- GP practice
Lanchester Medical Centre
We took urgent action to impose conditions on Dr Harpreet Singh Kalra on 12 August 2025 for failing to meet the regulations related to, safe care and treatment, receiving and acting upon complaints and good governance at Lanchester Medical Centre.
Assessment report published 30 October 2025
Contents
Ratings
Our view of the service
Date of Assessment: 9 July 2025 to 6 August 2025. On 24 July 2025 we carried out remote clinical searches of the patient’s records, and on 31 July 2025, we carried out a visit to the practice.
Lanchester Medical Centre is a GP practice and delivers service to approximately 4,100 patients under a contract held with NHS England. The provider of this service is Dr Harpreet Singh Kalra. They are registered to provide services at another separately registered GP practice, which was not inspected as part of this assessment.
This is the first assessment for this service since the provider registered the service with CQC. We carried out this assessment due to concerns raised with us by whistle-blowers and complaints to CQC from the public.
Information published by Office for Health Improvement and Disparities shows that deprivation within the practice population group is in the 8th decile (8 of 10). The lower the decile, the more deprived the practice population is relative to others. This assessment considered the demographics of the people using the service, the context the service was working within and how this impacted service delivery. Where relevant, further commentary is provided in the quality statements section of this report.
Safe; We saw that people were at risk of harm. There was a limited amount of monitoring of safety. We could not establish if there was a safe process for significant events or a system to record and investigate complaints. We identified concerns with the handling and workflow of test results and hospital letters. There was no system in place for patient safety alerts or Medicines Healthcare Regulatory Agency (MHRA) alerts. We had concerns that the processes and arrangements in place for safeguarding were not strong enough or given sufficient priority. The service did not make sure there were enough qualified, skilled and experienced staff. Clinical governance was poor. Medicines and treatments were not always safe or met people’s needs, capacities and preferences. People were not always involved in planning or risks of medication explained to patients. The service did not always manage the risk of infection.
Effective; We identified significant risk of future harm to patients due to ineffective management and oversight of long-term conditions. The service did not plan and deliver people’s care and treatment with them. They did not always follow legislation and current evidence-based good practice and standards. The service did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff made sure people understood their care and treatment to enable them to give informed consent.
Caring; We received mixed feedback regarding whether the service treated people with kindness, empathy and compassion, or respected their privacy and dignity. The National GP Patient Survey results were above the national average. However, more recently we received poor feedback from patients regarding care and treatment. We saw the service did not demonstrate it cared about or promoted the wellbeing of their staff.
Responsive; Services were not planned or delivered in a way that met people’s needs. There were shortfalls identified in how the service understood the health and care needs of patients. Communication with patients was sometimes poor. The practice could not demonstrate that they handled complaints or investigated them properly, therefore they did not make it easy for people to share feedback and ideas. People were sometimes unable to access care and treatment when they needed it.
Well-led; The delivery of high-quality care was not assured by the leadership, governance or culture in place. Governance arrangements were unclear. There was no monitoring of performance. There was no effective system to identify, capture and manage risks. Staff did not feel supported to give feedback and were not treated equally, free from bullying or harassment. There was limited evidence of ongoing quality improvement.
We found breaches of regulation in relation to Regulation 12, Safe Care and Treatment, Regulation 16 Receiving and acting on Complaints and Regulation 17 Good Governance. We have asked the provider for an action plan in response to the concerns found at this assessment.
This service is being placed in special measures. The purpose of special measures is to ensure that services providing inadequate care make significant improvements. Special measures provide a framework within which we use our enforcement powers in response to inadequate care and provide a timeframe within which providers must improve the quality of the care they provide.
Following our assessment we raised with the provider examples of where we needed immediate reassurance regarding examples of poor patient care which we identified from our clinical searches. We saw their clinical needs were not being met and there were risks posed to the patients. These concerns had to be raised with the provider on multiple occasions before patients were contacted by them to review these issues.
Following this CQC took urgent action to impose conditions on the registration of the provider. The condition was that Registered Provider must not carry on any of the regulated activities they were registered for at the location of Lanchester Medical Centre for three months.
In order to implement recommended improvements the provider temporarily subcontracted the provision of services to another service provider. CQC consulted with the new provider to ensure they were fully aware of the concerns identified and arrangements to make improvements were put in place by them.
People's experience of this service
Feedback from patients from the various sources of information available was mixed.
The most recent National GP Patient Survey results were all above average (results reported on are from 30/12/2024 to 01/04/2025). For example, the percentage of respondents to the GP patient survey who responded positively to the overall experience of their GP practice was 89.5%, while the national average was 75.4%.
The practice sent us some analysed results of NHS friends and family test data from April to June 2025. The results showed that the practice averaged over 80% as being very good and an average of 1.6% as poor. The overall comments in April and May mainly centred on appointments. There were a high number of positive comments regarding staff, including professional, courteous, knowledgeable and friendly staff who listened to patients.
There was an active patient participation group (PPG) who represented the views of people using the service. The group gave us feedback on the practice. They said recently there had been a loss of faith in the running of the practice. Confidence had begun to deteriorate in the last 18 months. This was in relation to availability of clinicians and clinical competence. There were concerns regarding the stability of staff. The process of repeat prescribing of medication was noticed to be failing with many members noticing mistakes in prescribing. There was a lack of feedback to patients regarding test results, including when they were normal or needed explaining by a healthcare professional. The group felt that they had raised concerns with the provider, and these had not been listened to. They saw that the attitude from the provider towards staff was poor.
Positive feedback the PPG gave us was that they were given good support from staff to promote the group. The group had a larger than average attendance for a PPG and many local patients were supportive of the group. They had a good relationship with the reception team and their managers and local pharmacy. The building and facilities were good.
Starting 7 months prior to our assessment we began to receive negative feedback from whistleblowers, staff and patients. All of the 12 items of feedback were negative raising issues regarding clinical care, medication errors, leadership and culture within the practice.
When we announced our assessment, we shared our online link with the practice to forward to patients to share their experiences. We received 66 responses. From these 46 items were positive and 20 were negative. Positive feedback included friendly and professional staff, prompt and efficient reception staff and friendly and helpful nurses. The negative feedback raised concerns regarding access to appointments, medication reviews and errors, clinical care and staff behaviours and attitudes.