Church Langley Medical Centre Also known as Dr M Kisenyi & Partners

We carried out an announced comprehensive inspection at Church Langley Medical Centre on 14 November 2023. Overall, the practice is rated as Inadequate.

Safe - Inadequate

Effective – Requires improvement.

Caring – Requires Improvement

Responsive - Inadequate

Well-led - Inadequate

Following our previous inspection on 11 June 2015, the practice was rated good overall and for all key questions.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Church Langley Medical Centre on our website at www.cqc.org.uk

Why we carried out this inspection.

We carried out this inspection in line with our inspection priorities. In this case, the practice was selected for inspection due to the length of time since our previous inspection.

How we carried out the inspection.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included :

• An announced site visit.
• Conducting staff interviews using video conferencing.
• Completing clinical searches on the practice’s patient records system (this was with consent from the provider and in line with all data protection and information governance requirements).
• Reviewing patient records to identify issues and clarify actions taken by the provider.
• Requesting evidence from the provider.

Our findings

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as inadequate overall.

We rated the provider inadequate for providing safe services because:

• Systems and processes to keep people safe and safeguarded from abuse were not consistently implemented.
• Staff vaccinations had not been maintained in line with UK Health and Security (UKHSA) guidance.
• There were gaps in systems to assess, monitor and manage risks to patient safety.
• Vaccines were not appropriately stored to ensure they remained safe and effective.
• Appropriate standards of cleanliness and hygiene were not met.
• The practice did not have an effective system to learn and make improvements when things went wrong.

We rated the provider requires improvement for providing effective services because:

• There were examples of potential missed diagnoses of some long term conditions.
• Management of people with long term conditions was not always in line with national guidance.
• The practice was unable to demonstrate that all staff had the skills, knowledge, and experience to carry out their roles.

We rated the provider requires improvement for providing caring services because:

• National GP Patient Survey showed that patient satisfaction about their experience of the practice had decreased and was below local and national targets.
• The practice had not undertaken an analysis of the needs of the local population.

We rated the provider inadequate for providing responsive services because:

• National GP Patient Survey results were below local and national averages and patients were not able to access appointments and treatment in a timely way.

• Complaints were not always used to improve the quality of care.
• The practice did not adequately seek and act on feedback from patients.

We rated the provider inadequate for providing well-led services because:

• Governance and management arrangements were not effective, for example cold chain processes and the management of emergency equipment were ineffective.
• There were gaps in the systems and processes for managing risk.
• The practice had a vision and strategy, however not all staff aware of this.
• The practice culture did not always effectively support the delivery of high-quality sustainable care.
• There was a lack of engagement with patients about their experience of the practice.

The provider must:

• Provide care and treatment in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• Ensure sufficient numbers of suitably qualified, competent, skilled and experienced staff are deployed to meet the needs of patients.

In addition, the provider should:

• Complete risk assessments of emergency medicines arrangements.
• Take action to manage the ongoing management of historical safety alerts within the national alerts system policy.
• Improve the coding of patients within clinical systems.
• Improve the process for managing test results, to ensure timely review of abnormal test results.
• Take steps to review all patients on long-term steroids to ensure that all patients prescribed oral steroids for an asthma exacerbation are following up in accordance with NICE guidelines.
• Continue efforts to identify and undertake second cycle audits to promote quality improvement.
• Implement systems to manage, control and mitigate risk relating to the practice.
• Continue to take action to reinvigorate an active Patient Participation Group (PPG).

I am placing this service in special measures. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement, we will move to close the service by adopting our proposal to remove this location or cancel the provider’s registration.

Special measures will give people who use the service the reassurance that the care they get should improve.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Health Care