You are here

The Limes Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 16 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection visit of The Limes Medical Centre, in January 2016. As a result of our comprehensive inspection breaches of legal requirements were found and the practice was rated as requires improvements for providing safe services. This was because we identified an area where the provider must make improvement and additional areas where the provider should improve.

We carried out a focussed desk based inspection of The Limes Medical Centre on 15 November 2016 to check that the provider had made improvements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Limes Medical Centre on our website at www.cqc.org.uk. Our key findings across all the areas we inspected were as follows:

  • Since our comprehensive inspection in January 2016, the practice had embedded an effective system to monitor and track the use of their prescriptions. We saw evidence to support this as part of our desk based review.

  • When we inspected the practice during January we found that learning and outcomes from incidents were not communicated widely enough and effectively in order to support improvements. As part of our desk based review we saw minutes of meetings which supported how learning was shared in the practice. Monthly practice meetings took place and key topics such as significant events and complaints were discussed during the meetings. We also saw records which demonstrated that staff received appraisals.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 16 December 2016

The practice is rated as good for providing safe services.

  • When we inspected the practice during January we found that learning and outcomes from incidents were not communicated widely enough and effectively in order to support improvements. As part of our desk based review we saw minutes of meetings which supported how learning was shared in the practice.

  • Topics such as significant events and complaints were discussed during practice meetings. Meetings were governed by structured agendas and supporting minutes. Minutes of meetings highlighted that opportunities to share learning were maximised.
  • During our inspection in January we found that the practice did not have an adequate system in place to monitor the use of their prescriptions. The practice had embedded an effective system to monitor and track the use of their prescriptions following our inspection and we saw records of evidence to support this during our desk based inspection.

Effective

Good

Updated 16 December 2016

The practice is rated as good for providing effective services.

  • When we inspected in January we found that that staff appraisals were slightly overdue. As part of our desk based review we saw evidence of records to demonstrate that staff received regular reviews and appraisals.

Caring

Good

Updated 16 December 2016

Responsive

Good

Updated 16 December 2016

Well-led

Good

Updated 16 December 2016

Checks on specific services

People with long term conditions

Good

Updated 11 February 2016

The practice is rated as good for the care of people with long-term conditions.

  • Clinical staff members had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

  • Performance for overall diabetes related indicators was 83% compared to the CCG average of 88% the national average of 89%.

  • The lead GP explained that they were finding diabetes to be more of a local risk with a prevalence increase from 4% to 6%. The practice were focusing on improving this area by working through recall systems. We also saw notices in the waiting room encouraging patients to attend for diabetes checks, as well as a diabetes educational event facilitated by the CCG.

  • All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
  • Flu vaccinations for those patients in the at risk groups was 51%, compared to the national average of 52%.

Families, children and young people

Good

Updated 11 February 2016

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

  • There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances.
  • Childhood immunisation rates for the vaccinations given were comparable to CCG and national averages. For example, childhood immunisation rates for under two year olds ranged from 72% to 100% compared to the CCG averages which ranged from 40% to 98%. Immunisation rates for five year olds ranged from 95% to 100% compared to the CCG average of 93% to 98%.
  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
  • Urgent access appointments were available for children and those with serious medical conditions.

Older people

Good

Updated 11 February 2016

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

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

  • It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

  • Flu vaccination rates for the over 65s was 73%, which was in line with the national average of 73%.
  • 81% of the practices patients above the age of 75 had received a health check.

Working age people (including those recently retired and students)

Good

Updated 11 February 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

  • The practice was proactive in offering a full range of health promotion and screening that reflects the needs for this age group.

  • The practice’s uptake for the cervical screening programme was 70%, compared to the national average of 81%. We discussed the figures with members of the nursing team who explained that they had identified this as an area for improvement.

  • The practice offered extended hours on a Monday until 8:40pm for working patients who could not attend during normal opening hours.
  •  Appointments could be booked over the telephone, face to face and online. The practice also offered telephone consultations.

People experiencing poor mental health (including people with dementia)

Good

Updated 11 February 2016

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

  • There were longer appointments available at flexible times for people experiencing poor mental health.

  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

  • Performance for mental health related indicators was 96% compared to the CCG average of 93% and national average of 92%.
  • Data showed that diagnosis rates for patients with a dementia were 100%, with an exception rate of 0%. Exception reporting is used to ensure that practices are not penalised where, for example, patients do not attend for review, or where a medicine cannot be prescribed due to a contraindication or side-effect.

People whose circumstances may make them vulnerable

Good

Updated 11 February 2016

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

  • Vulnerable patients, patients with a learning disability, patients with hearing impairments and those who did not have English as a first language were flagged on the practice’s system. We also saw that special notes were applied to vulnerable patient’s records to remind receptionists to give them a choice of a longer appointment time.

  • The practice shared data with the inspection team which highlighted that they had identified 157 patients from vulnerable groups. Most of these patients had care plans in place with regular medication and face to face reviews.

  • There were 28 patients on the learning disability register and 83 patients on the mental health register most of whom had received a health review and further reviews were planned. We reviewed a sample of care plans and saw that they were supported to make decisions through the use of care plans, which they were involved in agreeing.

  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
  • It had told vulnerable patients about how to access various support groups and voluntary organisations.