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

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

At the last inspection we rated the practice as requires improvement for providing caring services because National GP Patient Survey data 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. At this inspection, we continued to rate the practice as requires improvement for caring because patients continued to express frustration of negative staff attitudes. There was mixed feedback from patients regarding how they were treated by staff.

This service scored 55 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The 2024 National GP Patient Survey showed that 83% of patients stated that during their last appointment, the healthcare professional was very good or fairly good at treating them with care and concern and this was similar to the national average of 85%.The practice's own survey results highlighted patients were happy with very helpful and polite staff. NHS feedback reported professional, caring staff who went above and beyond to provide a caring service. In feedback to CQC, 17 of the 40 people described a positive experience at the practice.However, CQC also received feedback from 10 patients where they felt there were not treated with kindness; reported some staff members were officious, sometimes rude and obstructive. This was consistent with feedback posted online by verified NHS reviews.Complaints received by the practice also highlighted issues with different members of staff attitude towards patients and not always having their privacy respected at reception.

Leaders told us they were committed to creating a working environment where all were treated with dignity and respect. However, we received mixed feedback from staff relating to the culture of kindness, compassion and dignity within the organisation. Some staff felt proud of their work and maintained a positive attitude; however, some staff felt practice management would not support them or act on their concerns if they encountered rude and aggressive patients on the frontline. TheHertfordshire and West Essex Integrated Care Board (HWEICB) told us they had supported staff when concerns had been raised regarding staff culture of kindness and respect. They followed up these concerns and visited the practice to speak to a number of staff. They observed staff and observed staff were happy in their work and there was no further action needed.

When we carried out the site visit, we mostly observed happy and motivated staff. All staff were very welcoming to the inspection team and we observed front line staff treat patients with kindness and respect. We observed staff hold the door open for a patient in a wheelchair. We also observed a quiet room which was available for people who needed some time away, including nursing mothers. We saw that privacy could be an issue at the reception desk as the open layout meant some conversations taking place at the reception desk could be overheard. The practice had policies in place relating to kindness and dignity. The practice statement of purpose highlighted their intention to offer a consistent and fair service to patients. They strived to provide a consistent culture of kindness, compassion and dignity; however, further improvement and monitoring was required to ensure all staff and people using the service felt the same way and action to be taken when they didn’t. The practice was aware of the feedback from patients. Reception team meetings records showed complaints, were discussed.Although there was evidence of kindness, compassion and dignity towards patients, there were consistent reports of poor customer service, poor attitude from staff.

People’s feedback was inconsistent in relation to treatment as individuals. Some patients told us the GP took his time to explain everything but other patients felt they were not always treated with dignity and respect.

The practice told us they treated people as individuals and made sure their care, support and treatment met their needs and preferences; for example, they could participate in their own care plans. The practice also told us people’s communication needs were met to enable them to engage in their care, treatment and support to maximise their experience and outcomes. Nursing staff told us they sent text messages to patients to communicate about their long-term conditions such as asthma and their inhaler choices. Patients almost always replied and liked this way of communicating with them as it saved them a lot of time. New patient registrations and invitations for immunisation appointments were sent in different languages. Patients also had access to their interpretation and sign language service. Staff told us patients with hearing impairment were noted on the system and had the option to communicate via letters and texts rather than calling the practice. Patients were offered a chaperone where required. The Herts and West Essex ICB (HWEICB) provided summary feedback regarding the reviews on the NHS website. Of these reviews for 2023-2024, 10 in total were related to clinical treatment and staff attitude. There was 1 negative comment about late running of appointments. In 2024-25 to the time of the on-site assessment there was 1 positive feedback concerning clinical treatment.

There was an equality and diversity policy in place. The practice used an interpreting and translation services which offered face to face, telephone or video services; however, we did not see any data on translation services used the past year. There was also an Accessible Information Standard policy in place which aimed to ensure people with a disability, impairment or sensory loss received information they could easily read or understand and received any communication support they needed.There was a hearing loop in the practice and a chaperone poster was displayed in the waiting room. We saw childhood immunisation and flu vaccination posters issued by the UK Health Security Agency in Pashto, Polish and Turkish and we also saw chaperone posters in Pashto, Polish and Romanian. We observed patients had access to google translate on the practice website and access to different languages on their check in screen; however, the practice leaflet did not provide any information about how patients could access their interpretation service. All staff were up to date with their equality, diversity and inclusion training. The practice did not receive any complaints or feedback related to discrimination or not observing people's human rights.

The 2024 National GP patient survey data showed that 93% of patients were involved as much as they wanted to be in decisions about their care and treatment and this was comparable to the local and national averages of 91%. The practice also carried out their own internal patient survey in 2024 and sent out 2,500 invitations by text message. 564 patients responded to this survey and results showed 23% of patients found it very easy to use their online services and 7% of patients thought it was not at all easy to use their online services.Feedback from patients regarding choice and control over their own care and treatment decisions was mixed. Patients were happy they could select their chosen pharmacy for their prescriptions and were able to access advice whilst at home, with some patients sharing the practice was very accommodating to their family needs. However, feedback was mostly negative where patients did not always feel they had control over their own care and decisions about their treatment. We saw examples of concerns raised where patients felt they had no control over their prescribed medicines despite them reporting they caused them adverse effects. Some patients told us their requests to be referred to secondary care clinics were not acted upon in a timely manner and some university students trying to re-register with the practice faced barriers in being able to do so.

