Limes Medical Centre

Updated 8 July 2016

The Limes Medical Centre is run by a partnership of two GPs. The practice is located in Alfreton town centre at Limes Avenue, Alfreton, Derbyshire DE55 7DW. The Limes Medical Centre provides primary medical services to approximately 8,000 patients. Alfreton is a former coal mining area, and has areas of higher deprivation. The registered practice population are predominantly of white British background.

The partners own the premises, which were purpose built in the 1980’s.

The partners also manage three other local practices under a separate registration and locations.

The Limes Medical Centre is an established teaching practice for medical and nursing students and GP registrars in training.

The practice team includes administrative staff, a practice manager, deputy practice manager, four practice nurses, an advanced nurse practitioner, two health care assistants including an apprentice, two salaried GPs and two partners (three male, one female). Four clinical staff also worked at the partners other practices.

The practice is open between 8am and 6.30pm Monday to Friday. Appointments are generally available from 8am to 11.30am and 2pm to 6.30pm daily. Extended hour surgeries are available on Saturday from 9am to 1pm and on Sunday from 12 to 4pm. This is jointly run with the partners other local practices.

The practice does not provide out-of-hours services to the patients registered there. During the evenings and at weekends an out-of-hours service is provided by Derbyshire Health United. Contact is via the NHS 111 telephone number.

The practice holds the Personal Medical Services (PMS) contract to deliver essential primary care services.

Updated 8 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Limes Medical Centre on 21 March and 21 April 2016. The routine inspection was over two days to include a GP specialist advisor. Overall the practice is rated as good.

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

Feedback generally from patients was consistently positive about the care and services they received. The majority of patients said that they were treated with compassion, dignity and respect at all times, and were involved in decisions about their care and treatment.

Patients told us they were able to access care and treatment when they needed it, and most people said that they could access appointments or telephone consultations in a way, and at a time that suited them.

Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this. People’s needs were central to the planning and delivery of services. The practice worked in partnership with other services to meet patients’ needs, and used innovative ways to improve outcomes for patients.

There was a proactive and innovative approach to seeking out and embedding new ways of working to ensure the services were effective.

The practice team was forward thinking and took part in national and local projects to develop the services. They had led a project, which enabled the practice to offer extended surgery hours on Saturday and Sunday.

The practice were also part of a national project designed to bring clinical pharmacists into the general practice workforce. The new way of working will help improve health outcomes for patients and workload pressures, to enable the GPs to focus their skills where they are most needed.

Comprehensive systems were generally in place to keep patients safe. Information about safety was used to promote learning and improvement, although r ecords kept of safety alerts did not always show that all relevant issues had been actioned.

The practice had appropriate facilities and was well equipped to treat patients and meet their needs.

Staff had the skills, knowledge and experience to deliver effective care and treatment. The culture and leadership promoted the delivery of high-quality, compassionate care. The practice had a highly motivated and cohesive staff team to enable them to deliver well-led services.

The commitment to learning and the development of staffs’ skills was recognised as essential to ensuring high quality care. The Limes Medical Centre was an established teaching practice and had an active role in training medical students and GP registrars. A third GP had become a trainer to enable the practice to further expand their teaching role.

The practice sought the views of patients and staff, which it acted on to improve the services. Complaints were effectively managed and reviewed to ensure that appropriate learning and improvements had taken place.

We saw several areas of outstanding practice:

• The practice had a high number of patients with learning disabilities and had initiated and led various projects with involvement of other agencies, to improve care, inequalities and access to services for patients. This included a programme to improve the uptake of cancer screening, by ensuring patients were not excluded inappropriately. This had led to increased use of capacity and best interest assessments for patients, and improved access to screening. For example, 53% of eligible patients had attended breast screening, of which 67% had a capacity and best interest assessment completed (compared to the local screening rate of 43.5% and assessment rate of 48%). The programme had also led to improvements countywide.
• The practice also had a lead role in developing care pathways, templates and information for people with learning disabilities, including an annual health check with involvement of the learning disability team . T hese were available in picture and easy to read form that patients could understand. Various templates and information had been adopted for use by the CCG and countywide as good practice.
• The CCG had a higher prevalence of patients with asthma. To improve access and enable patients to see a health professional that best meets their needs, the practice had led an initiative with involvement of local pharmacies, to co-ordinate reviews and improve outcomes for patients with asthma. Local pharmacists carried out an annual review of patients who were well controlled. In the first 12 months of the project this had freed up 120 appointments, to enable the GPs to focus their skills where they are most needed, including patients whose asthma was poorly controlled.

The provider should make the following improvement:

• Monitor the system for recording and acting on safety alerts to ensure all relevant issues have been actioned to mitigate risks to patients.

​Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 8 July 2016

• The practice held a register of people with long term conditions.
• Various clinical staff had lead roles in in managing long-term conditions and patient reviews, having received appropriate training.
• Patients with long term conditions and other needs were reviewed at a single appointment where possible. Longer appointments and home visits were available where needed.
• Dedicated clinics were held to support patients with conditions such as diabetes to enable them to be treated locally.
• Patients were offered an annual and interim reviews when required, to check their health and medicines needs were being met. Health reviews included education and strategies to enable patients to manage their conditions effectively.

• The number of patients who had received an annual health review in the last 12 months was high. For example, 92% of patients with chronic obstructive pulmonary disease, 98% of patients with coronary heart disease and 96% of patients with rheumatoid arthritis had received a review.

