We previously carried out an announced comprehensive inspection at The Limes Medical Centre on 12 January 2017. The overall rating for the practice was requires improvement. The full comprehensive report on the January 2017 inspection can be found by selecting the ‘all reports’ link for The Limes Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 7 March 2018 to confirm that the practice had carried out improvements in relation to the areas of improvements we identified in our previous inspection on 12 January 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as Good.

Our key findings were as follows;

• Significant events were being documented and reviewed and there were systems in place to ensure that learning was being embedded.

• The practice showed evidence to demonstrate they had been proactive in promoting cancer screening programmes and encouraging attendance.

• The practice had reviewed access to appointments and increased the number of available clinicians, and additional clinics had been provided

• For vulnerable patients, the practice had reviewed and negotiated improved access for patients who were homeless and staying at a local hostel. Double appointments were available for people with learning disabilities and reception staff were responsive to those with physical disabilities who accessed the practice for appointments.

• The practice’s national GP survey remained low in some areas but the practice had commissioned its own survey and had analysed patient feedback in various other ways including “You said, we did” posters in the reception area.

• Appropriate information was available to patients with regards to joint injections.

• The practice worked to encourage attendance and improve uptake for national screening programmes that were below both local and national average at the last inspection by proactively sending personalised letters and calling patients, including those who consistently failed to attend. Cervical screening uptake had increased since our last inspection and was now in line with local and national averages.

However, there were also areas of practice where the provider should make improvements;

• Review the complaints response letter and include details of who patients should contact if they are not satisfied.

• Ensure that all Patient Specific Direction (PSD) forms are appropriate for their intended purpose.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Limes Medical Centre on 12 January 2017. Overall the practice is rated as requires improvement.

Our key findings across all the areas we inspected were as follows:

• Systems and processes were in place to support the reporting and recording of significant events. Significant events were discussed with relevant staff but there was limited evidence that events were reviewed to ensure any learning was embedded.
• Most risks to patients were assessed and well managed within the practice.
• Staff used current evidence based guidance to plan and deliver care for patients. Staff had undertaken training to equip them with the skills and knowledge they required to deliver effective care.
• Patient outcomes were generally in line with or above local and national averages. The practice was aware of areas for improvement and had been working to improve the uptake of the cervical cancer screening. However, uptake for other national cancer screening programmes was below average.
• Feedback we received as part of the inspection indicated that patients felt they were treated with compassion, dignity and respect and found staff polite, friendly and helpful.
• Information about services and how to complain was available and easy to understand. In addition information about raising complaints and concerns was provided in a number of different community languages.
• Patients said they were generally able to make urgent appointments when these were required but a number of patients said it could be difficult to access routine appointments.
• The practice had adequate facilities and was equipped to treat patients and meet their needs.
• There was a leadership structure in place and staff were positive about the support they received from management.
• We saw evidence of action taken by the practice in response to feedback. For example in response to feedback from their patient participation group the practice had made improvements to their telephone system.

The areas where the provider should make improvement are:

• Ensure all information related to significant events is documented and reviewed to check that learning identified has been embedded.
• Continue to promote national cancer screening programmes and encourage attendance.
• Continue to review and improve access to appointments; including ensuring ease of access for vulnerable patients.
• Ensure feedback from patients is analysed and continue to take action to improve patient satisfaction levels
• Review the information provided to patients in respect of joint injections.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

On the day of our inspection we spoke with five patients, two doctors and three members of staff.

All patients we spoke with were satisfied with the appointment system and when necessary were given an appointment on the same day. Two patients told us they found it difficult to get through to the surgery by telephone at times. One told us: “It can be a problem at busy times, but you have to keep trying.” One patient told us: “If you avoid ringing them first thing in the morning, you can usually get through.”

We saw that patients’ views and experiences were taken into account in the way the service was provided and that they were treated with dignity and respect. When patients received care or treatment they were asked for their consent and their wishes were listened to.

The practice is located in a modern single storey building. It is fully accessible for patients with disabilities. There were disabled parking bays close to the entrance in the car park. The surgery is also fitted with a hearing aid loop. One patient said: “There’s a nice atmosphere here. I’ve used this practice since it opened.”

We found the practice to be clean and well organised. Processes were in place to minimise the risk of infection. There were also processes in place for monitoring the quality of service provision. There was an established system for regularly obtaining opinions from patients about the standard of the service they received.