Lanchester Medical Centre

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture

This is the first inspection for this service since the provider registered the service with CQC. This key question has been rated as inadequate.

The provider was in breach of Regulation 17 in relation to good governance. Issues identified included concerns around clinical governance and the provider’s understanding of this, inadequate supervision of clinical staff, no meeting structure to support clinical governance. There was an inadequate system for significant events. There were poor policies and procedures. There was poor infection control governance and poor culture at the practice.

This led to the CQC taking enforcement action and imposing conditions on the provider. Further details can be found in the overall service commentary earlier in this report.

This service scored 36 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service did not have a clear shared vision. They did not always understand the challenges and the needs of people and their communities and their staff

Decisions made by the provider did not support the overall direction of the practice. Goals and priorities were not shared with staff. Some staff did not feel valued or supported. Some whistleblowers and staff told us that issues were not honestly discussed or feedback welcomed. The needs of patients were not prioritised.

However, the provider told us that they were aware of the challenges with staffing and the new 10-year NHS plan. Following our assessment the provider sent us a business development plan.

The service did not have a leader who ensured systems were in place to monitor performance, safety, and quality. They did not take responsibility for outcomes and act or seek on feedback and concerns. They did not have the skills, knowledge, experience and credibility to lead effectively, and they did not do so with integrity, openness and honesty.

People did not feel they could speak up and that their voice would be heard.

The practice whistleblowing policy set out who the freedom to speak up guardian was, they were independent and worked at another surgery. However, staff reported feeling afraid to raise issues, citing that management was unapproachable. Some individuals described experiences of bullying, while others reported that colleagues had been threatened or undermined.

The service did not always value diversity in their workforce. They did not always work towards an inclusive and fair culture by improving equality and equity for people who work for them.

There was not a culture where everyone felt welcome, respected, and able to contribute. Staff were not actively involved in decision-making and improvement processes.

The service did not have clear responsibilities, roles, systems of accountability and good governance. There were no effective systems in place for identifying, capturing and managing issues and risks.

For example, where policies were in place they were either inefficient, ineffective or not being followed. We could not establish if there was a safe process for significant events or a system to record and investigate complaints.

Significant issues that threatened the delivery of safe and effective care were not identified or adequately managed.

For example, we identified significant risk of future harm to patients due to ineffective management and oversight of long-term conditions, and the service did not make sure that medicines and treatments were safe and met people’s needs.

The service did not always understand their duty to collaborate and work in partnership, so services work seamlessly for people. They did not always share information and learning with partners or collaborate for improvement.

The practice had a larger than average PPG. The group was well organised and effective in representing the patients. There was an elected chairperson, regular meetings and a Facebook page, to update people who could not attend the meetings. The meetings had an agenda which was set by the group and minutes. The group had been established for several years.

The group had 2 separate subgroups, one who were dedicated to fund raising and another patient engagement. Fund raising events had been held with good support from the community included funds for a national cancer charity. There had been a summer prize draw which generated funds for a local hospice.

The group planned to hold focus groups with topics to support patients’ needs and provide articles for the local village magazine.

The group 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. The group felt that they had raised concerns with the provider, and these had not been listened to. They saw that their attitude towards staff was poor.

The service did not focus on continuous learning, innovation and improvement across the organisation. They did not encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not actively contribute to safe, effective practice and research.

There was little innovation or service development. There was minimal evidence of learning and reflective practice. Clinical audits were ineffective and did not demonstrate improvements to patient care or outcomes.

Staff did give us some examples of how they had put forward ideas to improve the appointment system. Some staff told us they had been supported to develop and progress in their nursing career.