The Limes Medical Centre

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

At the last assessment, we found concerns in the leadership and culture of the practice and found the provider had not taken action to address areas of governance, management and accountability. We found there were no clear systems in place to ensure staff had the skills and knowledge to be able to do their role effectively.

Staff morale continued to be very low with a number of staff reporting a lack of communication, support and fear of retribution to speak up. We found no improvements had been made in the culture of the practice which was supported by whistle blowing concerns we had received at the CQC.

The providers had increased the number of staff in the leadership team to provide ongoing support to staff and ensure there was adequate oversight and systems in place to manage risk, issues and performance, however we continued to receive negative feedback from staff on the lack of improvements that had been implemented since the last assessment. We found limited evidence that the health and wellbeing of staff was considered. On the day of assessment, the practice told us they had a business continuity plan, however staff we spoke with were unaware of a plan or how to access the information if an emergency arose. We were unable to gain assurances that processes had been embedded and learning was shared with staff to sustain improvements.
 

This service scored 36 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

At the last assessment in May 2024, we found the practice culture did not always effectively support high quality sustainable care. At this assessment we found no improvements had been made and staff reported there had been no change since the last assessment with staff still fearful of sharing concerns for fear of retribution.

Staff shared their concerns and highlighted how they are not listened too, expected to do job roles for which they had received no training and the lack of support provided by the leadership team had impacted on their health and wellbeing. The leadership team told us they were aware of the concerns and faced challenges in getting the staff to engage. However, the leadership team provided no assurances that they had effective plans in place to engage with the staff to improve the culture.

The practice continued to have a closed culture and staff feedback highlighted the continuous blame culture, the lack of respect they were shown and how management failed to engage with the team to make improvements. We found significant concerns in the poor communication amongst the staff and leaders, leading to staff feeling pressured into doing tasks they were unfamiliar with and work not being completed effectively.

We found systems to ensure compliance with the requirements of the duty of candour, however the knowledge of some of the management team required strengthening to ensure they understood what duty of candour meant and how this was applied in practice.

Due to the lack of effective systems in place we were unable to confirm staff had not completed mandatory training which included equality and diversity.

We previously identified inconsistencies in how the leadership team communicated and supported staff. We found no improvements at this assessment with staff still reporting that some of the leaders were unapproachable, showed no compassion and made staff fearful to speak up. Staff reported that due to the lack of support provided by some of the leadership team this had impacted on people's care and treatment with potential delays in treatment being provided. Staff told us they would avoid asking certain leaders within the practice for support as they would be unwilling to help. We found leaders continued to lack the appropriate oversight of staff wellbeing.

Staff described some of the practice team as supportive, however we were told that some leaders were unapproachable, and relationships had broken down. At times staff felt they had no one to turn to if they had a concern and when these had been raised there was no review to address this. We found leaders did not have the appropriate oversight and supervision to ensure staff were carrying out their roles effectively.

Staff told us they were not valued and supported in their role. We found leaders did not support many of the staff to be able to do their role effectively and there was no emphasis on the wellbeing of staff. Overall, we found that leaders did not actively encourage staff to drive improvement or provide an environment where staff felt able to raise concerns without being worried about the outcome.

We were unable to gain assurances that the leaders understood the challenges to quality and sustainability to ensure there was capable and effective leadership. A new management team had been employed following the last assessment in June 2024, however we found there was a breakdown in the relationship with some of the staff. We were unable to gain assurances that all of the management team had the appropriate experience and knowledge to support staff and implement processes to improve and sustain the practice moving forward.

We previously identified inconsistencies in how the leadership team communicated and supported staff. We found no improvements at this assessment with staff still reporting that some of the leaders were unapproachable, showed no compassion and made staff fearful to speak up. Staff reported that due to the lack of support provided by some of the leadership team this had impacted on people's care and treatment with potential delays in treatment being provided. Staff told us they would avoid asking certain leaders within the practice for support as they would be unwilling to help. We found leaders continued to lack the appropriate oversight of staff wellbeing.

Staff described some of the practice team as supportive, however we were told that some leaders were unapproachable, and relationships had broken down. At times staff felt they had no one to turn to if they had a concern and when these had been raised there was no review to address this. We found leaders did not have the appropriate oversight and supervision to ensure staff were carrying out their roles effectively.

We were unable to gain assurances that the leaders understood the challenges to quality and sustainability to ensure there was capable and effective leadership. A new management team had been employed following the last assessment in June 2024, however we found there was a breakdown in the relationship with some of the staff. We were unable to gain assurances that all of the management team had the appropriate experience and knowledge to support staff and implement processes to improve and sustain the practice moving forward.

