcohol specific admissions tells a different story with rates of admission seeing a welcome reduction since the baseline of 2006/07.The rate for Ashford was originally higher than Kent but has maintained a lower admission rate than Kent in all subsequent years since then with a significantly lower rate than Kent since 2011/12. Local Alcohol Profiles for England A more detailed area profile focusing on indicators relating to alcohol is available for every local district in England, the main link for the South East section of the website is: http://www.lape.org.uk/LAProfile.aspx?reg=X25004AE
You can then use the drop down box underneath where it says ‘Change Profile Area’ to select your preferred local authority.
There is also the option to download the data as a PDF if required which will also include the indicator definitions.
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Ashford LAPE Profile (2012 Update)
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LAPE table with values
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Chronic Disease Patterns Multi-Morbidity An ageing population and increased prevalence of chronic diseases requires a service re-orientation away from the current emphasis on acute and episodic care, towards prevention, self-care, more consistent standards of primary care and care that is well co-ordinated and integrated. The King’s Fund has identified 10 priorities for action: King’s Fund 10 Priorities for Commissioners
Active support for self-management Primary prevention Secondary prevention Managing ambulatory care sensitive conditions Improving the management of patients with both mental and physical health needs Care co-ordination through integrated health and social care teams Improving primary care management of end-of-life care Effective medicines management Managing elective activity – referral quality Managing emergency activity – urgent care
A common feature of all 10 priorities is the degree to which they are dependent upon a change within primary care services and the way in which such services relate to the rest of health and social care. Clinical practise conventionally treats and thus measures individual diseases. Such an approach is increasingly challenged by the scale of service demands facing the NHS (and is also a worldwide problem) through the concept of multi-morbidity. In essence patients with chronic conditions often have more than one such condition simultaneously. It is the challenge of managing the complexities of co-morbid and multi-morbid conditions that gives rise to complications, often leading to high cost, unplanned, unscheduled care. A landmark Scottish study (Barnett et al 2012) has examined the distribution of multi-morbidity and of co-morbidity of physical and mental health disorders in relation to both age and socio-economic deprivation. In a cross sectional study data from 40 morbidities relating to 1,751,841 people registered with 314 medical practices in Scotland as of March 2007 was analysed according to the number of morbidities, disorder type (physical or mental), age, sex and socio-economic status. Multi- morbidity for the purpose of this study was defined as the presence of two or more disorders. 42.2% of all patients had one or more morbidity. 23.2% were multi-morbid. Although the prevalence of multi-morbidity increased substantially with age and was present in most people aged 65 and older, the absolute number of people with multi-morbidity was higher in those younger than 65 (210,500 v 194,196). Onset multi-morbidity occurred 10-15 years earlier in people living in the most deprived areas compared to the most affluent. The presence of a mental health disorder increased as the number of physical morbidities increased and was much greater in more deprived than in less deprived people. The authors recommend that generalist clinicians provide personalised, comprehensive continuity of care since the single disease framework on which most health care research and indeed medical education is based is profoundly challenged by this study. An ageing population and increased prevalence of chronic disease requires a strong re-orientation away from the current emphasis on acute and episodic care, towards prevention, self-care and more consistent standards of primary care that are well co-ordinated and integrated. The King’s Fund (2011) has identified 10 priorities for action and most of these demand a change within primary care and in the way in which primary care relates to the rest of the health care system.
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The Ashford CCG Health & Well-being Board through its leadership need to enable:
The systematic and pro-active management of chronic disease within primary care. This will improve health outcomes, manage down inappropriate use of hospital services but will also make a significant and positive contribution to reducing health inequalities; The empowerment of patients. Patients are arguably the greatest untapped resource within the NHS. The active engagement of patients is a common thread throughout the 10 priorities identified by the King’s Fund; A population-based approach to commissioning. This presents a dichotomy in relation to the primary care clinician’s role as advocate for the individual patient but also in shifting a focus from patients that present in practice to the wider population needs and disease patterns. The presentation of this needs assessment, keeping separate the population- based patterns from practice-based patterns of disease, is illustrative of the conceptual challenge of this task; More integrated models of care. The aim is to improve the quality of care for patients and reduce waste, especially as CCGs are being tasked with providing leadership within the NHS at a time of financial constraint in which the burden of disease is growing, driven in part by demographic change, yet medical advances offer increasing opportunities to treat disease. Long Term Conditions Cancer Registrations Figure 52- Crude cancer registration rates at ward level 2008-2012 for all cancers, all ages
Cancer registrations are collected by the National Cancer Registration Service and cover all ages. The registration rate in Ashford CCG overall is lower than that for Kent but has 15 Wards with a higher rate than Kent for the period 2008-2012. The crude rate was calculated by dividing the total number of cancer registrations between 2008 and 2012 and dividing it into the total population figure for each ward using the combined 2008-2012 ONS mid-year resident population estimates. Page | 59
Figure 52.5- Map of crude cancer registration rates for Ashford CCG 2008-2012, All Ages
Figure 53- Crude cancer registration rates for Kent CCG’s 2008-2012, All Ages
Ashford CCG had the lowest registration rate of Females and Persons of all ages across the 7 Kent CCGs, only Dartford, Gravesham & Swanley CCG had a lower rate for Males for the period 2008- 2012. Page | 60
Figure 54- Crude cancer registration rates for Kent CCG’s, 2008-2012, Under 75s
For the under 75’s Ashford CCG has the lowest cancer registration rate for Males, Females and Persons across the whole of Kent for the period 2008-2012. Figure 55- Map of under 75s Mortality due to cancer 2009-2013 by Electoral Ward
There are some similarities between areas with the highest rates of mortality due to cancer and areas which are the 20% most deprived in Ashford CCG. This is particularly prominent in Aylesford Green and Beaver wards. However Park Farm ward also had high cancer mortality rates for the under 75’s yet it is in one of the 20% least deprived areas in the CCG. Page | 61
Quality Outcomes Framework (QOF) What is the QOF? (Extracted from: http://www.nice.org.uk/aboutnice/qof/qof.jsp) Introduced in 2004 as part of the General Medical Services Contract, the QOF is a voluntary incentive scheme for GP practices in the UK, rewarding them for how well they care for patients. The QOF contains groups of indicators, against which practices score points according to their level of achievement. NICE's role focuses on the clinical and public health domains in the QOF, which include a number of areas such as coronary heart disease and hypertension. The QOF gives an indication of the overall achievement of a practice through a points system. Practices aim to deliver high quality care across a range of areas, for which they score points. Put simply, the higher the score, the higher the financial reward for the practice. The final payment is adjusted to take account of the practice list size and prevalence. The results are published annually here: http://www.hscic.gov.uk/qof usually around October each year. Other useful link: QOF 2013/14 data explained: http://qof.hscic.gov.uk/ Disease Registers on QOF Due to the nature of the QOF and the way patient data is collected and registered on the GP’s I.T system, you can’t fully rely on the prevalence data at any level being 100% accurate as it doesn’t account for those patients who are unaware they have the disease and therefore haven’t sought advice from their doctor. I.e. the patient is only recognised by the system once they have been to see their GP who has then subsequently diagnosed them with the condition and input it onto their system. It is for this reason that we use APHO Modelled estimates for prevalence of certain disease indicators on the QOF register which are found at: http://www.apho.org.uk/diseaseprevalencemodels to roughly estimate the number of people who are unidentified at practice or local authority level. **PLEASE NOTE I have merged the patient registers for G28050 and G82748 as well as the disease registers and prevalence estimates due to G82748 closing and merging with G82050.
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Diabetes Figure 56- Prevalence of Diabetes in Ashford Practices, QOF Register 2013/14
The recorded prevalence of diabetes varies between practices from 4.69% to 6.95%. The prevalence for the CCG is 6.08%, slightly lower than England overall but higher than Kent, it is the third lowest of the 7 CCGs in Kent. Figure 57- Prevalence of Diabetes in Kent CCGs, QOF Register 2013/14
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Figure 58- Modelled expected prevalence of Diabetes Vs Observed Prevalence 2013/14
We are currently reviewing the way we calculate this indicator due to flaws within the APHO define your own area tool which doesn’t account for individual practice deprivation break- downs based on the residential location of their patients. We hope to re-introduce this figure in due course.
Figure 59- Correlation between diabetes and obesity prevalence QOF 2013/14 data
Please note the R² value is equal to 0.23 and while this does denote a positive correlation it should be made clear that it is a very mild positive correlation which holds very little significance.
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Figure 60- Elective and Emergency hospital admission rates for diabetes 2006/07-2013/14
The trend in elective and emergency admission rates for diabetes has seen a year on year increase since 2006/07 for Kent patients overall as well as being similarly represented by the Ashford CCG rates. Since 2006/07 Ashford and Kent have had a lower elective admission rate compared to emergency admissions which suggests there could’ve been a better management of the condition at practice level to ensure there are fewer emergency admissions compared to elective. Figure 61- Map of age-standardised emergency admission rates for diabetes 11/12 – 13/14
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The wards with the highest emergency admission rates for diabetes are Great Chart with Singleton North (2959.5 per 100,000), Beaver (1927), Boughton Aluph & Eastwell (1881.4), Victoria (1866.9) and Biddenden (1739.6). Figure 62- Mean cost per hospital spell for diabetes 2006/07 – 2013/14
Data for this indicator does not currently contain a geographical code. We have contacted our data providers who have assured us they will be added within 1-2 months.
