The Limes Medical Practice

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that staff involved people in decisions about their care and treatment and provided them advice and support. Staff regularly reviewed people’s care and worked with other services to achieve this.

At our last assessment, we rated this key question as good. At this assessment, the rating remains the same.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

The practice assessed patient needs using clinical searches and structured reviews, particularly for long-term conditions. Nurses were involved in long-term condition management, supported by Health Care Assistants for initial checks, with GPs undertaking medication reviews.

Feedback from people using the service was positive. People felt involved in any assessment of their needs and felt confident that staff understood their individual and cultural needs. For example, the GP patient survey showed that 93% of respondents felt the healthcare professional they saw or spoke to was good at treating them with care and concern, compared to the national average of 86%. Reception staff were aware of the needs of the local community. Reception staff used digital flags within the care records system to highlight any specific individual needs, such as the requirement for longer appointments or for a translator to be present. Staff checked people’s health, care, and wellbeing needs during health reviews. Clinical staff used templates when conducting care reviews to support the review of people’s wider health and wellbeing. The provider had effective systems to identify people with previously undiagnosed conditions. Staff could refer people with social needs, such as those experiencing social isolation or housing difficulties, to a social prescriber.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Systems were in place to ensure staff were up to date with evidence-based guidance and legislation. Clinical records we saw demonstrated care was provided in line with current guidance.

Individual clinicians demonstrated use of guidelines and training, such as nurses completing diabetes courses and actively monitoring patients after initiating treatment.

The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff had access to the information they needed to appropriately assess, plan, and deliver people’s care, treatment, and support. The practice worked with other services to ensure continuity of care, including where clinical tasks were delegated to other services.

The practice worked collaboratively within the multidisciplinary team and with external services to ensure safe care delivery. Internally, learning and information sharing took place through regular clinical and practice meetings. Staff described working alongside GPs, nurses, pharmacists, and care coordinators to manage patient care, including follow-up and monitoring.

The practice coordinated care with a range of services, including urgent care teams, district nurses, Macmillan services, and out-of-hours providers. For example, patients approaching end of life were referred and their information shared appropriately with community and emergency services. In addition, safeguarding processes involved communication across teams, with administrative staff, clinicians, and external agencies working together to follow up concerns such as missed appointments.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff focussed on identifying risks to patients’ health, including those in the last 12 months of their lives, patients at risk of developing a long-term condition and those with caring responsibilities.

The practice supported national health priorities by signposting patients to external services, including weight management and health improvement teams. A smoking cessation clinic had previously been provided but had ceased due to staffing issues, with patients instead referred to external services such as Salford clinics.

The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The practice used clinical searches and undertook quality improvement work, including initiatives focused on chronic kidney disease and fatty liver disease.

The practice was slightly below with some clinical targets including cervical screening and childhood immunisations, but we reviewed practice data (unverified) during our assessment and found that the practice had made improvements from the previous year. For example, the practice was now achieving 93% for cervical screening for the 25 to 49 years old group (previous year 73%). This improvement was supported by targeted quality improvement work, where the practice had identified barriers to patients attending such as access to appointments, health literacy and patient anxiety, and implemented actions including increased appointment flexibility, proactive patient engagement and tailored communication.

From the clinical notes we reviewed, we found that people who used the service experienced positive outcomes as set out in legislation, standards, and evidence-based clinical guidance.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Processes were in place to ensure consent was obtained and recorded appropriately. Staff demonstrated understanding of consent requirements, including the Mental Capacity Act and Gillick competence, and records showed documented consent and the routine offer of chaperones to patients undergoing procedures. Do not attempt cardiopulmonary resuscitation (DNACPR) decisions were appropriate and were made in line with relevant legislation.

Consent was routinely obtained and appropriately recorded within patient records. For example, staff were able to provide evidence of documented consent in clinical records, and patients were offered chaperones where appropriate.