Limes Medical Centre

Updated 19 October 2016

Limes Medical Centre is a GP practice, which provides primary medical services to approximately 14,181 patients predominately living in Narbrough and surrounding areas. All patient facilities are accessible. East Leicestershire and Rutland Clinical Commissioning Group (EL&RCCG) commission the practice’s services.

The practice has five GP partners (three male and two female) and two salaried GPs (one female and one male). The nursing team consists of three nurse practitioners, three practice nurses and four health care assistants. The practice also has two extended scope physiotherapists and a GP registrar. They are supported by a Practice Manager, Assistant Practice Manager and a team of administrative and reception staff.

The practice is open between 8am and 6pm Monday to Friday. Extended hours appointments are offered between 7am and 8am Tuesday to Thursday with either a GP or a nurse. In addition to pre-bookable appointments that can be booked up to three weeks in advance, urgent appointments are also available for people that need them.

To assist with access the practice also holds an urgent care clinic Monday to Friday from 8am to 6pm, a musculoskeletal (MSK) service provided by two extended scope physiotherapists and a sexual health clinic on a weekly basis.

Patients can also access out of hours support from the national advice service NHS 111. The practice also provides details for the nearest walk-in centre, as well as accident and emergency departments.

The practice is an approved training practice.

Updated 19 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Limes Medical Centre on 08 September 2016 Overall the practice is rated as good.

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

• There was an effective system in place for reporting and recording significant events and lessons learnt were discussed at staff meetings.

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

• Appropriate recruitment checks were undertaken before employment for permenant staff and locum staff members.

• Risks to patients were assessed and managed. The practice provided evidence to show an updated fire risk assessment would be carried out, as well as a five year electrical installation safety check.

• Staff assessed needs and delivered care in line with current evidence based guidance.

• Clinical audits were carried out to demonstrate quality improvement and findings were used to improve services.

• Staff had the skills, knowledge and experience to deliver effective care and treatment.

• Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

• The practice had devised a guide of health promotion for patients with learning disabilities.

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

• We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

• The practice identified carers and written information was available, however there was a limited number of carers identified.

• The practice had recently started to host a carers clinic which was run by Voluntary Action South Leicestershire (VASL), which patients could self refer to.

• The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. For example, near patient testing for patients receiving oral anticoagulation therapy, a joint clinic with a Diabetic Specialist Nurse, a musculoskeletal service provided by two extended scope physiotherapists and an urgent care clinic.

• The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example, the practice had recently changed the telephone system, which allowed the practice to review and analyse the call system identifying the periods of time with higher demand. As a result, the practice had increased reception staff cover during certain times.

• The practice had a five year business plan in place which underpinned the vision for the practice. Staff were clear about the vision and their responsibilities in relation to it.

• The practice had a meeting structure in place to ensure relevant topics were discussed at the relevant meetings.

• The PPG had worked with the practice to create five videos regarding services provided by the practice and how to use them. This included, online services, self check in and the urgent care system.

The areas where the provider should make improvement are:

• Continue to review the carers register and identify patients, as appropriate.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 October 2016

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

• 85% of those diagnosed with diabetes had a blood test to assess diabetes control (looking at how blood sugar levels have been averaging over recent weeks) compared to the national average of 78%.

• Longer appointments and home visits were available when needed.

• All these patients had a named GP and were offered a structured annual review to check their health and medicines needs were being met.

• For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

• The practice provided additional services including near patient testing for patients receiving oral anticoagulation therapy, a joint clinic with a Diabetic Specialist Nurse.

• The practice hosted a diabetic eye screening service.

Updated 19 October 2016

The practice is rated as good for the care of families, children and young people.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances.

• Immunisation rates were relatively high for all standard childhood immunisations.

• The practice’s uptake for the cervical screening programme was 81%, which was comparable to the CCG average of 79% and the national average of 74%.

• Appointments were available outside of school hours and the premises were suitable for children and babies.

• We saw positive examples of joint working with midwives, health visitors and school nurses.

• The practice has a twitter account to target younger people to keep them up-to-date with information.

Updated 19 October 2016

The practice is rated as good for the care of older people.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• Quarterly visits, as well as visits as required, were carried out at two care homes the practice supported.

Updated 19 October 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

• The practice was proactive in offering online services including booking appointments online and requesting repeat prescriptions.

• A full range of health promotion and screening was offered that reflected the needs for this age group.

• The practice provided additional services including a musculoskeletal service provided by two extended scope physiotherapists.

Updated 19 October 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• 98% of those with a diagnosis of schizophrenia, bipolar affective disorder or other had a comprehensive and agreed care plan in place, compared to the national average of 88%.

• 98% of patients with a diagnosis of dementia had their care reviewed in a face-to-face review, compared to the national average of 84%.

• The practice identified patients experiencing poor mental health and these patients were given a named GP.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice carried out advance care planning for patients with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 19 October 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• Staff knew how to recognise signs of abuse in vulnerable adults and children and were aware of their responsibilities.