Figure 63- Total annual expenditure on hospital spells for diabetes 2006/07 – 2013/14
Data for this indicator does not currently contain a geographical code. We have contacted our data providers who have assured us they will be added within 1-2 months.
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Coronary Heart Disease Figure 64- Prevalence of Coronary Heart Disease in Ashford Practices, QOF 2013/14
Figure 65- Prevalence of Coronary Heart Disease in Kent CCGs, QOF 2013/14
The prevalence of coronary heart disease varies between practices from 1.8% to 5.8%. The prevalence for the CCG is 3.1% which is lower than the average for England but slightly higher compared to the Kent and Medway area team. Page | 67
Figure 66- CHD: Expected prevalence (APHO 2011) Vs Observed prevalence (QOF 2013/14)
In 2013/14 there were 3,921 people recorded on the Coronary Heart Disease register at practices in Ashford CCG, this equates to 76.9% of the total expected number of patients with CHD according to the APHO 2011 modelled prevalence estimates for CHD. This leaves potentially 1,179 patients in Ashford CCG who are unaware they have the condition. Figure 67- Elective & Emergency admission rates for Coronary Heart Disease 2006/07-2013/14
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Both elective and emergency admission rates present an upward trend for coronary heart disease in Kent and Ashford CCG. This is another condition that could be managed better at a practice level in order to identify patients who are at risk before they require an emergency admittance to hospital. Figure 68- Mean cost per hospital spell for Coronary Heart Disease 2006/07-2013/14
Data for this indicator does not currently contain a geographical code. We have contacted our data providers who have assured us they will be added within 1-2 months.
Figure 69- Total annual expenditure on hospital spells for CHD 2006/07-2013/14
Data for this indicator does not currently contain a geographical code. We have contacted our data providers who have assured us they will be added within 1-2 months.
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Figure 70- Age-standardised emergency admission rates for Ashford CCG residents for acute myocardial infarction 2011/12-2013/14 by electoral ward
The wards with the highest emergency admission rates for acute myocardial infarction are Aylesford Green (282.5 per 100,000), Biddenden (275.5), Boughton Aluph & Eastwell (271.0), Victoria (242.3) and Beaver (237.7). Figure 71- Age-standardised emergency admission rates for Ashford CCG residents for revascularisation 2011/12-2013/14 by electoral ward
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The highest emergency admission rates for revascularisation are found in Downs West (83.9 per 100,000), Aylesford Green (77.5), Weald Central (67.6), North Willesborough (63.9) and Tenterden North (62.1) wards. Stroke or Transient Ischaemic Attacks Figure 72- Prevalence of Stroke or Ischaemic Transient Attacks in GP practices, QOF 2013/14
Figure 73- Prevalence of Stroke & Ischaemic Transient Attacks by CCG, QOF 2013/14
The prevalence for Stroke or Ischaemic Transient Attacks ranges between practices from 0.9% to 2.8%. The CCG has a prevalence of 1.8% which is slightly higher than the Kent and England average (both 1.7%). Page | 71
Figure 74- Stroke: Expected prevalence (APHO 2011) Vs Observed prevalence (QOF 2013/14)
There were 2,258 patients registered on the Stroke or Transient Ischaemic Attack register in 2013/14 out of an expected estimate of 2,289 (98.6%). This leaves a potential total of 31 patients unidentified who may have- or be at risk of getting- the condition. Figure 75- Elective & Emergency hospital admission rates for Stroke 2006/07-2013/14
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The admission rates for Stroke in Ashford CCG and Kent have remained relatively stagnant over the last 8 years with Ashford’s emergency admission rate remaining higher than Kent’s continuously. Overall Ashford and Kent present slight upward trends for both elective and emergency admissions. As you would expect the elective admission rates are very low for this condition. Figure 76- Mean cost per hospital spell for Stroke 2006/07-2013/14
Data for this indicator does not currently contain a geographical code. We have contacted our data providers who have assured us they will be added within 1-2 months.
Figure 77- Total annual expenditure on hospital spells for Stoke 2006/07-2013/14
Data for this indicator does not currently contain a geographical code. We have contacted our data providers who have assured us they will be added within 1-2 months.
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Figure 78- Age standardised emergency admission rates for Stroke 2011/12-2013/14
The highest emergency admission rates for Stroke are found in Tenterden South (345.3 per 100,000), South Willesborough (287.4), Aylesford Green (252.5), North Willesborough (248.1), Little Burton Farm (240.5) and Godinton (228.4). Figure 79- Age standardised mortality rates for under-75 circulatory disease 2009-2013
The highest rates of mortality due to circulatory conditions in Ashford are found in Park Farm North (143.3 per 100,000), Beaver (135.5) and Aylesford Green (135.3) wards. Page | 74
Hypertension Figure 80- Prevalence of Hypertension in GP practices QOF 2013/14
Figure 81- Prevalence of Hypertension by CCG, QOF 2013/14
The prevalence of hypertension in practices ranges from 8.4% to 17.8%. The CCG has a value of 14.1% for Hypertension which is higher than the average for England (13.7%) but lower than the average for the Kent & Medway area team (14.4%). Page | 75
Figure 82- Hypertension: Expected (APHO 2011) Vs Observed prevalence (QOF 2012/13)
In 2013/14 there were 17,715 patients registered with Hypertension out of an estimated 29,084 according to the APHO prevalence estimates. This means 60.9% of the expected number of patients have been identified with 11,369 potentially unaware they have the condition. Figure 83- Elective and emergency admission rates for Hypertension 2006/07-2013/14
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Admission rates for Hypertension have shown a dramatic increase since 2006/07 for both Kent and Ashford CCG. Since 2011/12 Ashford has had lower rates than Kent for elective admissions whereas Ashford had a slightly higher emergency admission rate than Kent in 2013/14. A higher elective admission rate compared to that for an emergency suggests that patients with hypertension in Kent overall are being identified and managed well in a primary care setting. Figure 84- Mean cost per hospital spell for hypertension 2006/07-2013/14
Data for this indicator does not currently contain a geographical code. We have contacted our data providers who have assured us they will be added within 1-2 months.
Figure 85- Total annual expenditure on hospital spells for hypertension 2006/07-2013/14
Data for this indicator does not currently contain a geographical code. We have contacted our data providers who have assured us they will be added within 1-2 months.
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Figure 86- Age standardised emergency admission rates for hypertension 2011/12-2013/14
The highest emergency admission rates for Hypertension are found in South Willesborough (3798.8 per 100,000), North Willesborough (3790.5), Aylesford Green (3499.0), Godinton (3383.3), Little Burton Farm (3324.7) and Tenterden South (3197.7) wards.
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Chronic Obstructive Pulmonary Disorder (COPD) Figure 87- Prevalence of COPD in practices, QOF 2013/14
The prevalence of COPD in practices ranges from 1.06% to 2.46% in Ashford CCG, as a CCG they have the second lowest overall prevalence in Kent at 1.6%. Kent & Medway’s prevalence is similar to England at 1.8% and 1.78% respectively. Figure 88- Prevalence of COPD by CCG, QOF 2013/14
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Figure 89- COPD: Expected prevalence (APHO 2011) Vs Observed prevalence (QOF 2013/14)
In Ashford CCG there were 2,030 patients registered in 2013/14 as having COPD out of an estimated total of 2,845. With 71.4% of the expected number of patients identified this leaves a potential 815 patients who could be unaware they have the condition. Figure 90- Elective and Emergency admission rates for COPD 2006/07-2013/14
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There is an upward trend in admission rates for both elective and emergency admissions in Kent and Ashford CCG. In order to try and reduce the number of emergency admissions there should be an initiative to raise awareness of the condition and its symptoms amongst the general population as the majority of people who develop these symptoms often disregard them as a ‘smokers cough’. Figure 91- Mean cost per hospital spell for COPD 2006/07-2013/14
Data for this indicator does not currently contain a geographical code. We have contacted our data providers who have assured us they will be added within 1-2 months.
Figure 92- Total annual expenditure on hospital spell for COPD 2006/07-2013/14
Data for this indicator does not currently contain a geographical code. We have contacted our data providers who have assured us they will be added within 1-2 months.
Figure 93- Age-standardised emergency admission rates for COPD 2011/12-2013/14
The highest emergency admission rates for COPD are found in Isle of Oxney (1429.7 per 100,000), Downs West (1410.4), Biddenden (1323), Weald East (1295.3), Bouthon Aluph & Eastwell (1238.4) and Weald South (1163.2) wards.
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Figure 94- Age standardised emergency admission rates for Asthma 2011/12-2013/14
The highest emergency admission rates for Asthma are in Wye (1478.2 per 100,000), Weald East (1178.4) and Weald South (1141.6) wards. Figure 95- Age standardised mortality rates for all respiratory diseases 2009-2013
High rates of mortality due to respiratory conditions are found in Beaver (65.8), Little Burton Farm (64.4), Kennington (56.9), Tenterden South (54.9) and Aylesford Green (51.6) wards, the lowest rates are found in Weald North, Rolvenden and Tenterden West, Isle of Oxney and Washford (All 0). Page | 82
Mental Health Dementia Figure 96- Prevalence of Dementia in practices, QOF 2013/14
Figure 97- Prevalence of Dementia by CCG, QOF 2013/14
The prevalence of Dementia in practices ranges from 0.15% to 1.59%, the prevalence in Ashford is slightly lower than the score for Kent & Medway and England; 0.56% compared to 0.59% and 0.62% respectively.
