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

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Limes Medical Centre on 13 January 2016. Overall the practice is rated as good.

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

• There was a system in place for reporting and recording significant events. However, learning and outcomes from incidents were not communicated widely enough and effectively in order to support improvements.

• The practice had systems, processes and practices in place to keep patients safe and safeguarded from abuse.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.

• There were procedures in place for monitoring and managing risks to patients’ and staff safety.

• The practice did not have an adequate system in place to monitor the use of their prescriptions and for tracking their whereabouts.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Feedback during the inspection highlighted that staff would benefit from more frequent meetings to improve communication.

• Information for patients about the services available was easy to understand and accessible. Information about how to complain was available and easy to understand and evidence showed the practice responded openly and quickly to issues raised.

The areas where the provider must make improvement are:

• Ensure the use of prescriptions is adequately tracked and monitored.

The areas where the provider should make improvement are :

• Ensure learning and outcomes from incidents are communicated widely enough and effectively in order to support improvements.

• Ensure staff performance and training needs are identified and documented through a regular programme of annual appraisals.

• Improve communication and ensure staff needs are listened to and used to drive improvements to the quality and safety of services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

We previously inspected The Limes Medical Centre on 14 October 2013. We found that improvements were required and asked the provider to submit an action plan outlining how they intended to address the issues we had identified.

At this inspection visit we looked to see what improvements had been made. We met three GP partners and spoke with two of the partners. We spoke with staff members including the practice manager, two reception staff and the advanced nurse practitioner. We also spoke with nine patients so that we could get their views with regards to the service provided.

At this inspection we were given mixed comments from patients about the way one GP communicated with patients. Some patients told us the GP did not explain things to them about their health needs. This was similar to our findings at the previous inspection; however we noted improvements had been made by the practice to ensure all patients felt involved in their care and were respected. This work was on-going at the time of our inspection.

At our last inspection we also found that there was an unacceptable gap in staff annual appraisals. This meant that they had not been adequately assessed as being competent. At this inspection we found that appraisals had been carried out and most staff we spoke with said that they felt supported in their role.

During our inspection we spoke with seven patients and eight members of staff.

Patients told us they were treated with respect and that staff protected their right to privacy. We were given a mixture of positive and negative comments about the way that Doctor B communicated with patients.

We saw that patients' views and experiences were taken into account in the way the service was provided. The patients we spoke with provided positive feedback about their care. A patient told us: "It's very good. Whatever I say they are attentive. I really wouldn't go elsewhere". Patients received their medicines when they needed them and their medicines were regularly reviewed.

Staff had received training in safeguarding children and vulnerable adults. They were aware of the appropriate agencies to refer safeguarding concerns to that ensured patients were protected from harm.

We found that staff had received appropriate training for the roles they carried out. There was an unacceptable gap in staff annual appraisals. This meant that they had not been adequately assessed as being competent.

The provider had systems in place for monitoring the quality of service provision. There was an established system to regularly obtain opinions from patients about the standards of the services they received. However, where negative comments had been received they had not always taken action to ensure that on-going improvements were made for the benefit of the patients.

We discussed with the practice manager why there was a need for the provider (senior partner) to make an application to register for the regulated activity of maternity and midwifery services. We were informed by the practice manager that an application had been made and sent to the Care Quality Commission before the inspector had left the premises.