The Limes Medical Centre

On this page

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

We looked for evidence that the service met people’s needs and that staff treated people equally and without discrimination.

The service understood the diverse health and care needs of people and their local communities. People could not always access care, support and treatment when they needed it. Staff and leaders were innovative in how they listened to information about people who are most likely to experience inequality in experience or outcomes. They mostly supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs; however, people did not always feel they were placed at the centre of their care and treatment choices. People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

However, they did not always decide in partnership with people how to respond to any relevant changes in people’s needs. The provider could not demonstrate that they always handled complaints or investigated them properly.

This service scored 71 (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 were at the centre of their care and treatment choices.

We saw examples of patient centred care across all the population groups; for example, working age population, people experiencing poor mental health, long-term conditions and children, families and young people. We saw how they were involved in the planning of their care needs; for example, they offered 30-minute Saturday appointments for their learning disability patients as the practice was quieter and this could reduce anxiety for the patients.

The practice also provided patient centred care for all their 8 care homes where they provided care to a diverse range of patients such as those with dementia, learning disabilities and one specialist neurological centre for acquired brain injuries. The centre confirmed that all their residents had their secondary health care needs reviewed by the GP and this was in part due to the frequency of the GP’s input which greatly benefited their residents. Feedback also obtained from one of the care homes, told us how the practice was responsive to their end-of-life patients and involved their families, and discussed any anticipatory care needs and medicines. They also told us the GPs arranged annual dementia reviews for their patients on the Gold Standard Framework, or sooner if required.

Patient feedback on person-centred care was mixed. While some reported that clinicians accommodated their needs and provided high-quality care, others expressed concerns about continuity, citing difficulty seeing the same GP and challenges in sharing results by email. Several patients felt they were not consistently involved in decisions about their treatment, lacked discussions on side effects and did not always receive timely reviews. Overall, feedback ranged from praise for exceptional care to reports of unmet expectations.

When we reviewed the 2024 GP National patient survey, we saw that 51% of patients responded positively to the overall experience of their GP practice and this was significantly lower than the national average of 74%. The practice was aware of this and told us their Patient Participation Group (PPG) would be consulted on these results and asked for feedback on what could be done to improve patient satisfaction.

Following the inspection and action implemented by the practice, we compared the data from the 2024 National GP Patient Survey to the now available 2025 data and found significant improvement in patient satisfaction scores, with a similar cohort of patients. For example, 67% of people responded positively to the overall experience of their GP practice and this was an improvement from 51% from 2024 data and comparable to the local and national averages.

The service had an exceptional understanding of the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity. For example, their diabetic patients were assigned across their healthcare assistant team to facilitate continuity of care and follow ups with the same clinician and there was joint working with the community diabetes nurses and secondary care for managing more complex and housebound cases. Patients also benefited from GPs with special interests in areas such as respiratory disease and other areas; for example, 2 of their GPs specialised in joint injections and held 20-minute joint injection clinics for evaluation and treatment. This had a positive impact on functional improvement, as well as pain relief for patients and reduced long waiting lists for secondary care. This was consistent with patient feedback on NHS reviews where they noted a significant improvement in their mobility following joint injections.

Patients requiring replacement of ring pessaries could also attend the practice for this to be carried out in 30-minute appointments by a GP. This also had a positive impact on patients who were experiencing long waits to be seen in secondary care and prevented complications. The practice also offered a GP-run vasectomy clinic service on Saturday mornings to facilitate better access to their working population. They told us this service was effective and popular with their patients.

We saw the practice had strong partnerships with other services to meet the needs of its patient population, in relation to their 8 care homes. They were part of a 6-practice Primary Care Network (PCN) and they recruited staff who they shared with the rest of the PCN. We saw an effective joint approach with a diverse range of staff working at the specialist neuro rehab centre including a physiotherapist, occupational therapist, psychologist and a visiting private psychiatrist who worked together with members of the multi-disciplinary team (MDT) and participated in fortnightly MDT ward rounds led by the practice GP. The practice escalated to secondary and tertiary care where required. The practice also took part in MDT meetings for the rest of their practice population and had tailored its services to meet the diverse needs of its community, for example, they worked closely with a homeless shelter. They also worked directly with government agencies, local services and the charity sector to provide tailored mental and physical healthcare provision for refugees and asylum seekers, together with other local practices.