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Figure 98- Emergency admission rates for Dementia diagnoses 1-3, 2006/07-2013/14
The emergency admission rate for Dementia (with ICD10 code appearing in the first 3 diagnosis fields) has seen a year on year increase in Kent and Ashford however the latter has continuously held a lower admission rate than Kent since 2006/07. Recent years figures suggest the rates have reached a plateau at Kent level. Figure 99- Mean cost per emergency hospital spell for Dementia diagnoses 1-3, 2006/07 - 2013/14
Data for this indicator does not currently contain a geographical code. We have contacted our data providers who have assured us they will be added within 1-2 months.
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Figure 100- Total annual expenditure on hospital spells for dementia diagnoses 1-3, 2006/07- 2013/14
Data for this indicator does not currently contain a geographical code. We have contacted our data providers who have assured us they will be added within 1-2 months.
Mental Illness Needs Index 2000 In different types of areas, people are more or less likely to incur common mental illnesses. To some extent this can be predicted from characteristics of the population measured by the census or other types of survey. Mental health needs indices estimate by how much. A needs index of 0.8 suggests that there will be 20% less illness in an area than in the country as a whole, an index of 1.2 suggests 20% more Figure 101- Mental Illness Needs Index 2000
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Figure 102- Prevalence of Mental Illness in practices, QOF 2013/14
Figure 103- Prevalence of Mental Illness by CCG, QOF 2013/14
The prevalence of Mental Illness in practices ranges from 0.36% to 1.38%, Ashford CCG has the lowest prevalence of mental illness of all the Kent CCGs and is also lower than the England total (0.86%). This QOF indicator includes a register of patients who have schizophrenia, bipolar affective disorder or any other psychoses as well as any other patients on lithium therapy. Page | 86
Figure 104- Adult (ages 15-64) mental illness patient contact rates, 2012-2013
Figure 105- Elderly (aged 65+) mental illness patient contact rates, 2012-2013
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Figure 106- Number of older people receiving enablement or active care, August 2013
Figure 107- Older people with a mental health problem living in residential or nursing homes
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Figure 108- Older people who receive domiciliary/ community support services care
Figure 109- Older people who are in receipt of day care
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Falls Figure 110- Emergency admission rates as a result of a fall, 2006/07-2013/14
Emergency hospital admission rates as a result of a fall display a slight upward trend at CCG and Kent level over the last 8 years, however since 2009/10 the rate in ASHFORD has shown a downward trend. Figure 111- Mean cost per hospital spell due to a fall, 2006/07-2013/14
Data for this indicator does not currently contain a geographical code. We have contacted our data providers who have assured us they will be added within 1-2 months.
Figure 112- Total annual expenditure on hospital spells due to falls, 2006/07-2013/14
Data for this indicator does not currently contain a geographical code. We have contacted our data providers who have assured us they will be added within 1-2 months.
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Figure 113- Age-standardised emergency admission rates due to a fall, 2011/12-2013/14
The highest rates of emergency admission as a result of a fall are found in North Willesborough (1341.2 per 100,000), South Willesborough (1303.81), Weald North (938.9), Rolvenden & Tenterden West (927.8) and Great Chart with Singleton North (898.6) wards. The lowest rates are found in Stanhope, Tenterden North, Weald East, Norman and the Isle of Oxney. Figure 114- Age-standardised elective admission rates for 65+, 2011/12-2013/14
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The highest elective admission rates for persons aged 65 and over are found in Park Farm North (51,288.7 per 100,000 65+ year olds), Saxon Shore (47,815), Wye (46,364), Charing (43,867) and Downs West (42,870) wards. The lowest rates are found in Singleton South, Tenterden North, Park Farm South, Great Chart with Singleton North and Biddenden wards. Figure 115- Age-standardised emergency admission rates for 65+, 2011/12-1013/14
The highest emergency admission rates for persons aged 65 and over are found in Park Farm North (32,608 per 100,000 65+ year olds), Highfield (32,579), Norman (28,400), Beaver (27,481) and Aylesford Green (26,614) wards. The lowest rates are found in Park Farm North, Tenterden North, Tenterden South, Weald North and Biddenden wards.
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Figure 116- Age-standardised emergency admission rates due to fractured neck of femur, 2011/12-2013/14
The highest emergency admission results due to fractured neck of femur are found in South Willesborough (396.3 per 100,000), Downs West (256.1), North Willesborough (238.6), Downs North (218) and Weald South (211.5). The lowest rates are found in Wye, Kennington, Tenterden North, Weald East and Isle of Oxney. Figure 117- Age-standardised emergency admission rates due to hip or knee replacement, 2011/12-2013/14
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The highest emergency admission rates due to a hip or knee replacement are found in Park Farm North (64.9 per 100,000), Wye (42.8), Little Burton Farm (30.1), Aylesford Green (28.6), Weald East (27.6) and South Willesborough (27). The wards with the lowest rates are Downs North, Norman, Biddenden, Bybrook, Stanhope and Kennington (all with a rate of 0) Figure 118- Age-standardised mortality rates for all age, all cause 2009-2013
The highest rates for all age, all cause mortality are found in Singleton South (1205.5 per 100,000), Park Farm South (1178), Aylesford Green (1160), North Willesborough (1141) and Downs North (1132). The wards with the lowest mortality rates for all age all cause are Weald East, Tenterden North, Tenterden South, Washford and Weald North.
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Hospital Activity: A&E Attendances and Admissions Ashford CCG A&E Attendance Rates Figure 119- Accident & Emergency attendance rates for children aged 0-4 years.
There are high rates of A&E admissions in Bybrook, Highfield, Godinton, Weald East and Stanhope wards, the lowest rates are found in Great Chart with Singleton North, Tenterden North, Weald North, Tenterden South and Rolvenden and Tenterden West.
For GP practices the highest rates are at South Ashford Medics, Dr Kelly J C & Partners and Willesborough Medical Centre. The lowest rates are found in Hollington Surgery, Front Road Surgery and Ivy Court Surgery.
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Ward Rates GP Practice Rates
Ward Code Ward Name 0-4 GP Code GP Surgery 0-4 29UBHE Bybrook 454.5 G82735 South Ashford Medics 221.8 29UBHL Highfield 287.7 G82730 Dr Kelly J C & Partners 184.0 29UBHJ Godinton 227.1 G82080 The Willesborough Medical Ctr 166.3 29UBJH Weald East 223.0 G82186 Hamstreet Surgery 159.8 29UBJA Stanhope 211.1 G82050 Sydenham House Medical Centre 155.2 29UBHS Park Farm North 199.3 G82712 Dr Thomas A 141.7 29UBGZ Aylesford Green 194.6 G82748 Musgrove Park 141.4 29UBJE Victoria 176.7 G82658 Sellindge Surgery 136.0 29UBHC Bockhanger 166.7 G82142 Wye Surgery 128.9 29UBHT Park Farm South 166.1 G82688 Dr Setty M V S & Partner 127.9 29UBHF Charing 157.9 G82094 The Charing Surgery 125.6 29UBHY Singleton South 157.7 G82087 New Hayesbank Surgery 123.7 29UBJL Wye 157.6 G82049 Hollington Surgery 112.1 29UBJG Weald Central 156.9 G82053 Front Road Surgery 107.9 29UBHD Boughton Aluph and Eastwell 154.4 G82114 Ivy Court Surgery 90.3 29UBHR North Willesborough 151.5 29UBJF Washford 147.8 29UBHW St Michaels 136.8 29UBHM Isle of Oxney 136.8 29UBHZ South Willesborough 132.6 29UBHB Biddenden 131.8 29UBJK Weald South 128.8 29UBHA Beaver 124.7 29UBJB Stour 112.4 29UBHG Downs North 109.6 29UBHP Little Burton Farm 103.0 29UBHQ Norman 102.1 29UBHX Saxon Shore 96.3 29UBHN Kennington 96.2 29UBHH Downs West 94.0 29UBHK Great Chart with Singleton North 88.9 29UBJC Tenterden North 85.1 29UBJJ Weald North 68.6 29UBJD Tenterden South 63.1 29UBHU Rolvenden and Tenterden West 52.6
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Figure 120- Accident & Emergency attendance rates for children aged 5-19 years
The highest A&E attendance rates for 5-19 year olds are found in Charing, Aylesford Green, Weald East, Weald North and Stanhope wards, the lowest rates are located in Downs North, Stour, Rolvenden & Tenterden West, Highfield and Park Farm North.
The GP practices with the highest rates are Dr Thomas A, Front Road Surgery and Charing Surgery, the lowest rates are found in New Hayesbank Surgery, Dr Kelly J C & Partners and Wye Surgery.
