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.

At our last assessment, we rated this key question as inadequate. At this assessment, the rating has changed to requires improvement.

The service was in breach of legal regulation in relation to good governance. We found the service did not always listen to feedback from patients and staff, or concerns about safety. They did not always fully investigate and learn from complaints and safety events. There was ineffective communication with some staff and an entrenched poor culture which placed the embedding of improvements and best practice at risk.

This service scored 46 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The practice had a vision and strategy, with a clear focus on improvement. However, this was not always shared and the culture within the service acted as a potential barrier to the improvement and embedding of any new processes and procedures.

At our previous inspection in July 2025, we reported 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. In April 2026, we found some changes had been made that had led to improvements in the quality and safety of care provided. For example, the way test results were managed had improved, as had the reviews for patients with long term conditions and those prescribed medicines that need monitoring. The provider had sought external support to help the practice improve. However, some staff reported to us that they were frustrated. They told us the way change had been implemented meant they felt their views were ignored and they were left unclear on what they should be doing due to the constant change. There was a lack of clarity on which policies they should be following. They reported there was a blame culture within the practice, with lingering concerns about bullying behaviour and a very toxic culture. Overall, the inspection findings highlighted an underlying poor and ineffective culture within the practice. Although steps had been taken to address this, they had not yet been successful.

Not all leaders understood the context in which the service delivered care, treatment and support. They did not always embody the culture and values of their workforce and organisation. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively, or they did not always do so with integrity, openness and honesty.

In our July 2025 inspection, we found the service did not have a leader who ensured systems were in place to monitor performance, safety, and quality. In this inspection we found improvements had been made, but further action was required to meet essential standards and ensure these were well embedded within the service.

There was a perception among some staff of a lack of leadership within the practice and that the provider did not demonstrate sufficient accountability to the failings which had been identified. This was a clear message shared with the CQC by staff and the Patient Participation Group (PPG). The PPG gave the example of the letter to patients following the last CQC inspection not being written and signed by the provider. This was compounded by a lack of public update by the provider on what changes have been made and what further improvements will follow. This was perceived by others as the provider not caring about the quality of service provided and not being invested in the service. However, this contradicts with the findings of CQC at this inspection. The provider had invested heavily in making improvements and had sought advice from others to bolster areas where he considered himself to lack experience. This, however, had exacerbated tensions within the leadership team. The change process had not been implemented in a way that encouraged staff to be involved and instrumental in changes. This had led some to feel that changes were imposed rather than everyone working as a team and invested in making improvements. This had created a toxic culture and had made it a very difficult working environment for everyone.

There had been a lack of progress on identifying and addressing the issues that had led to the toxic working environment. The provider saying they wanted to move on from past concerns did not mean that everyone had been able to move forward. There was still a feeling of resentment from some staff. This was affecting the practice being able to make and sustain improvements.

At our last inspection, we found that people did not feel they could speak up or that their voice would be heard. At this inspection, we found some improvements had been made. Some systems had been implemented to support staff to have a voice, such as regular supervision sessions for clinical staff. However, these were not always effective and were hampered by the culture within the practice. The change process employed within the practice had led some to feel excluded from the process to make improvements. Also, there was a lack of a formal forum for non-clinical staff to influence change, as most were not invited to or attended team meetings within the practice.

However, the practice had established Freedom to Speak up arrangements with other practices in the primary care network. Staff were aware of how to raise concerns, and there were some examples where staff had used the arrangements in place to positive effect.

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.

At our previous assessment in July 2025, we found the service did not value diversity of the workforce. At this inspection, we found although the provider had tried to address these concerns, some staff reported they still did not feel valued.

Policies and procedures to promote diversity and equality were in place. All staff management policies had been renewed. The provider had invited staff to move past previous concerns to work towards improvement. However, the culture within the practice made this challenging and there were pockets of resistance. Some staff did not feel involved or influential in the change process, considering changes as imposed and not the right fit for the practice.

The service had strengthened aspects of its governance, and the provider demonstrated more effective oversight of quality and safety. However, there were still some gaps in good governance arrangements, and the provider did not always use information about safety and quality effectively. We were not yet fully assured the level of improvement was able to be continued or sustained.

We previously found the service did not have clear responsibilities, roles, systems of accountability and good governance. At this inspection, we found the provider had continued with the improvement plan initiated by the interim provider. They had identified and implemented actions to address areas of concern and had realised improvements in some areas, most notably relating to clinical concerns. However, there were still some areas that were not effective.

Staff expressed frustrations with the continual changes being made to policies and procedures and poor communications around this. There was a lack of an effective strategy to tackle the cultural issues within the practice, which was risking the ability of the practice to continue to improve. There was a limited forum for non-clinical staff to influence change. Learning, improvement and embedding of good practice was ineffective, as the practice did not routinely learn from complaints and significant events. Clinical audit processes were at an early stage.

However, there was good oversight of arrangements for monitoring and managing the safety of the practice environment. Improvements had been made to the governance of infection prevention and control, but as these were recent, more time was needed to demonstrate effective embedding.

More effective clinical supervision had been implemented with more effective competency assessments. The provider had established improved governance processes that were appropriate for their service. Staff took patient confidentiality and information security seriously.

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 represented the views of patients. There was an elected chairperson, regular meetings and a social media 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 3 separate subgroups. One was dedicated to fund raising, another to patient engagement and the third had been set up in response to the findings of the last CQC inspection to support the practice to improve. Fund raising events had been held with good support from the community.

At our last inspection, we found the service did not understand their duty to collaborate and did not work in partnership to support services to work seamlessly for people. We found continuing concerns about the way the practice worked with and responded to the Patient Participation Group. They told us they felt that the provider did not value their contribution and had not acted appropriately on their feedback and suggestions. They felt the provider did not share appropriate information with them about the progress with improvements being made and were not convinced that changes made were sufficient or being made quickly enough. They felt conversations lacked solidity and that the value and benefit of the PPG was not appreciated. Due to concerns with the providers handling of concerns and complaints, the PPG had found itself getting deeply involved with the details of patients’ personal health problems and concerns. We found a lack of candour in the way the practice handled complaints, with responses not well evidenced and no clear rationale to findings.

However, we found other healthcare partners reported improved collaboration and working relationships since the last CQC inspection. The local linked care home and community health service reported that ward rounds at the home had become more focused and effective and general communication had improved. The provider worked with other practices within their primary care network to offer extended access, and to offer access to additional healthcare roles.

The service had an improved focus on continuous learning and improvement across the organisation and local system. However, not all systems and processes were working effectively. Due to the scope of improvements identified as required at the last CQC inspection, the provider had focussed on the areas which needed addressing most urgently to improve the quality and safety of the service. The service did not feel they were in a position yet to innovate but hoped to do this when they had stabilised the quality and safety of the service.

The practice had a quality improvement plan in place to help drive improvements in services. This was focussed on the areas of concern identified following the July 2025 CQC inspection. We found significant improvements had been made to clinical processes, such as the monitoring and review of people with long term conditions and handling of clinical tasks. However, there remained concerns about the culture within the practice. This risked limiting the ability to continually learn, improve and innovate to ensure services could continue to meet the needs of the local population.

The practice did not fully analyse and use the information from complaints and significant events to support service improvement. Lessons were not always learnt to continually identify and embed good practice.