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

At this assessment we found that the practice did not always organise and deliver services to meet patients’ needs, patients could not always access appointments in a timely way and complaints were not used to drive continuous improvement. Overall, we found that systems and processes needed strengthening to ensure these were consistent to enable patients to access care in a timely way.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Patient feedback through the GP patient survey showed 70% felt the healthcare professional recognised or understood any mental health needs during their last general practice appointment, this was in line with the local averages but just below national averages. The survey also showed 90% of patients questioned said they were involved as much as they wanted to be in decisions about their care and treatment during their last general practice appointment, this was slightly above local averages but just below national averages.

Staff were unable to tell us how they regularly involved patients in planning and making shared decisions about their care and treatment that meets their needs. At the time of our assessment there had been no active patient participation group (PPG) since 2019. On reviewing staff training we found some staff had not received training updates in equality and diversity, deprivation of liberty and mental capacity. The practice reviewed the family and friends test; however, we found no evidence to demonstrate the outcome of the national patient survey had been reviewed and used this to make improvements.

We were unable to gain assurances that staff and leaders worked consistently with external agencies to ensure that people’s care and treatment was delivered in a way that met their needs and were responsive. For example, the practice was supported by a paramedic to support clinical care and availability, however feedback from staff in clinical roles showed a continuous lack of support from the leadership team. We saw engagement with some agencies such as health visitors and the midwife to review safeguarding concerns. The practice told us they attended primary care network meetings; however, we saw no evidence of this during our assessment. Evidence was provided to demonstrate that palliative care patients were reviewed within the practice. The practice held registers of patients living in vulnerable circumstances including those with a learning disability, mental health or safeguarding concern.

We were provided with evidence to demonstrate that there were meetings with the paramedic and practice team, however there had been 1 practice meeting in the last 6 months and the last meeting with paramedics was in August 2023. At the time of our assessment, there were no planned programme of meetings being held with staff and we found no evidence that processes had been implemented to ensure that community teams were included in discussions. Safeguarding meetings were held at the practice, however the minutes contained minimal information. For example, minutes showed no evidence of discussions with health visitors when safeguarding concerns had been highlighted.

The practice website was accessible to patients. The website included useful information on health awareness and promotion. Information and resources were available for patients to support them to understand how to access services. For example, there were arrangements in place for people who need translation services or who may be digitally excluded

We found the practice had some processes which complied with the Accessible Information Standard. For example, flags on patient records; however, we found that a hearing loop was not available in the practice to support those with a hearing impairment.

We found there was a system for recording complaints, however there was no evidence to demonstrate that they were regularly reviewed and discussed in practice meetings to share learning. The practice had received 3 complaints in the last 12 months. On reviewing these complaints, we found evidence that some appropriate action was taken, however for 1 complaint there was a note that action would be taken, but we were unable to verify that this had been carried out. The practice told us they collated feedback via the Friends and Family test to make improvements to the service. The practice leadership team told us that they were trying to organise a patient participation group and we saw evidence that this had been started.

The practice had a complaints policy in place; however, we found the systems to monitor complaints and use patient comments to improve the quality of care was not embedded to ensure improvements were demonstrated. At the time of our assessment the practice manager was not in work, however the complaints policy documented that they were the named complaints manager. There had been 1 practice meeting in the last 6 months, and we found evidence from minutes of the meeting that significant events and complaints were a standing agenda item. Information about how to complain was available and patients could make a complaint in person, or via the practice website.

The practice had processes in place to respond to the needs of their population. For example, a duty doctor, paramedic and pharmacy support, however we found that care, support and treatment was not always consistent. The National GP Patient Survey data was below local and national averages. We found that patient feedback regarding access to care and treatment was significantly lower than national averages for how easy it was to get through to someone at their GP practice on the phone. For example: 39% found it easy to get through on the phone. Patients could access appointments by phone, online and by visiting the practice. The practice website provided information for patients regarding how to book an appointment, however 17% of patients found it easy to access the practice by website. There had been no reviews on NHS.uk website in the last 12 months, however reviews on google rated the practice 1.8 out of 5 stars with some feedback reporting poor staff attitude, unhelpful staff, unable to access appointment and lack of empathy, whilst others reported they were able to get an appointment, excellent GP, and kind nurses.