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Ward Rates GP Practice Rates
Ward Code Ward Name 5-19 GP Code GP Surgery 5-19 29UBHF Charing 132.1 G82712 Dr Thomas A 94.4 29UBGZ Aylesford Green 131.9 G82053 Front Road Surgery 92.6 29UBJH Weald East 106.9 G82094 The Charing Surgery 91.5 29UBJJ Weald North 95.9 G82049 Hollington Surgery 91.2 29UBJA Stanhope 92.5 G82658 Sellindge Surgery 89.1 29UBHJ Godinton 90.2 G82050 Sydenham House Medical Centre 85.3 29UBHP Little Burton Farm 90.2 G82735 South Ashford Medics 79.5 29UBHA Beaver 88.1 G82688 Dr Setty M V S & Partner 79.3 29UBHE Bybrook 85.8 G82080 The Willesborough Medical Ctr 75.9 29UBHW St Michaels 85.8 G82186 Hamstreet Surgery 70.6 29UBJF Washford 82.3 G82748 Musgrove Park 69.3 29UBHR North Willesborough 82.1 G82114 Ivy Court Surgery 69.1 29UBHN Kennington 81.5 G82087 New Hayesbank Surgery 68.6 29UBHT Park Farm South 80.5 G82730 Dr Kelly J C & Partners 59.8 29UBJD Tenterden South 79.1 G82142 Wye Surgery 57.7 29UBJK Weald South 78.7 29UBJL Wye 75.5 29UBHD Boughton Aluph and Eastwell 75.1 29UBJE Victoria 71.1 29UBHQ Norman 70.9 29UBHK Great Chart with Singleton North 70.5 29UBHY Singleton South 70.0 29UBHB Biddenden 69.9 29UBHH Downs West 62.9 29UBHZ South Willesborough 62.3 29UBHM Isle of Oxney 62.2 29UBHX Saxon Shore 60.0 29UBHC Bockhanger 56.7 29UBJC Tenterden North 55.4 29UBJG Weald Central 55.4 29UBHG Downs North 53.7 29UBJB Stour 50.2 29UBHU Rolvenden and Tenterden West 50.1 29UBHL Highfield 50.1 29UBHS Park Farm North 47.5
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Figure 121- Accident & Emergency attendance rates for people aged 20-44 years
Wards with the highest rates for people aged 20-44 are Stanhope, Aylesford Green, Bockhanger, Downs West and Tenterden South wards, the lowest rates are found in Weald South, Highfield, Biddenden, Tenterden North and Kennington wards.
The practices with the highest rates are Dr Thomas A, South Ashford Medics and Sydenham House Medical Centre, the lowest rates are found in Hollington Surgery, Front Road Surgery and Wye Surgery.
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Ward Rates GP Practice Rates
Ward Code Ward Name 20-44 GP Code GP Surgery 20-44 29UBJA Stanhope 300.6 G82712 Dr Thomas A 251.6 29UBGZ Aylesford Green 300.1 G82735 South Ashford Medics 230.2 29UBHC Bockhanger 268.5 G82050 Sydenham House Medical Centre 211.1 29UBHH Downs West 259.8 G82730 Dr Kelly J C & Partners 195.0 29UBJD Tenterden South 253.9 G82080 The Willesborough Medical Ctr 186.9 29UBHE Bybrook 229.9 G82658 Sellindge Surgery 186.6 29UBJE Victoria 229.5 G82114 Ivy Court Surgery 182.0 29UBJF Washford 225.5 G82748 Musgrove Park 176.8 29UBHA Beaver 212.8 G82688 Dr Setty M V S & Partner 175.0 29UBHD Boughton Aluph and Eastwell 211.8 G82094 The Charing Surgery 174.4 29UBHU Rolvenden and Tenterden West 206.6 G82186 Hamstreet Surgery 171.3 29UBJH Weald East 204.0 G82087 New Hayesbank Surgery 164.4 29UBHR North Willesborough 197.8 G82049 Hollington Surgery 160.1 29UBHJ Godinton 194.1 G82053 Front Road Surgery 149.7 29UBHF Charing 194.0 G82142 Wye Surgery 140.5 29UBJL Wye 193.2 29UBHW St Michaels 192.8 29UBHQ Norman 191.9 29UBHS Park Farm North 189.0 29UBHK Great Chart with Singleton North 188.2 29UBHM Isle of Oxney 186.8 29UBHX Saxon Shore 182.9 29UBHZ South Willesborough 182.1 29UBJG Weald Central 181.8 29UBHT Park Farm South 170.1 29UBHY Singleton South 166.7 29UBJB Stour 161.5 29UBHP Little Burton Farm 157.3 29UBHG Downs North 151.3 29UBJJ Weald North 147.2 29UBJK Weald South 143.9 29UBHL Highfield 140.1 29UBHB Biddenden 139.1 29UBJC Tenterden North 130.8 29UBHN Kennington 105.9
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Figure 122- Accident & Emergency attendance rates for people aged 45-64 years
The highest ward rates for A&E attendances for people aged 45-64 are in Stanhope, South Willesborough, Highfield, Beaver and Biddenden wards, the lowest rates are found in Isle of Oxney, Tenterden South, Singleton South, Rolvenden and Tenterden West and Charing wards.
The highest GP attendance rates are at Hamstreet Surgery, South Ashford Medics, Sydenham House Medical Centre and The Willesborough Medical Centre, the lowest rates are found in Ivy Court Surgery, Charing Surgery and Dr Setty M V S & Partners.
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Ward Rates GP Practice Rates
Ward Code Ward Name 45-64 GP Code GP Surgery 45-64 29UBJA Stanhope 397.5 G82186 Hamstreet Surgery 316.9 29UBHZ South Willesborough 341.5 G82735 South Ashford Medics 307.6 29UBHL Highfield 336.6 G82050 Sydenham House Medical Centre 290.5 29UBHA Beaver 336.1 G82080 The Willesborough Medical Ctr 275.6 29UBHB Biddenden 322.4 G82730 Dr Kelly J C & Partners 252.1 29UBHH Downs West 320.4 G82748 Musgrove Park 246.2 29UBJK Weald South 313.3 G82053 Front Road Surgery 236.9 29UBJL Wye 298.4 G82712 Dr Thomas A 234.9 29UBHW St Michaels 292.6 G82142 Wye Surgery 232.5 29UBHR North Willesborough 291.8 G82087 New Hayesbank Surgery 231.2 29UBHS Park Farm North 277.8 G82658 Sellindge Surgery 230.3 29UBJB Stour 276.9 G82114 Ivy Court Surgery 221.7 29UBHD Boughton Aluph and Eastwell 274.4 G82049 Hollington Surgery 219.5 29UBHE Bybrook 269.5 G82094 The Charing Surgery 206.8 29UBJE Victoria 264.3 G82688 Dr Setty M V S & Partner 173.6 29UBGZ Aylesford Green 263.7 29UBHX Saxon Shore 252.4 29UBHN Kennington 250.0 29UBHP Little Burton Farm 248.4 29UBHG Downs North 243.3 29UBHT Park Farm South 239.2 29UBHC Bockhanger 236.0 29UBJH Weald East 236.0 29UBJJ Weald North 235.2 29UBJF Washford 226.3 29UBHQ Norman 223.1 29UBJG Weald Central 220.8 29UBHJ Godinton 218.1 29UBJC Tenterden North 212.2 29UBHK Great Chart with Singleton North 211.8 29UBHM Isle of Oxney 202.5 29UBJD Tenterden South 202.4 29UBHY Singleton South 195.1 29UBHU Rolvenden and Tenterden West 192.2 29UBHF Charing 170.1
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Figure 123- Accident & Emergency attendance rates for people aged 65-84 years
The highest attendance rates at ward level are found in Stanhope, Wye, Aylesford Green, Norman and Beaver wards, the lowest are situated in Isle of Oxney, Singleton South, Tenterden North, Great Chart with Singleton North and Biddenden.
The highest attendance rates broken down by GP practice are at Sellindge Surgery, Wye Surgery and Sydenham House Medical Centre, the lowest rates are found in Ivy Court Surgery, Dr Setty M V S & Partners and Front Road Surgery.