The practice integrated with their local hospice and provided a dedicated GP to manage their end-of-life patients. Part of this integration included shared learning where they worked with the hospice to support 2 specialist GP registrars for 6-month placements, in order to forge a close link between their inpatient and primary care end of life care. There were established mechanisms for engaging with the community healthcare provider as well as health visitors and school nurses and we saw complimentary feedback from the health visiting team confirming effective joint working. There was a home visit policy in place for housebound patients and their dedicated ECP team undertook such home visits.

The practice worked in collaboration with the Hertfordshire and West Essex integrated care board (HWEICB), an integrated care system that brought together social care providers, local government, the NHS, community organisations and other partners to improve the lives of people living and working in their area. HWEICB reported good engagement with the practice.

The service generally provided accurate, up-to-date information in formats suited to individual needs but monitoring was needed to ensure all relevant details were available at branch sites following patient concerns about access.

The practice was innovative in removing barriers for patients accessing information by offering IT lessons for their patients who felt digitally excluded. This included lessons to help them set up online services and their NHS App.

There was a staff board at the main practice, with pictures of staff, their roles and identifiable by first name only. Patients we spoke to suggested this could be located in a prominent position so that all patients were of this. We also saw information boards at all the 4 locations, which contained information such as drug use support. We observed all 4 sites had TV screens that displayed the same information across all the sites. Information to promote the take up of screening and immunisation programmes was available in a range of languages.

The practice had a communications policy and access to interpreter services, including British Sign Language. Information provided by the service met the Accessible Information Standard. The use of the Accurx messaging system played a significant part in patient communication within the practice, as it included patient advice, video calls for housebound patients and providing information relating to clinical images and vital readings.

Their practice leaflet was displayed in the reception and offered various clinics and a self-referral barcode with access to external services such as counselling, sexual health clinic services and smoking cessation support.

The practice also shared information with their Patient Participation Group (PPG) members and we saw evidence of this from their September 2024 meeting minutes where some patients attended. They had a list of the various dates they would be undertaking PPG engagement in the practice, which included invites to complete questionnaires and carers events. A link to joining the PPG was provided on their website and we spoke to one member of the PPG on inspection who confirmed this.

Feedback received from the 8 care homes highlighted overall good communication from the practice.

When we reviewed the 2024 GP National patient survey results, we saw that 90% of patients knew what the next step would be within 2 days of contacting their GP practice and this was comparable to comparable to 93% of the local and national averages.

Whilst we saw evidence that the service enabled people to share feedback and ideas, or raise complaints about their care, treatment and support via various channels, we were not assured the systems and processes in place were effective enough to ensure this was consistently applied within the practice, as we found gaps in the management of complaints.

There was a complaints lead, procedure and complaints leaflet on their website. Staff who were responsible for managing complaints told us all complaints were investigated and responded to and any learning was shared with the wider clinical team. The complaint leaflet provided people with information on how to complain; however, it omitted Care Quality Commission’s (CQC) details and did not provide patients information on how to escalate their concerns to CQC if they wanted to share their concerns.

The practice held monthly Time to Learn Events which all staff were required to attend; however, we did not see evidence of how learning from complaints were shared with all staff. The practice submitted 3 complaints logs between 2023 and 2025, including a complaints summary for complaints logged between May 2024 and March 2025. The logging of these complaints was not clear due to the different logs provided and some of the complaints received since March 2025 were omitted from this summary log. The complaints log we reviewed did not capture all information to establish if the complaint had been upheld or not upheld and the documented complaint information was not always clear on what the issues were and at times inconsistent. For example, we found one entry appeared to suggest the complaint was solely about a recurring, unresolved clinical issue; however, when we reviewed this complaint, we found it was mostly about a clinician’s attitude towards the patient and an incorrect referral.

