The Limes Medical Centre

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

At the last assessment we found peoples' needs were not always assessed in a timely way, and care and treatment was not always delivered in line with current legislation, standards and evidence-based guidelines. At this assessment, we found improvements had been made and there were systems and processes for assessing needs, delivering evidence-based care and treatment, monitoring and improving outcomes and supporting people to live healthier lives, however some areas still required strengthening to ensure all people received the appropriate monitoring.

At the last assessment we found the culture of the practice had the potential to impact on the care provided to people. We found no improvements in the culture and staff feedback demonstrated how people had been affected by the lack of clinical leadership and oversight.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The National Patient Survey results demonstrated that 88% of people felt their needs were met during their last general practice appointment which was in line with local averages and national averages.

Leaders and staff told us the practice used codes and alerts on clinical records to highlight any communication needs and any impairments. On reviewing a sample of clinical records, we found appropriate alerts were in place to inform staff of any additional needs people may have.

We found improvements had been made in systems and processes to ensure the safe, care and treatment of people. Referral pathways were in place to make sure that patients’ needs were addressed, however we found that clinicians continued to work in silos and were responsible for their own patients lists, with some senior clinical staff refusing to see patients and sign prescriptions for patients that they were not their named GP. We saw evidence of a refusal to do a home visit which delayed treatment of a patient who was in need of a clinical review.

During the clinical review we carried out as part of this assessment we found improvements had been made in the care and management of people's conditions. Systems had been strengthened to ensure the effective monitoring of people's care and treatment. We carried out a range of clinical searches and found the appropriate reviews had been completed. For example: Clinical searches showed 93 people with diabetes who had a blood sugar glucose level (HbA1c) of 75 and above. We sampled 5 clinical records and found all had received a diabetic review and medication review in the past 12 months.

We found people with long-term conditions were now being offered a structured annual review to check their health and medicines needs were being met. The remote clinical searches that we undertook of the practice’s clinical records system showed the monitoring of people with some long-term conditions was in line with National Institute for Health and Care Excellence (NICE) recommendations. For example: Clinical searches suggested that 19 people had been prescribed 2 or more courses of rescue steroids as part of their asthma control. We reviewed a random sample of 5 clinical records and found the appropriate monitoring and assessments had been completed.

There were systems and processes in place to enable information to be shared between the provider and services to ensure continuity of care. Regular meetings were held with multi-disciplinary teams to ensure care is co-ordinated effectively.

Staff told us how they worked together with other organisations to deliver effective care and treatment. There were regular integrated care meetings with community health care staff as part of the primary care network to discuss the care and support needs of all patients. Staff said they had access to the information they need to appropriately assess, plan and deliver people’s care, treatment and support; however, we were told there were over 800 documents awaiting action from the out of hours service and we were unable to gain assurances that plans were in place to address the backlog. Staff also reported they had 2 weeks of outstanding tasks to action, but due to staff shortages this had impacted on the work being completed.

Processes were in place to support people to live healthier lives. There were flags on patients who were vulnerable and required ongoing monitoring and recalls in place to review patients and educate them to manage their health needs. There was regular engagement with community services and referral pathways in place. The practice website detailed information and links for health promotion, health conditions and common health questions.

We found improvements had been made in the systems the practice had in place to ensure that people were being routinely monitored. As part of this assessment, we carried out a clinical review and found annual reviews had been routinely carried out for those with a long-term condition. We found medicine reviews and ongoing monitoring were actively being reviewed and recalled. Our clinical searches showed systems were effective to ensure people were safely monitored.

The practice was below national targets for screening and immunisations. Staff reported they had difficulties in encouraging patients to attend for screening and immunisation appointments. We were told that children were followed up who failed to attend their appointments. The overall trend for child immunisation was below 90% for 4 of the 5 indicators and cervical screening was significantly below the 80% target with the practice having achieved 54%. We were unable to gain assurances that there were effective plans in place to increase attendance for screening.

Staff were able to tell us the process they followed when obtaining consent. For example, when carrying out examinations. We found that the practice always obtained consent to care and treatment in line with legislation and guidance. For example, we reviewed a random sample of 4 records and found Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions in place.