• The CCG had a higher prevalence of patients with asthma (6.3% compared with the national average of 5.9%). The practice was involved in an initiative with local pharmacies to co-ordinate reviews and improve outcomes for patients with asthma. 

• The practice was involved in a project, funded by the British Heart Foundation to offer patients with chronic heart conditions and those at risk, extended services and support to improve their care and outcomes. 

• The practice provided insulin initiation (teaching patients how to inject and manage their insulin regime) for patients with diabetes, whose body doesn't produce enough insulin to function properly.
• The practice provided an in-house anticoagulation service to monitor patient’s blood to determine the correct dose of their medicine. This enabled them to attend local services. 

Updated 8 July 2016

• Priority was given to appointment requests for children; they were seen the same day if unwell. Appointments and telephone consultations were available outside of school and college hours.
• The premises were equipped and suitable for children and young people.
• Systems were in place to identify and follow up children at risk of abuse, or living in disadvantaged circumstances. The practice held a register of children at risk of abuse or harm.

• Children and young people had access to a counselling service.
• The practice worked in partnership with midwives and health visitors, to provide shared maternity and child development care.
• The practice provided family planning services, including contraceptive implants and a vasectomy service. Patients from other practices could also access the vasectomy service.
• Patients could be referred to a specialist contraception clinic held at one of the partners other practices, which was led by a family planning consultant. The partners had initiated this service in response to high teenage and unplanned pregnancy rates in the area. Data showed that there had been an increase in the update of contraception, and a reduction in the number of pregnancies since the clinic was established in 2011.
• Chlamydia testing kits were available to young people at the practice.
• Immunisation rates for all standard childhood vaccinations were high. 

Updated 8 July 2016

• The practice offered 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 who needed them.

• Older people and palliative care patients had a named GP for continuity of care and to oversee their needs.
• Patients over 75 years had access to a health check on request. Records showed that 101 out of 123 patients over 75 years had been seen in the last six months. The remaining patients were sent an invite to attend a health check, which four people attended.
• As part of the care home initiative a named GP carried out regular structured visits to review patients’ needs.
• The practice was signed up to the unplanned admissions enhanced services, and maintained a register of over 2% of vulnerable or at risk patients. All vulnerable and older patients at risk had a care plan in place to ensure they received appropriate care and support, to help avoid hospital admissions.
• The practice worked in line with recognised standards of high quality end of life care, and held a palliative care register, which included older people with enhanced needs, at risk of harm or vulnerable.
• End of life care plans were in place for patients where appropriate, which set out their needs and wishes.The practice worked closely with other services, and held fortnightly multidisciplinary meetings to discuss and review patients’ needs. 
• The 2014 to 2015 flu vaccination rates for the people aged 65 and over were 70%, compared to the national average of 73% and the local average of 74%.

Updated 8 July 2016

• 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 and flexible.
• Patients were able to book appointments around their working day by telephone or on line. They also had access to telephone consultations.
• Repeat prescription requests were available on line, which patients could collect from their preferred pharmacy.
• Extended opening hours were available on Saturday morning and Sunday afternoon for working people and those unable to attend during the week.
• The practice was proactive in offering online services as well as health checks and screening that reflects the needs for this age group. The uptake for both health checks and screening was high. For example, 78.4% of women aged 25 to 64 had attended cervical screening (compared to the local average of 76% and national average of 74%).

Updated 8 July 2016

• The practice held a register of patients experiencing poor mental health, including people with dementia.
• Patients were offered longer appointments or home visits where needed. Patients were invited to attend an annual health check. Out of 79 eligible patients 75 had been reviewed and had a care plan in place to meet their needs.
• The practice worked with multi-disciplinary teams in the case management of people with poor mental health, including those with dementia.
• Systems were in place to follow up patients discharged from hospital or who had attended the accident and emergency department, where they may have been experiencing poor mental health.
• The practice was aligned to an independent hospital for people with mental health needs. An established named GP provided continuity of care. Where able, people were encouraged to attend the practice. The named GP also carried out regular visits to review patients’ needs, where required.
• Patients had access to counselling and psychological therapies.
• The practice screened appropriate patients for dementia, to support early referral and diagnosis where indicated.  

Updated 8 July 2016

• The practice was responsive to the needs of people whose circumstances may make them vulnerable. Patients were offered longer appointments or home visits where needed.
• The practice held a register of patients living in vulnerable circumstances including those with a learning disability.
• The practice worked closely with multi-disciplinary teams to meet the needs of vulnerable people, and to safeguard children and adults from abuse or harm.
• All staff had received relevant training on safeguarding vulnerable children and adults. Staff knew how to recognise and respond to signs of abuse and how to contact relevant agencies. All staff had also received training on learning disabilities. 
• Patients were informed about how to access various support groups and voluntary organisations.
• The practice had 115 patients on the learning disability register, which was high compared with other practices in the CCG. The practice had initiated and led various projects with involvement of other agencies, to improve care, inequalities and access to services for patients. This included a CCG programme to improve the uptake of cancer screening, by ensuring patients were not excluded inappropriately from this.
• The above programme had led to increased  use of capacity and best interest assessments for patients, and  improved access to screening. It had also led to improvements countywide.
• Patients with learning disabilities were supported to attend an annual health check. Out of 77 eligible patients 55 had received a health check in the last 12 months. All patients were invited to attend and 22 had declined this.
• The practice supported a care home providing nursing for people with learning disabilities. An established named GP provided continuity of care, and carried out regular visits to review patients’ needs. The GP was also involved in various best interest meetings for patients, where appropriate.