Staff in reception had been provided with new seating; however, we found the seats leant forward and provided no back support. Staff were unaware if risk assessments had been completed. At the time of the onsite assessment, staff were expected to work in very warm conditions as the leadership team were unable to change the settings on the heating system. Lighting continued to be very poor behind reception for staff trying to do administrative tasks.

We found limited processes in place to review and improve the culture of the practice in relation to equality, diversity and inclusion. There were limited processes to support staff to feel empowered or confident that their concerns and ideas resulted in positive change to shape services and create a more equitable and inclusive organisation.

There were policies and procedures in place for the safe recruitment of staff, however we found induction checklists had been completed, but there was no evidence to demonstrate who had supervised the induction and when it had been completed. We were unable to gain assurances that all staff had completed equality and diversity training and had access to regular appraisals. The management team reported they had an open-door policy, however due to the breakdown in communication and the fear staff had about sharing concerns, we found no evidence to demonstrate that staff were able to use the open door-policy when required.

We found processes required strengthening to ensure risk monitoring was effective. There was an ineffective process to identify, understand, monitor and address current and future risks including risks to people's safety. This included ensuring learning was shared to mitigate future risk and identify trends.

Staff told us that practice policies were accessible, however due to staff shortages, roles and responsibilities were not clear with staff expected to carry out duties they had not been trained for. Staff felt they were not supported by the leadership team. We found there were 104 administration tasks awaiting action, dating back approximately 2 weeks. The workflow processes had not been actioned since December 2024, with over 800 documents awaiting action and clinical records had not been summarised since December 2024.

We were not assured that newly appointed staff had completed an induction and training and had opportunities through training and development to improve their job skills. We found induction checklists were in place; however, there was no evidence to demonstrate who had supervised the induction and when the induction had occurred. We were unable to gain assurances that staff were up to date with training deemed mandatory by the practice.

Staff feedback highlighted how patients could not be booked with any GP. At the previous assessment we found some of the GPs refused to see patients that they were not the named GP for and this had continued. The leadership team were aware of this; however, no action had been taken to resolve this and ensure all patients were seen by whichever GP was available at the time.

We found there was no clear governance oversight in place. A newly appointed management team were in place, however we found their knowledge needed strengthening to ensure risks were identified and acted on. For example, we found vaccine fridge temperatures were not being monitored, blank prescriptions were not stored appropriately and there was no oversight of staff training.

 

Since the last assessment an active patient participation group (PPG) was now in place. We were provided with minutes of 2 meetings that had taken place, one in November 2024 and the second one in March 2025. There had been between 2-3 people at each meeting supported by practice staff. On reviewing the minutes we found one of the action points from the March 2025 meeting was the information in the waiting room to be reorganised to make it clearer for people. We found on the day of the onsite assessment this had not been actioned and the noticeboards looked disorganised which proved difficult to see any information that could provide details of support or other advice people may require.

Practice meetings were now being held on a monthly basis; however, feedback from staff was negative on the format of the meetings. Staff told us the blame culture continued and on reviewing the minutes of the meetings we were provided with, we found no evidence to demonstrate staff input or opportunities for staff to feedback. Staff reported a lack of support and poor communication from the leadership team.

The leadership team told us they were working with the primary care network and stakeholders to ensure that resources were planned and there was regular collaboration and partnership working to meet the needs of the patients.

The practice had processes in place for partnership and community engagement. For example, we received evidence to demonstrate that palliative care meetings and safeguarding meetings were held to ensure people in the community received the appropriate support, care and treatment.

We found improvements had been made in the clinical monitoring of people's care and treatment. However, due the lack of communication at the practice, we found no evidence to demonstrate that staff were given the opportunities to share ideas or actively contribute to improvements.

We spoke with a range of staff on the day of the onsite assessment. Staff told us they had completed some training, but we were unable to gain assurances that staff had completed all training relevant to their role. New staff had a completed induction checklist in their personnel folders, however we were unable to determine who supervised the induction and when the induction had taken place.

We found there was a system for complaints and significant events, but this was not effective in ensuring investigations were completed and actions were taken to mitigate future risks. Practice meetings were held on a monthly basis, but on reviewing the minutes we found incidents that had occurred had not been discussed with the practice team to share learning. The learning from complaints was also not shared on a regular basis and this was confirmed by the management team.