Leaders demonstrated they were aware of the challenges to patient access and a new telephone system was being installed to improve access. However, we identified concerns that these improvements would not be sufficient to address the shortfalls in the appointment availability and the culture within the practice. We were told of many examples, where clinical staff in various roles said they were under constant pressure to provide appointments and on numerous occasions, patients were allocated to them, but they were unable to provide care as the patients’ needs were complex and outside of their competencies. Due to GPs working in silos we were told that there were difficulties in staff booking patients appointments. For example, some GPs refused to offer routine appointments and there was a lack of consistency for telephone and face to face appointments. Staff told us that GPs managed their own patient lists and often refused to see other clinician’s patients or action tasks or prescription requests. In addition, we were told GPs refused to do home visits which could impact on patients being seen in a timely way. We were told that an advanced nurse practitioner and other non-clinical staff had left in the last 12 months and not been replaced, and this was impacting on the delivery of services. Staff reported that leaders had taken no action to address the issues raised to ensure patients received an appointment with the appropriate clinician and that their care was followed up in a timely way.

The practice offered appointments by telephone, online, and in person by visiting the practice. The practice offered a range of appointment types to suit different needs, however there were consistencies in the management of the type of appointment offered amongst GPs. For example, we reviewed access to appointments over a 4-week period and found on 2 separate occasions 1 GP had offered 90% of appointments as a telephone consultation with 1 consultation lasting over 60 minutes and other GPs had offered 90% of appointments as a face to face. Appointments with a GP were offered throughout the week, however staff reported that GPs were not always available at relevant times. The practice had arrangements in place for prioritising patients, however due to feedback we were not assured this was managed safely and effectively. Staff were trained to book appointments with members of the practice clinical team or signpost patients to other appropriate services but there were often barriers to some appointments.

The practice had implemented the Friends and Family test (FFT) which indicated that 88% of feedback rated the practice as good or very good. There were some systems in place to support patients who face communication barriers to access treatment (including those who might be digitally excluded). For example, interpreter services were available for patients who did not have English as their first language, however there was no hearing loop in place for patients with a hearing loss.

People could leave feedback via NHS UK and the practice website. There had been no active patient participation group (PPG) since 2019 and the leadership team told us they were in the process of setting this up. We saw some evidence that contact had been reestablished with previous members. At the time of our assessment, we found no evidence to demonstrate that the 2023 GP national patient survey had been discussed with staff to discuss ideas and what improvements could be made to improve patient outcomes.

The practice needed to strengthen their compliance with legal equality and human rights requirements. For example, avoiding discrimination, having regard to the needs of people with different protected characteristics and making reasonable adjustments to support equity in experience and outcomes, including meeting the Accessible Information Standard. We saw examples where the practice had met the needs of some vulnerable patient groups and removed barriers for improved patient experience, however we found, the practice had access to interpreters available, but the premises did not have a hearing loop in place. People with learning disabilities and poor mental health experienced additional care through annual reviews, however we found processes needed reviewing to ensure these were being routinely monitored.

We found evidence to demonstrate that the practice held palliative care meetings internally to discuss information relating to patient care and treatment, however there was no evidence to demonstrate how this was shared with other agencies. During our assessment CQC received information of concern in the lack of support offered to a patient during the end of life care received and told the practice to take action to address the concerns raised.

There were systems in place for staff to keep up with training, but on reviewing staff training we found there was no systems in place to monitor staff training and when updates were required. We found some clinical staff had not kept up to date in training relating to the Mental Capacity Act, Deprivation of Liberty and safeguarding. There were registers held for those patients who were vulnerable, on the palliative care register or at the end of their life. We found that clinicians understood the requirements of legislation and guidance when considering consent but found this was not always reviewed and documented.