We were also not assured that all complaints were being captured by the practice. This is due to some written complaints where CQC had been copied into that had been sent to the practice but not included in their complaints log submitted as part of the inspection. For example, one such complaint was raised in July 2024 but was omitted from the complaints log submitted by the practice as part of the inspection. When we also reviewed 5 of the individual complaints, we found one complaint raised in January 2025 was also omitted from their complaints log; therefore, we were not assured all complaints were being captured by the practice.

When we reviewed 5 individual complaints, we found the practice thoroughly investigated them and we found escalation details were provided in 4 of the 5 complaint responses. We saw some evidence complaints were used to drive improvement. However, not all complaints were handled in a timely manner as we saw a 4-month delay in responding to one complaint but it was unclear as to why. This was consistent with feedback we received directly to CQC where patients told us their complaints handling was delayed. Patients did not always receive an apology when their complaint was upheld or partially upheld and this was consistent with the feedback sent directly to CQC, where some patients reported that they never received an apology when they complained about patient care and they did not always feel listened to.

The practice responded to all of their NHS reviews feedback and additionally, we saw patient feedback sent directly to the practice between May 2024 and May 2025, which was mostly positive. The practice could consider analysing this particular feedback to identify trends and themes, as there were concerns such as, inaccurate record keeping and poor communication received as part of this feedback.

We spoke to 5 patients on inspection and they were all aware of how to make a complaint but some stated they were never asked to complete a survey on the practice; however, survey results were displayed on the website for patients to access.

The practice offers a range of appointment types including book on the day, telephone consultations and advance appointments. Out of hours services are provided by NHS 111. Some of the nursing staff were subcontracted by Stella healthcare to provided extended access clinics on Saturdays. Services provided include, chronic disease management, steroid injections, ring pessary clinic, IT drop-in sessions, social prescribing, travel vaccinations, dietitian, first contact physiotherapy and new patient health checks.

People could not always access the care, support and treatment they needed when they needed it. Information about the practice’s opening times was available on the practice website and practice leaflet. Patients were signposted to NHS 111 when the surgery was closed. There was a duty team available each day comprising the duty GP, acute GP, duty healthcare assistant and duty clinical pharmacist, whereby the practice manager maintained oversight.

The practice website also advised patients that access to their North Weald and Theydon Bois branch sites were only via a pre-booked appointment. However, we also received some concerns from patients who told us they did not have the choice to access one of the branch locations which had staffing issues and was always closed. As a result, some of their elderly patients who could not drive found it difficult to access the service due to mobility and terrain issues. They also reported some test kits were not available at the branch sites but following discussion with the practice, they told us they would consider stocking some testing kits at the branch sites to improve their access. When we discussed the reported access issues with the practice, they explained that this was an ongoing concern amongst their patients; however, they held a few public meetings with patients, including 2 open nights at the branch surgery to answer questions from the relevant patients. Rotas provided by the practice showed that all branch locations were appropriately staffed, with no evidence of staffing shortages. Staff we spoke to suggested a timetable for when rotas for appointments were going to be released, as part of their feedback.

The practice had decided not to roll out total triage in the practice, to make access easier for their patients. Patients could book appointments at the reception desk, except for GP appointments which could not be booked via this method. People could access the online service via e-consult, telephone and video consultations. Same day appointments were available for urgent appointments and pre-bookable weekend appointments were available through the enhanced access service. This was consistent with feedback from the Herts and West Essex Integrated Care Board (HWEICB). When we reviewed the premises at all 4 locations, we found some the sites had recently been refurbished and the smaller North Weald branch location had limited space and typically used by their local patients. We observed an appropriately furnished waiting room and clear walkways and it was accessible for wheelchair users and prams. There was ramp and step access.

One branch location did not have an emergency pull cord in its standard toilet, which is not a mandatory requirement outside a designated disabled facility. However, the practice did not have a risk assessment in place in order to identify any potential risks to disabled patients using the standard toilet and to establish how a patient could request assistance in an emergency.