Staff told us patients were supported to have choice and control over their own care and to make decisions about their care, treatment and wellbeing. For example, when annual reviews were due, they told us patients had the choice to have either face to face or virtual appointments, or complete printed paper versions.

The practice website offered patients access to different local services and a variety of links to access services such as, self-referrals to physiotherapy, counselling and links to a variety of wellbeing services.Outcomes relating to patient choice over the tailored weight management services showed how the practice was proactive in this area; for example, since April 2024, over 300 patients were referred for weight management programmes, 21 to the diet replacement programme and 63 were signposted to this service; however, 94 patients declined a referral to the weight management programme.Community pharmacy teams worked closely with the practice to offer a new Pharmacy 1st service to enable the management of 7 conditions across various age ranges. They also offered a more convenient way to access healthcare, including support with stop smoking, blood pressure monitoring, contraception. The results of the pharmacy’s survey found that over 90% of patients who sought guidance from a community pharmacy within the past year.The practice had a Patient Participation Group (PPG) of 15 members whose collective thoughts and ideas helped to improve the practice through collaboration with patients.

We received significantly mixed feedback about how the practice responded to people’s immediate needs. For example, some people told us they felt their immediate needs were well taken care of and other patients told us they had never had a negative experience at the surgery. One patient described receiving 1st class treatment. However, some patients did not always feel that staff responded promptly or that the support provided met their needs. Patients told us that they did not always receive the immediate care and treatment when needed. The practice’s significant? and complaint records, as well as feedback sent to CQC showed patients did not always receive correct diagnosis and timely referral to secondary care when needed. Some patients with immediate health concerns shared their distress when being told they had to wait 5 weeks before accessing a doctor after they missed an unscheduled telephone call from the GP. 5 patients described how their symptoms were dismissed and they experienced a deterioration which, for 3 of them involved emergency admissions into hospital.The practice also provided the 2024 GP patient survey data which showed that 41% of patients felt their needs were definitely met when compared to the local and national averages of 57%.

The practice told us they acted as advocates for patients and checked for their welfare and safeguarding concerns, escalating any concerns. Nursing staff told us they reviewed patients on their active treatment list on a weekly basis and arranged home visits or consultations where required. They also looked at their local needs and identified patients found it hard to see nurses for an urgent on the day appointment, so changes were made to block on the day slots for one clinician a day to be released for patients requiring them; for example, for urgent wound care. Staff told us they tried to meet the needs of bereaved families by sending condolence cards and providing them with links to counselling. Where people required support, we saw staff offered support in a sensitive and respectful way. However, wewere not assured the processes in place were effective enough to listen to and respond to people's immediate needs. The practice did not act quickly to analyse why these events/shortfalls were taking place. In some cases where these concerns were raised, we were not satisfied the practice had sufficiently addressed these concerns to prevent a recurrence.

There was a home visit policy to triage visit requests and they prioritised home visits for housebound, terminally ill patients and other eligible criteria. Patients could also request double appointments where requested and some nurse appointments were doubled.

We received mixed views from staff regarding how the provider cared for their wellbeing. The majority of staff described leaders as supportive and several staff told us how the practice had supported them during a period of health and personal life challenges. However, some staff were not happy and told us they did not feel valued or supported especially when they had to deal with difficult patients being aggressive towards them, they felt leaders did not protect them from such incidents when they happened. Some staff told us they did not receive training for their role. Leaders told us they were proud of their staff and sought their views via their confidential staff comment box and via survey monkey staff surveys.

The practice had notable practices in place to enable their workforce and improve their wellbeing at work. We saw evidence of how the leaders were proactive in celebrating their staff and improving the good days for staff at work. Leaders implemented a monthly staff newsletter which shared practice news including a ‘Word from the manager’ section, staff updates, highlighted staff birthdays and congratulated individual and group staff achievements.

The provider invested a lot of resources in different activities and events for staff and we saw that they went above and beyond usual practice to promote their staff wellbeing. They also held regular team building events such as quiz nights 4 times a year where work and non-work-related questions were asked. Winners' prizes included an annual leave day. We saw evidence of summer BBQ events and festive parties, 1-year anniversary, birthday and festive celebrations, London away days, karaoke nights and pizza lunches for passing exams and long service awards for nurses. As a bonus event for the end of 2024, the provider planned a manicure and message day at work on one of the days in the staff room. Every time there was a positive review that named a member of the team, would receive a card and small box of chocolates. For the 2 main festive seasons, partners would meet to decide what they would purchase as gift bags for staff. There were also processes in place to support staff in their roles, including access to occupational health and staff could attend medical appointments when required. The provider told us they were committed to staff feeling their best.

There was a revamped staff room with an access to a computer for staff use. Staff were engaged well with the inspection team and were able to discuss their concerns when they wanted to raise them. When we tested staff responsiveness to their emergency call systems, staff responded immediately and despite this exercise being a drill, they engaged well with the inspection team and were very cheerful. However, we did observe some of the staff did not feel valued and this was consistent with individual staff feedback on inspection. Management told us they had an open-door policy on inspection; however, this was not always reflected in staff views. Although feedback was mixed from staff, we saw evidence of the practice going above and beyond to ensure staff satisfaction and improve the number of good days at work. This included supporting staff with their health, for example utilising their external occupational health service and referrals for blood tests relating to measles, mumps and rubella (MMR) immunisations.