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Ward Rates GP Practice Rates
Ward Code Ward Name 65-84 GP Code GP Surgery 65-84 29UBJA Stanhope 774.5 G82658 Sellindge Surgery 645.3 29UBJL Wye 770.5 G82142 Wye Surgery 617.4 29UBGZ Aylesford Green 756.8 G82050 Sydenham House Medical Centre 616.5 29UBHQ Norman 744.4 G82049 Hollington Surgery 597.6 29UBHA Beaver 728.6 G82735 South Ashford Medics 569.9 29UBHX Saxon Shore 708.2 G82186 Hamstreet Surgery 543.7 29UBHP Little Burton Farm 692.1 G82748 Musgrove Park 541.1 29UBHT Park Farm South 671.9 G82087 New Hayesbank Surgery 536.3 29UBJH Weald East 667.6 G82080 The Willesborough Medical Ctr 516.3 29UBHL Highfield 656.2 G82094 The Charing Surgery 514.2 29UBHF Charing 641.1 G82730 Dr Kelly J C & Partners 484.4 29UBHE Bybrook 637.7 G82712 Dr Thomas A 484.0 29UBHN Kennington 621.0 G82114 Ivy Court Surgery 478.1 29UBHC Bockhanger 616.8 G82688 Dr Setty M V S & Partner 438.1 29UBHD Boughton Aluph and Eastwell 613.6 G82053 Front Road Surgery 393.0 29UBJF Washford 612.0 29UBHG Downs North 602.9 29UBJB Stour 598.0 29UBHZ South Willesborough 570.9 29UBHJ Godinton 569.9 29UBHS Park Farm North 569.4 29UBHH Downs West 564.3 29UBJJ Weald North 542.7 29UBHU Rolvenden and Tenterden West 541.3 29UBHR North Willesborough 540.8 29UBJK Weald South 537.0 29UBHW St Michaels 535.2 29UBJD Tenterden South 526.3 29UBJG Weald Central 524.3 29UBJE Victoria 517.1 29UBHM Isle of Oxney 503.7 29UBHY Singleton South 464.0 29UBJC Tenterden North 433.1 29UBHK Great Chart with Singleton North 433.0 29UBHB Biddenden 432.3
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Figure 124- Accident & Emergency attendance rates for people aged 85+ years
The highest attendance rates for persons aged 85 and over are found in Park Farm North, Downs West, Victoria, Downs North and Norman wards, the lowest rates are found in St Michaels, Biddenden, Weald North, Stanhope and South Willesborough wards.
The practices with the highest rates are Hollington Surgery, Sydenham House Medical Centre, Dr Kelly J C & Partners and Charing Surgery, the lowest rates are found in South Ashford Medics, New Hayesbank Surgery and Front Road Surgery
Page | 105
Ward Rates GP Practice Rates
Ward Code Ward Name 85+ GP Code GP Surgery 85+ 29UBHS Park Farm North 1347.8 G82049 Hollington Surgery 1196.7 29UBHH Downs West 1306.5 G82050 Sydenham House Medical Centre 1140.8 29UBJE Victoria 1187.5 G82730 Dr Kelly J C & Partners 1123.8 29UBHG Downs North 1175.4 G82094 The Charing Surgery 1044.8 29UBHQ Norman 1131.6 G82186 Hamstreet Surgery 972.2 29UBHU Rolvenden and Tenterden West 1065.9 G82142 Wye Surgery 963.1 29UBHE Bybrook 1063.5 G82712 Dr Thomas A 960.0 29UBJG Weald Central 1062.5 G82658 Sellindge Surgery 853.7 29UBJK Weald South 1026.3 G82114 Ivy Court Surgery 844.0 29UBJF Washford 1000.0 G82748 Musgrove Park 811.2 29UBHX Saxon Shore 985.0 G82080 The Willesborough Medical Ctr 804.8 29UBHM Isle of Oxney 977.3 G82688 Dr Setty M V S & Partner 789.5 29UBJD Tenterden South 973.0 G82735 South Ashford Medics 736.8 29UBHC Bockhanger 971.4 G82087 New Hayesbank Surgery 725.8 29UBJL Wye 963.0 G82053 Front Road Surgery 654.9 29UBHL Highfield 960.0 29UBHF Charing 904.3 29UBHR North Willesborough 900.0 29UBHJ Godinton 891.9 29UBGZ Aylesford Green 854.8 29UBJB Stour 814.4 29UBHD Boughton Aluph and Eastwell 814.0 29UBHN Kennington 811.6 29UBJH Weald East 800.0 29UBHP Little Burton Farm 796.3 29UBHT Park Farm South 794.1 29UBHA Beaver 778.7 29UBJC Tenterden North 777.8 29UBHK Great Chart with Singleton North 733.3 29UBHY Singleton South 728.6 29UBHW St Michaels 714.3 29UBHB Biddenden 644.1 29UBJJ Weald North 527.3 29UBJA Stanhope 444.4 29UBHZ South Willesborough 406.3
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Figure 125- Accident & Emergency attendance rates for people of all ages
For A&E attendance rates for people of all ages the highest ward rates are in Wye, Bybrook, Downs West, Charing and Aylesford Green wards, the lowest are found in Park Farm South, Singleton South, Park Farm North and Great Chart with Singleton North.
Sellindge Surgery has the highest attendance rates of GP practices, Hamstreet Surgery, Sydenham House Medical Centre and Ivy Court Surgery also have high rates. Those with the lowest rates are Musgrove Park, Dr Kelly J C & Partners and Dr Setty M V S & Partners.
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Ward Rates GP Practice Rates
Ward Code Ward Name All Ages GP Code GP Surgery All Ages 29UBJL Wye 371.9 G82658 Sellindge Surgery 283.7 29UBHE Bybrook 327.4 G82186 Hamstreet Surgery 283.3 29UBHH Downs West 317.9 G82050 Sydenham House Medical Centre 274.8 29UBHF Charing 317.8 G82114 Ivy Court Surgery 267.0 29UBGZ Aylesford Green 313.0 G82142 Wye Surgery 261.4 29UBHX Saxon Shore 300.9 G82080 The Willesborough Medical Ctr 253.9 29UBHC Bockhanger 299.5 G82094 The Charing Surgery 249.4 29UBJD Tenterden South 298.7 G82053 Front Road Surgery 244.3 29UBHA Beaver 298.0 G82049 Hollington Surgery 240.5 29UBJK Weald South 294.3 G82735 South Ashford Medics 235.2 29UBHW St Michaels 290.3 G82712 Dr Thomas A 230.8 29UBHU Rolvenden and Tenterden West 285.3 G82087 New Hayesbank Surgery 229.9 29UBHR North Willesborough 281.2 G82748 Musgrove Park 220.9 29UBJH Weald East 276.3 G82730 Dr Kelly J C & Partners 212.6 29UBHN Kennington 275.4 G82688 Dr Setty M V S & Partner 184.3 29UBHG Downs North 274.3 29UBJC Tenterden North 272.3 29UBJA Stanhope 271.6 29UBHL Highfield 264.9 29UBHB Biddenden 253.5 29UBJG Weald Central 252.8 29UBJJ Weald North 249.9 29UBHM Isle of Oxney 249.2 29UBJE Victoria 247.2 29UBJB Stour 245.5 29UBHD Boughton Aluph and Eastwell 243.2 29UBHQ Norman 238.2 29UBHP Little Burton Farm 229.9 29UBHJ Godinton 221.3 29UBJF Washford 219.3 29UBHZ South Willesborough 213.4 29UBHT Park Farm South 206.3 29UBHY Singleton South 203.1 29UBHS Park Farm North 200.9 29UBHK Great Chart with Singleton North 189.5
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Emergency admission rates in Ashford, 2012/13 Figure 126- Emergency admission rates for children aged 0-4 years
Ashford CCG has 5 wards with an emergency admission rate for 0-4s higher than 65; Bybrook, Wye, Park Farm South, Stanhope and Weald East wards. The lowest rates are in Saxon Shore, North Willesborough, Little Burton Farm, Downs West and Rolvenden & Tenterden West.
The GP practices with the highest rates are Hamstreet Surgery, South Ashford Medics and Dr Thomas A, the lowest rates are in New Hayesbank Surgery, Musgrove Park and Ivy Court Surgery.
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Ward Rates GP Practice Rates
Ward Code Ward Name 0-4 GP Code GP Surgery 0-4 29UBHE Bybrook 128.3 G82186 Hamstreet Surgery 66.1 29UBJL Wye 90.9 G82735 South Ashford Medics 63.2 29UBHT Park Farm South 79.7 G82712 Dr Thomas A 50.0 29UBJA Stanhope 77.9 G82730 Dr Kelly J C & Partners 46.0 29UBJH Weald East 67.6 G82658 Sellindge Surgery 43.9 29UBJG Weald Central 63.7 G82688 Dr Setty M V S & Partner 42.6 29UBHF Charing 52.6 G82142 Wye Surgery 42.2 29UBHJ Godinton 52.4 G82050 Sydenham House Medical Centre 41.6 29UBJE Victoria 49.9 G82094 The Charing Surgery 35.2 29UBHC Bockhanger 43.5 G82049 Hollington Surgery 31.4 29UBJC Tenterden North 42.6 G82053 Front Road Surgery 28.8 29UBHZ South Willesborough 42.4 G82080 The Willesborough Medical Ctr 27.9 29UBHL Highfield 41.1 G82087 New Hayesbank Surgery 24.2 29UBHS Park Farm North 37.8 G82748 Musgrove Park 23.2 29UBHY Singleton South 37.3 G82114 Ivy Court Surgery 22.6 29UBJD Tenterden South 36.0 29UBHM Isle of Oxney 34.2 29UBHA Beaver 33.1 29UBHW St Michaels 31.6 29UBJF Washford 30.9 29UBJK Weald South 30.0 29UBHD Boughton Aluph and Eastwell 29.4 29UBJJ Weald North 29.4 29UBHN Kennington 28.8 29UBHQ Norman 25.5 29UBJB Stour 23.7 29UBHB Biddenden 23.3 29UBHG Downs North 20.5 29UBGZ Aylesford Green 13.6 29UBHK Great Chart with Singleton North 11.1 29UBHX Saxon Shore 9.2 29UBHR North Willesborough 8.7 29UBHP Little Burton Farm 4.3 29UBHH Downs West 0.0 29UBHU Rolvenden and Tenterden West 0.0
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Figure 127- Emergency admission rates for children aged 5-19 years
For emergency admission rates for people aged 5-19 the highest rates are found in Aylesford Green, Weald North, Charing, Tenterden South and Isle of Oxney, the lowest rates are found in Weald Central, Stour, Park Farm North, Highfield and Rolvenden and Tenterden West.