However, patient satisfaction for access was lower than average. The 2024 National GP survey showed the practice was significantly below the expected averages and were a negative outlier in 2 of the indicators relating to access. For example, results showed 11% of patients found it easy to get through to someone at the practice on the phone and this was significantly lower than the expected average of 50% and 49% responded positively to the overall experience of contacting their GP practice and this was lower than the expected average of 67%.

Following the inspection, we compared the 2024 National GP Patient Survey data this data to the now available 2025 data and found improvement in patient satisfaction scores, with a similar cohort of patients; however, patient satisfaction was still low. For example, 23% of patients found it easy to get through to someone at the practice on the phone and this had improved from 11%, however still lower than the expected local average of 48% and national average of 53%. Results also showed 51% responded positively to the overall experience of contacting their GP practice and this was lower than the local average of 68 and national 70% but an improvement from 49%.

The practice was aware of the low patient satisfaction scores and they told us they were in the bottom 10% of patient surveys in the area and this had been the case for a long time. They told us they faced challenges whereby they could not employ any more staff due to room space restrictions and they had reached the maximum capacity for staff and demand was outstripping supply.

We also reviewed feedback sent to CQC and saw mixed feedback regarding access where patients were not happy with access and described 2 occasions where under 5’s were refused access at the practice. We spoke to 5 patients on inspection and some raised concerns with access. Feedback received from the 8 care homes did not report any issues with access and told us the practice was responsive to their requests and there were dedicated team members visiting the homes to undertake reviews. Some of the care home residents could attend face to face appointments at the practice with their care staff if appropriate.

We found the overall themes of the May 2024 to May 2025 reviews was mixed around access but generally positive around care received. Positive feedback from patients stated that they found it easy to access the service for urgent issues, with examples seen of same day emergency appointments for children, whilst some patients expressed that they were seen on time for their appointments. Patients that raised issues with access stated that by 8.30am the queue was full and they could never manage to book appointments, whilst others said they were unable to make appointments online, in person or by telephone and this had been an ongoing issue.

In response to the telephone survey results, the practice invested in a new telephone system with a display board of analytics to show how many calls received, how many calls waiting and a call back function. Staff also received signposting training and they offered extended access appointments outside of core hours when available. In response to the 2024 National GP Patient Survey data and from feedback from members of the community the provider had identified changes to improve access to the service. For example, they increased the different types of appointments available including with the phlebotomist, physiotherapist, clinical pharmacists and telephone advice slots to improve patient satisfaction.

Staff and leaders were innovative in how they listened to information about people who are most likely to experience inequality in experience or outcomes. Staff and leaders actively used this information to provide exceptionally tailored care, support and treatment in response to this. Staff treated people equally and without discrimination.

Leaders proactively sought ways to address any barriers to improving people’s experience and worked with local organisations, including within the voluntary sector, to address any local health inequalities. For example, they had processes to ensure those in vulnerable circumstances such as the homeless could access the service. The practice was also a veteran friendly accredited practice committed to ensuring ex-forces patients had access to the best care and treatment. Some of the patients we spoke to were ex-forces and they were aware of the veteran’s support in the practice, although they told us they felt the veteran service seemed more geared towards the younger generation with mental health needs and not the older generation of ex-forces.

Staff told us they worked to support people moving between services and ensuring there was continuity of care when this happened. Staff responsible for arranging routine monitoring told us described the recall system and made referrals to the community nursing teams where required.

The practice described the barriers they faced with the hospital with regards to long delays; for example, some referrals were rejected by the hospital after 18 months, leading them to use consultant connect. The administration team implemented a new system to make it easier to distinguish between the different medical notes they received and a new process set up to ensure quick and easy access for the relevant teams.

Text messages were offered in different languages.People’s communication needs were coded on the system and those who had language communication needs had access to a wide variety of translation services; for example, they used Google translate and sent the translated information to patients via Accurx text messaging and had access to a dedicated language interpreter provider. The practice told us 17 different languages were spoken at the practice.