The GP practices with the highest admission rates are Sellindge Surgery, Hollington Surgery, Sydenham House Medical Centre and Dr Setty M V S & Partners. The lowest rates are in Musgrove Park, Hamstreet Surgery and Dr Kelly J C & Partners.
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Ward Rates GP Practice Rates
Ward Code Ward Name 5-19 GP Code GP Surgery 5-19 29UBGZ Aylesford Green 29.3 G82658 Sellindge Surgery 21.0 29UBJJ Weald North 24.0 G82049 Hollington Surgery 20.7 29UBHF Charing 22.0 G82050 Sydenham House Medical Centre 18.7 29UBJD Tenterden South 21.6 G82688 Dr Setty M V S & Partner 18.7 29UBHM Isle of Oxney 20.7 G82094 The Charing Surgery 17.9 29UBHH Downs West 20.2 G82735 South Ashford Medics 14.6 29UBJA Stanhope 20.0 G82053 Front Road Surgery 14.5 29UBHE Bybrook 19.3 G82712 Dr Thomas A 11.6 29UBHJ Godinton 19.1 G82142 Wye Surgery 11.5 29UBHQ Norman 19.0 G82080 The Willesborough Medical Ctr 10.9 29UBHR North Willesborough 16.6 G82087 New Hayesbank Surgery 10.9 29UBHD Boughton Aluph and Eastwell 16.5 G82114 Ivy Court Surgery 10.6 29UBHT Park Farm South 16.4 G82748 Musgrove Park 9.4 29UBHK Great Chart with Singleton North 15.8 G82186 Hamstreet Surgery 7.9 29UBHA Beaver 13.2 G82730 Dr Kelly J C & Partners 7.7 29UBJE Victoria 12.9 29UBHY Singleton South 12.3 29UBJL Wye 12.1 29UBHB Biddenden 12.0 29UBJF Washford 12.0 29UBHC Bockhanger 11.8 29UBHW St Michaels 10.7 29UBHG Downs North 10.2 29UBHP Little Burton Farm 9.7 29UBJK Weald South 8.9 29UBHN Kennington 8.2 29UBHZ South Willesborough 7.6 29UBJH Weald East 7.1 29UBJC Tenterden North 6.2 29UBHX Saxon Shore 5.7 29UBJG Weald Central 4.3 29UBJB Stour 4.0 29UBHS Park Farm North 4.0 29UBHL Highfield 3.9 29UBHU Rolvenden and Tenterden West 2.6
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Figure 128- Emergency admission rates for people aged 20-44 years
The highest admission rates for wards can be found in Stanhope, Downs West, Rolvenden & Tenterden West, Aylesford Green and Boughton Aluph and Eastwell wards. The lowest rates are found in Highfield, Biddenden, Weald South, Weald North and Kennington wards.
The highest rates at GP level are found at South Ashford Medics, Dr Thomas A and Sydenham House Medical Centre. The lowest rates are at Wye Surgery, Dr Setty M V S & Partners and Sellindge Surgery.
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Ward Rates GP Practice Rates
Ward Code Ward Name 20-44 GP Code GP Surgery 20-44 29UBJA Stanhope 81.7 G82735 South Ashford Medics 52.9 29UBHH Downs West 67.6 G82712 Dr Thomas A 46.0 29UBHU Rolvenden and Tenterden West 59.3 G82050 Sydenham House Medical Centre 40.3 29UBGZ Aylesford Green 57.1 G82080 The Willesborough Medical Ctr 38.1 29UBHD Boughton Aluph and Eastwell 55.7 G82748 Musgrove Park 36.7 29UBJH Weald East 51.7 G82094 The Charing Surgery 34.6 29UBHC Bockhanger 50.4 G82730 Dr Kelly J C & Partners 29.7 29UBHA Beaver 48.7 G82186 Hamstreet Surgery 28.2 29UBHZ South Willesborough 45.4 G82087 New Hayesbank Surgery 27.9 29UBJE Victoria 40.8 G82053 Front Road Surgery 27.7 29UBHE Bybrook 40.3 G82049 Hollington Surgery 27.5 29UBJG Weald Central 39.2 G82114 Ivy Court Surgery 25.1 29UBHQ Norman 33.7 G82142 Wye Surgery 23.6 29UBHK Great Chart with Singleton North 32.9 G82688 Dr Setty M V S & Partner 21.1 29UBJL Wye 32.5 G82658 Sellindge Surgery 19.1 29UBJB Stour 32.4 29UBHG Downs North 30.3 29UBHJ Godinton 29.7 29UBHX Saxon Shore 29.3 29UBHR North Willesborough 28.8 29UBHY Singleton South 28.6 29UBHM Isle of Oxney 28.5 29UBHP Little Burton Farm 27.2 29UBJF Washford 26.0 29UBHT Park Farm South 24.6 29UBHF Charing 24.5 29UBHW St Michaels 23.4 29UBHS Park Farm North 21.8 29UBJD Tenterden South 19.4 29UBJC Tenterden North 18.7 29UBHL Highfield 18.3 29UBHB Biddenden 15.8 29UBJK Weald South 14.1 29UBJJ Weald North 9.4 29UBHN Kennington 1.9
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Figure 129- Emergency admission rate for people aged 45-64 years
The highest emergency admission rates for persons aged 45-64 in Ashford are found in Beaver, Stanhope, South Willesborough, Aylesford Green and Weald South wards. The lowest rates are found in Tenterden South, Tenterden North, Rolvenden and Tenterden West, Charing, Great Chart with Singleton North and Weald North wards.
The highest rates at GP level are South Ashford Medics, Musgrove Park and Hamstreet Surgery, the lowest rates are found in Wye Surgery, New Hayesbank Surgery and Charing Surgery.
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Ward Rates GP Practice Rates
Ward Code Ward Name 45-64 GP Code GP Surgery 45-64 29UBHA Beaver 75.5 G82735 South Ashford Medics 76.4 29UBJA Stanhope 72.4 G82748 Musgrove Park 56.6 29UBHZ South Willesborough 71.9 G82186 Hamstreet Surgery 53.8 29UBGZ Aylesford Green 62.7 G82050 Sydenham House Medical Centre 53.7 29UBJK Weald South 60.6 G82080 The Willesborough Medical Ctr 52.2 29UBJL Wye 60.4 G82053 Front Road Surgery 43.7 29UBHD Boughton Aluph and Eastwell 54.9 G82049 Hollington Surgery 43.4 29UBJE Victoria 54.9 G82730 Dr Kelly J C & Partners 40.2 29UBHY Singleton South 54.2 G82658 Sellindge Surgery 39.4 29UBHT Park Farm South 53.0 G82688 Dr Setty M V S & Partner 38.1 29UBJB Stour 50.9 G82712 Dr Thomas A 36.9 29UBHR North Willesborough 50.8 G82114 Ivy Court Surgery 33.5 29UBHQ Norman 47.9 G82142 Wye Surgery 33.2 29UBHW St Michaels 47.1 G82087 New Hayesbank Surgery 30.5 29UBJF Washford 46.2 G82094 The Charing Surgery 30.1 29UBJH Weald East 44.9 29UBHE Bybrook 42.2 29UBHM Isle of Oxney 40.3 29UBHL Highfield 38.8 29UBHH Downs West 38.8 29UBHX Saxon Shore 38.4 29UBHP Little Burton Farm 37.7 29UBHG Downs North 35.9 29UBHN Kennington 32.5 29UBJG Weald Central 32.5 29UBHJ Godinton 32.2 29UBHS Park Farm North 31.9 29UBHB Biddenden 30.3 29UBHC Bockhanger 29.5 29UBJD Tenterden South 27.2 29UBJC Tenterden North 25.5 29UBHU Rolvenden and Tenterden West 25.1 29UBHF Charing 24.5 29UBHK Great Chart with Singleton North 23.3 29UBJJ Weald North 18.5
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Figure 130- Emergency admission rates for people aged 65-84 years
The highest emergency admission rates are found in Park Farm South, Aylesford Green, Stanhope, Norman and Beaver wards, the lowest rates are found in Great Chart with Singleton North, Isle of Oxney, Victoria, St Michaels and Tenterden North wards.
The highest GP rates are found in Dr Setty M V S & Partners, Sydenham House Medical Centre Hollington Surgery and Musgrove Park, the lowest rates are found in Ivy Court Surgery, Front Road Surgery and Dr Thomas A.
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Ward Rates GP Practice Rates
Ward Code Ward Name 65-84 GP Code GP Surgery 65-84 29UBHT Park Farm South 302.1 G82688 Dr Setty M V S & Partner 175.2 29UBGZ Aylesford Green 279.3 G82050 Sydenham House Medical Centre 173.5 29UBJA Stanhope 225.5 G82049 Hollington Surgery 171.0 29UBHQ Norman 217.3 G82748 Musgrove Park 151.9 29UBHA Beaver 206.6 G82142 Wye Surgery 145.1 29UBHP Little Burton Farm 199.4 G82080 The Willesborough Medical Ctr 137.2 29UBJL Wye 177.6 G82094 The Charing Surgery 135.3 29UBHR North Willesborough 177.2 G82087 New Hayesbank Surgery 130.7 29UBJB Stour 164.8 G82658 Sellindge Surgery 126.7 29UBHJ Godinton 157.7 G82735 South Ashford Medics 124.0 29UBHC Bockhanger 156.5 G82730 Dr Kelly J C & Partners 120.1 29UBHH Downs West 155.8 G82186 Hamstreet Surgery 101.0 29UBJH Weald East 149.3 G82114 Ivy Court Surgery 95.5 29UBHL Highfield 145.1 G82053 Front Road Surgery 79.5 29UBHF Charing 142.9 G82712 Dr Thomas A 72.0 29UBHG Downs North 142.9 29UBJF Washford 136.0 29UBHD Boughton Aluph and Eastwell 132.7 29UBHN Kennington 126.3 29UBJD Tenterden South 124.6 29UBJG Weald Central 122.3 29UBHY Singleton South 121.0 29UBHS Park Farm North 120.4 29UBHZ South Willesborough 118.1 29UBHX Saxon Shore 113.1 29UBHB Biddenden 112.8 29UBHE Bybrook 107.3 29UBJJ Weald North 107.2 29UBHU Rolvenden and Tenterden West 105.4 29UBJK Weald South 102.4 29UBHK Great Chart with Singleton North 99.7 29UBHM Isle of Oxney 94.1 29UBJE Victoria 93.0 29UBHW St Michaels 89.6 29UBJC Tenterden North 83.5
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Figure 131- Emergency admission rates for people aged 85+ years
The wards with the highest emergency admission rates for people aged 85 and over are Highfield, Washford, Victoria, Bybrook and Little Burton Farm wards. The wards with the lowest rates are Aylesford Green, Weald North, Tenterden South, Stanhope and South Willesborough wards.
The practices with the highest rates are Hollington Surgery, Dr Kelly J C & Partners, Sydenham House Medical Centre and South Ashford Medics, those with the lowest rates are Sellindge Surgery, Ivy Court Surgery, Front Road Surgery and Dr Setty M V S & Partners.
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Ward Rates GP Practice Rates
Ward Code Ward Name 85+ GP Code GP Surgery 85+ 29UBHL Highfield 720.0 G82049 Hollington Surgery 606.6 29UBJF Washford 666.7 G82730 Dr Kelly J C & Partners 476.2 29UBJE Victoria 645.8 G82050 Sydenham House Medical Centre 475.7 29UBHE Bybrook 619.0 G82735 South Ashford Medics 473.7 29UBHP Little Burton Farm 518.5 G82094 The Charing Surgery 467.7 29UBHT Park Farm South 485.3 G82748 Musgrove Park 440.6 29UBJG Weald Central 482.1 G82712 Dr Thomas A 440.0 29UBHS Park Farm North 478.3 G82186 Hamstreet Surgery 416.7 29UBHH Downs West 467.7 G82142 Wye Surgery 400.9 29UBHC Bockhanger 442.9 G82080 The Willesborough Medical Ctr 363.4 29UBHG Downs North 438.6 G82087 New Hayesbank Surgery 357.0 29UBJL Wye 422.2 G82658 Sellindge Surgery 308.9 29UBHF Charing 417.4 G82114 Ivy Court Surgery 232.3 29UBHR North Willesborough 413.3 G82053 Front Road Surgery 211.3 29UBJB Stour 401.2 G82688 Dr Setty M V S & Partner 184.2 29UBHM Isle of Oxney 386.4 29UBHU Rolvenden and Tenterden West 384.6 29UBHX Saxon Shore 383.5 29UBJK Weald South 381.6 29UBHN Kennington 362.3 29UBHJ Godinton 351.4 29UBHA Beaver 344.3 29UBHY Singleton South 328.6 29UBHK Great Chart with Singleton North 288.9 29UBHW St Michaels 285.7 29UBJC Tenterden North 259.3 29UBHD Boughton Aluph and Eastwell 255.8 29UBHQ Norman 236.8 29UBJH Weald East 200.0 29UBHB Biddenden 186.4 29UBGZ Aylesford Green 177.4 29UBJJ Weald North 163.6 29UBJD Tenterden South 153.2 29UBJA Stanhope 111.1 29UBHZ South Willesborough 62.5
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Figure 132- Emergency admission rate for all ages
The wards with the highest rates for all ages are Wye, Aylesford Green, Beaver, Downs West, Charing and Bybrook wards. Those with the lowest rates are Biddenden, Washford, Weald North, Great Chart with Singleton North and Park Farm North.
The highest rates amongst practices are in Sydenham House Medical Centre, Hollington Surgery, Willesborough Medical Centre and Charing Surgery. The lowest rates are at New Hayesbank Surgery, Dr Setty M V S & Partners, Dr Thomas A and Dr Kelly J C & Partners.
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Ward Rates GP Practice Rates
Ward Code Ward Name All Ages GP Code GP Surgery All Ages 29UBJL Wye 95.6 G82050 Sydenham House Medical Centre 65.2 29UBGZ Aylesford Green 77.3 G82049 Hollington Surgery 61.1 29UBHA Beaver 75.9 G82080 The Willesborough Medical Ctr 59.7 29UBHH Downs West 72.8 G82094 The Charing Surgery 58.6 29UBHF Charing 72.6 G82142 Wye Surgery 57.7 29UBHE Bybrook 70.1 G82735 South Ashford Medics 57.7 29UBJA Stanhope 69.7 G82186 Hamstreet Surgery 56.1 29UBHR North Willesborough 68.8 G82748 Musgrove Park 55.9 29UBHC Bockhanger 68.2 G82658 Sellindge Surgery 54.3 29UBJB Stour 60.5 G82053 Front Road Surgery 50.4 29UBHU Rolvenden and Tenterden West 60.4 G82114 Ivy Court Surgery 49.8 29UBHT Park Farm South 60.2 G82087 New Hayesbank Surgery 48.6 29UBJH Weald East 59.9 G82688 Dr Setty M V S & Partner 42.7 29UBHG Downs North 59.7 G82712 Dr Thomas A 42.5 29UBJK Weald South 57.9 G82730 Dr Kelly J C & Partners 40.9 29UBJG Weald Central 57.1 29UBHD Boughton Aluph and Eastwell 56.0 29UBJC Tenterden North 55.5 29UBHQ Norman 55.2 29UBJE Victoria 54.6 29UBJD Tenterden South 54.0 29UBHW St Michaels 53.4 29UBHX Saxon Shore 52.5 29UBHL Highfield 51.7 29UBHP Little Burton Farm 51.4 29UBHM Isle of Oxney 51.4 29UBHN Kennington 50.9 29UBHY Singleton South 49.6 29UBHZ South Willesborough 47.7 29UBHJ Godinton 44.8 29UBHB Biddenden 43.8 29UBJF Washford 38.8 29UBJJ Weald North 38.3 29UBHK Great Chart with Singleton North 34.3 29UBHS Park Farm North 29.1
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Elective admission rates in Ashford for older people, 2012/13 Figure 133- Elective admission rates for people aged 65-84 years
For Elective admission rates for people aged 65-84 the highest are found in Wye, Stanhope, Saxon Shore, Norman and Bybrook wards, the lowest rates are in Singleton South, Weald North and Biddenden wards.
The GP practices with the highest rates are Sellindge Surgery, Wye Surgery, Hollington Surgery and South Ashford Medics, the lowest rates are in Willesborough Medical Centre, Dr Kelly J C & Partners, Front Road Surgery and Dr Setty M V S & Partners.
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Ward Rates GP Practice Rates
Ward Code Ward Name 65-84 GP Code GP Surgery 65-84 29UBJL Wye 455.1 G82658 Sellindge Surgery 626.3 29UBJA Stanhope 436.3 G82142 Wye Surgery 351.6 29UBHX Saxon Shore 398.5 G82049 Hollington Surgery 323.9 29UBHQ Norman 396.2 G82735 South Ashford Medics 314.0 29UBHE Bybrook 394.7 G82050 Sydenham House Medical Centre 312.7 29UBHA Beaver 383.9 G82712 Dr Thomas A 304.0 29UBHL Highfield 369.1 G82186 Hamstreet Surgery 283.8 29UBJH Weald East 366.2 G82748 Musgrove Park 269.0 29UBHN Kennington 366.2 G82087 New Hayesbank Surgery 269.0 29UBHP Little Burton Farm 343.1 G82094 The Charing Surgery 248.2 29UBGZ Aylesford Green 339.3 G82114 Ivy Court Surgery 242.7 29UBHJ Godinton 326.2 G82080 The Willesborough Medical Ctr 238.9 29UBJF Washford 324.0 G82730 Dr Kelly J C & Partners 236.3 29UBHS Park Farm North 314.8 G82053 Front Road Surgery 203.5 29UBHF Charing 312.5 G82688 Dr Setty M V S & Partner 148.0 29UBHD Boughton Aluph and Eastwell 309.7 29UBHW St Michaels 296.4 29UBHC Bockhanger 292.1 29UBJK Weald South 282.3 29UBJB Stour 278.4 29UBHU Rolvenden and Tenterden West 261.9 29UBHG Downs North 260.5 29UBJG Weald Central 259.3 29UBHH Downs West 257.3 29UBJE Victoria 254.5 29UBHZ South Willesborough 248.0 29UBJD Tenterden South 242.1 29UBHK Great Chart with Singleton North 239.9 29UBHT Park Farm South 239.6 29UBJC Tenterden North 234.6 29UBHR North Willesborough 234.3 29UBHM Isle of Oxney 232.5 29UBHY Singleton South 198.8 29UBJJ Weald North 192.6 29UBHB Biddenden 178.6
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Figure 134- Elective admission rates for people aged 85+ years
The wards with the highest rates for Elective admissions in the 85+ are Park Farm North, Tenterden South, Downs West, Norman and Aylesford Green wards, the lowest are found in St. Michaels, South Willesborough, Little Burton Farm, Highfield and Park Farm South wards
The highest GP practice rates are found in Hollington Surgery, Dr Setty M V S & Partners, Dr Kelly J C & Partners and Dr Thomas A Practice, the lowest rates are found in Front Road Surgery, South Ashford Medics, New Hayesbank Surgery and Musgrove Park (which has now closed).