The practice held vulnerable patient registers and supported 2 of their residential learning disability care homes. They held a register for patients diagnosed with a learning disability in the practice and assigned a designated lead GP and healthcare assistant who had a relationship with them and their families. They ensured these patients received priority appointments if needed and received their annual reviews which they told us stood at 100% achievement. The practice carried out annual prevalence audits to pick up any coding issues and to ensure all relevant patients were included on this register. Learning disability patients were offered quieter Saturday appointments and longer 30-minute appointments.

The practice 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.

The practice had an Accessible Information Standard (AIS) policy and told us their accessible information standards relating to communication had been met. We saw evidence of this following patient feedback where communication cards had been successfully used for a patient by their social prescriber.

Staff were able to describe how they communicated with some of their hard of hearing patients and made efforts to improve their communication with them; for example, one staff member told us they were undergoing a basic sign language course and could speak some Makaton sign language.

However, improvement was required to ensure all staff were aware of the barriers faced by some of their patients with communication needs and the options available to them, as not all staff we spoke to were aware of the provisions in place for patients who were visually impaired and hard of hearing, such as a hearing loop which was available in the practice, or any sign language interpreting service in the practice.

The practice had a high percentage of elderly patients in their population and so assigned a dedicated Extended Care Practitioner (ECP) who had a practice vehicle to visit the homes and the 7 care homes and carry out housebound visits across the week. They did not usually work in the practice unless they were providing sickness cover.

Their Extended Care Practitioners (ECP) carried out home visits for respiratory and diabetes reviews, helping ensure continuity of care.

Staff used appropriate systems to capture and review feedback from people using the service, including those who did not speak English or had access to the internet.

The practice had notable practice whereby they recognised that some patients felt digitally excluded, so they supported these patients by assigning a designated staff member to provide structured IT lessons for patients who were digitally challenged and were interested in the programme. This included lessons to help them set up online services and their NHS App.

They were aware of the needs of the local community and their reception staff were instrumental in supporting members of the boating community to live healthier lives. For example, the practice implemented a register for the boating community upon recommendation from their reception staff, after witnessing the health inequalities impact often faced by this community, due to them being of no fixed abode. Following joint working with the Waterways Chaplain, the practice registered boaters with their address, informed them of secondary care appointments and welcomed them to access services when they were passing through.

However, we saw evidence of how the practice took account of people’s unique backgrounds and they understood and met their personal, social and equality characteristics to enable patients to be fully involved in their care. For example, they had systems in place to cater for their boating community whereby they could use the practice address and the practice would inform them of their secondary care appointments.They also supported a local homeless shelter.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

There was a palliative care lead GP and there was collaborative working with their local hospice and members of multidisciplinary team such as the consultants, specialist nursing team and community nurses.

We saw evidence of assessment of their needs and anticipatory care. The GPs also sent their Extended Care Practitioner (ECP) to the 8 care homes to review residents that were on the Gold Standard Framework pathway and that required a review and where required, would escalate to the GP.Monthly gold standard framework meetings were held to care for their end-of-life patients. They also had a clinical pharmacist who was a Macmillan information pharmacist and dementia friend and members of staff held the International Certificate in Palliative Care.

Our records review showed people were supported to consider their wishes for their end-of-life care, including cardiopulmonary resuscitation. There were consent, Mental Capacity Act (MCA) and Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) policies.Do not attempt cardiopulmonary resuscitation (DNACPR) decisions were appropriate and were made in line with relevant legislation. On inspection, we found 171 patients were currently on a DNACPR and when we sampled 5 of those patients, we found the forms had been completed appropriately. We saw evidence of end-of-life discussions via their MDT meeting minutes

This information was shared with other services when necessary. Feedback received from the care homes showed the practice was instrumental in supporting end of life care and honouring patient’s wishes in 3 instances provided by the care homes. We also saw some positive patient feedback regarding how the practice provided end of life care for their loved ones.

The extended care practitioners (ECPs) ensured that DNACPR systems and processes were in place and documentation returned to the patient’s home in a timely manner.

We saw positive patient feedback on how the wishes of their deceased loved ones were honoured by the practice. The practice told us that of their patients were on the end-of-life pathway and their appointments were booked at time to suit the patient and family.