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Ward Rates GP Practice Rates
Ward Code Ward Name 85+ GP Code GP Surgery 85+ 29UBHS Park Farm North 695.7 G82049 Hollington Surgery 475.4 29UBJD Tenterden South 693.7 G82688 Dr Setty M V S & Partner 473.7 29UBHH Downs West 645.2 G82730 Dr Kelly J C & Partners 447.6 29UBHQ Norman 552.6 G82712 Dr Thomas A 440.0 29UBGZ Aylesford Green 500.0 G82658 Sellindge Surgery 434.8 29UBHG Downs North 491.2 G82094 The Charing Surgery 403.0 29UBJH Weald East 466.7 G82114 Ivy Court Surgery 381.2 29UBJK Weald South 434.2 G82050 Sydenham House Medical Centre 373.8 29UBHM Isle of Oxney 409.1 G82186 Hamstreet Surgery 361.1 29UBHX Saxon Shore 375.9 G82142 Wye Surgery 336.4 29UBHF Charing 365.2 G82080 The Willesborough Medical Ctr 252.3 29UBHJ Godinton 364.9 G82053 Front Road Surgery 232.4 29UBJE Victoria 343.8 G82735 South Ashford Medics 184.2 29UBJA Stanhope 333.3 G82087 New Hayesbank Surgery 172.6 29UBJF Washford 333.3 G82748 Musgrove Park 139.9 29UBHC Bockhanger 328.6 29UBHB Biddenden 322.0 29UBJG Weald Central 321.4 29UBJC Tenterden North 321.0 29UBHK Great Chart with Singleton North 311.1 29UBJL Wye 303.7 29UBHU Rolvenden and Tenterden West 296.7 29UBHY Singleton South 285.7 29UBHD Boughton Aluph and Eastwell 279.1 29UBHN Kennington 275.4 29UBHR North Willesborough 266.7 29UBHE Bybrook 222.2 29UBJB Stour 215.6 29UBHA Beaver 213.1 29UBJJ Weald North 200.0 29UBHW St Michaels 187.5 29UBHZ South Willesborough 93.8 29UBHP Little Burton Farm 92.6 29UBHL Highfield 80.0 29UBHT Park Farm South 58.8
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Outpatient attendance rates in Ashford for older people, 2012/13 Figure 135- First outpatient attendance rates for people aged 65-84 years
Outpatient attendance rates for people aged 65-84 are highest in Wye, Stanhope, Aylesford Green, Norman and Beaver wards, the lowest rates are found in Isle of Oxney, Singleton South, Tenterden North, Great Chart with Singleton North and Biddenden wards.
The highest practice rates are found at Sellindge Surgery, Wye Surgery, Sydenham House Medical Centre and Hollington Surgery, the lowest rates are found in Ivy Court Surgery, Dr Setty M V S & Partner and Front Road Surgery.
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Ward Rates GP Practice Rates
Ward Code Ward Name 65-84 GP Code GP Surgery 65-84 29UBJL Wye 770.5 G82658 Sellindge Surgery 644.2 29UBJA Stanhope 764.7 G82142 Wye Surgery 617.4 29UBGZ Aylesford Green 744.7 G82050 Sydenham House Medical Centre 610.7 29UBHQ Norman 741.2 G82049 Hollington Surgery 597.6 29UBHA Beaver 726.2 G82735 South Ashford Medics 565.1 29UBHX Saxon Shore 707.2 G82186 Hamstreet Surgery 543.7 29UBHP Little Burton Farm 692.1 G82748 Musgrove Park 541.1 29UBHT Park Farm South 671.9 G82087 New Hayesbank Surgery 533.7 29UBJH Weald East 664.8 G82080 The Willesborough Medical Ctr 514.3 29UBHL Highfield 656.2 G82094 The Charing Surgery 512.9 29UBHF Charing 641.1 G82712 Dr Thomas A 484.0 29UBHE Bybrook 637.7 G82730 Dr Kelly J C & Partners 480.5 29UBHC Bockhanger 616.8 G82114 Ivy Court Surgery 477.8 29UBHD Boughton Aluph and Eastwell 613.6 G82688 Dr Setty M V S & Partner 435.0 29UBJF Washford 612.0 G82053 Front Road Surgery 393.0 29UBHN Kennington 608.1 29UBHG Downs North 602.9 29UBJB Stour 583.8 29UBHZ South Willesborough 570.9 29UBHS Park Farm North 569.4 29UBHJ Godinton 568.1 29UBHH Downs West 559.8 29UBJJ Weald North 542.7 29UBHU Rolvenden and Tenterden West 541.3 29UBHR North Willesborough 539.6 29UBJK Weald South 536.1 29UBHW St Michaels 535.2 29UBJD Tenterden South 526.3 29UBJG Weald Central 524.3 29UBJE Victoria 517.1 29UBHM Isle of Oxney 503.7 29UBHY Singleton South 464.0 29UBJC Tenterden North 433.1 29UBHK Great Chart with Singleton North 433.0 29UBHB Biddenden 432.3
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Figure 136- Outpatient first attendance rates for people aged 85+ years
Ashford CCG has 10 wards with rates higher than 1,000 per 1,000 85+ year olds for Outpatient appointments, these are Park Farm North, Downs West, Victoria, Downs North, Norman, Rolvenden and Tenterden West, Bybrook, Weald Central, Weald South and Washford wards, the lowest rates are found in Biddenden, Weald North, Stanhope and South Willesborough wards. The highest GP practice rates are found in Hollington Surgery, Sydenham House Medical Centre, Dr Kelly J C & Partners and Charing Surgery, the lowest rates are found in South Ashford Medics, New Hayesbank Surgery and Front Road Surgery.
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Ward Rates GP Practice Rates
Ward Code Ward Name 85+ GP Code GP Surgery 85+ 29UBHS Park Farm North 1347.8 G82049 Hollington Surgery 1196.7 29UBHH Downs West 1306.5 G82050 Sydenham House Medical Centre 1131.1 29UBJE Victoria 1177.1 G82730 Dr Kelly J C & Partners 1123.8 29UBHG Downs North 1175.4 G82094 The Charing Surgery 1044.8 29UBHQ Norman 1131.6 G82186 Hamstreet Surgery 965.3 29UBHU Rolvenden and Tenterden West 1065.9 G82142 Wye Surgery 963.1 29UBHE Bybrook 1063.5 G82712 Dr Thomas A 880.0 29UBJG Weald Central 1062.5 G82658 Sellindge Surgery 853.7 29UBJK Weald South 1026.3 G82114 Ivy Court Surgery 844.0 29UBJF Washford 1000.0 G82748 Musgrove Park 811.2 29UBHX Saxon Shore 985.0 G82080 The Willesborough Medical Ctr 795.8 29UBHM Isle of Oxney 977.3 G82688 Dr Setty M V S & Partner 789.5 29UBJD Tenterden South 973.0 G82735 South Ashford Medics 736.8 29UBHC Bockhanger 971.4 G82087 New Hayesbank Surgery 725.8 29UBJL Wye 963.0 G82053 Front Road Surgery 654.9 29UBHL Highfield 960.0 29UBHF Charing 904.3 29UBHR North Willesborough 900.0 29UBHJ Godinton 891.9 29UBGZ Aylesford Green 822.6 29UBJB Stour 814.4 29UBHD Boughton Aluph and Eastwell 814.0 29UBHN Kennington 811.6 29UBJH Weald East 800.0 29UBHP Little Burton Farm 796.3 29UBHT Park Farm South 794.1 29UBJC Tenterden North 777.8 29UBHA Beaver 754.1 29UBHK Great Chart with Singleton North 733.3 29UBHY Singleton South 728.6 29UBHW St Michaels 714.3 29UBHB Biddenden 644.1 29UBJJ Weald North 527.3 29UBJA Stanhope 444.4 29UBHZ South Willesborough 406.3
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