Dr Rana Chowdhury

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The provider and leaders had responded to the concerns found at the previous assessment and had made improvements to the systems for significant events, safeguarding, referrals, storage of prescriptions. However, some systems were still not effectively embedded to ensure the consistent provision of safe care. For example, oversight of staff training and immunisations and medicines optimisation.

This service scored 63 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

At our previous assessment in March 2025, we found the system for the management of significant events was not fully effective or embedded because learning from incidents had not been carried out. In addition, some staff were unsure about what constituted a significant event.

At this assessment we found the system to review, investigate and look at ways of learning from significant events had improved. The practice manager had developed a leaflet for staff to explain a significant event and staff told us they understood what constituted a significant event.

The Primary Care Network pharmacist was responsible for the review and action of Medicines and Healthcare products Regulatory Agency (MHRA) safety alerts. At the previous assessment in March 2025, we found that safety alerts were not always discussed at clinical meetings as described in the practices policy and discussions with clinical staff demonstrated they were unsure of the safety alerts process. At this assessment we found safety alerts were responded to and actioned and discussed briefly at clinical meetings.

At our previous assessment in March 2025, we found there was a backlog of tasks to complete, which included an urgent and two week wait referrals and prescription requests. At this assessment we found the management of tasks and test results had improved. The practice manager-maintained oversight of all tasks and results to ensure prompt completion.

At our previous assessment in March 2025, we found two week wait referrals contained limited information to assist clinicians in secondary care (hospital) to determine next steps for the patients care and some referrals were not sent to the appropriate departments. In addition, the practice did not have a system in place to review routine referrals, to check whether patients’ conditions had deteriorated or improved. At this assessment, a review of 16 patient referrals carried out by the CQC GP specialist adviser found the system for both urgent and routine referrals were appropriate, sent to the appropriate departments, followed up and safety netted. In addition, the provider carried out regular audits of the consultations referrals made by GPs to ensure they were appropriately completed.

Patients’ summary care records were updated by the provider, and the practice had recently employed a member of staff to lead on this area.

The provider now attended both multi-disciplinary, safeguarding and district nursing meetings.

The pharmacist had recently completed an audit to ensure all shared care agreements were updated for all patients on disease-modifying antirheumatic drugs. This audit had found four patients who did not have an agreement in place, who were then followed up by staff.

The provider supported a local residential home, where they had completed universal care plans to ensure patients had a safe transition to secondary care.

At our previous assessment in March 2025, we found the practice systems to identify, review, and safeguard patients were only partially embedded or not effective. At this assessment we reviewed patient records and the practice’s system and management of safeguarding. We found the practice had allocated a member of administration staff who reviewed the patient safeguarding registers, to ensure patients were seen regularly by members of healthcare staff and coded on the computer software correctly. In addition, they audited the children who were not brought in to appointments and audited accident and emergency appointments to identify any safeguarding risks. We saw minutes that demonstrated the provider and safeguarding administrator met every two weeks to review any safeguarding issues.

All non‑clinical staff had completed the required safeguarding training for their roles. However, the practice manager could not provide evidence of safeguarding adults and children training for 1 of the 3 GPs, or the required adult safeguarding level for the advanced nurse practitioner.

Although, the provider did not attend regular safeguarding meetings, they told us they would contact the safeguarding team when they required advice. The provider had attended the local integrated board safeguarding meetings and met with the lead to improve their knowledge following a safeguarding incident.

The safeguarding policy had been reviewed by the practice manager in September 2025; it now contained the correct names of the safeguarding lead and the correct codes to ensure vulnerable patients could be identified by staff.

At our previous assessment in March 2025, we found the practice did not have sufficient checks and guidance in place to ensure that receptionists carried out patient triage correctly when patients were being diverted to other services. At this assessment we found the practice had purchased a medical triage computer software toolkit that supported receptionists to correctly triage and refer patients to other services if needed and to enable the prioritisation of patients with urgent needs. In addition, 5 reception staff had completed care navigation training.

We observed the practice was equipped to respond to medical emergencies, and most staff were suitably trained in emergency procedures, and sepsis.

At our previous assessment in March 2025, we found the practice did not have an action plan in place to respond to all the recommendations in the environmental risk assessments. At this assessment we found that all recommendations from risk assessments had been responded to. For example, a new gate with a push button release catch had been installed at the rear fire escape route.

Staff told us that facilities and equipment were safe, and that equipment was maintained according to manufacturers’ instructions. The practice provided evidence of annual portable appliance testing, and calibration of equipment and systems for safely managing healthcare waste.

Most staff had completed their fire safety and the principles of health and safety training.

To ensure the continuity of the service, leaders had a business continuity plan which was regularly reviewed.

At our previous assessment in March 2025, we found staff directly employed by the practice had completed mandatory training, but the practice did not have evidence that the clinical staff had completed their role specific training such as travel vaccines, cervical screening and childhood immunisations.

At this assessment we found the practice manager mostly had oversight of mandatory and role specific training. For example, the practice had engaged an advanced nurse practitioner through the primary care network. The practice had a letter from their employer confirming their recruitment process and training, and a scope of practice. However, the scope of practice, which states what patients they could provide clinical care for at the practice had not been agreed by the practice’s provider and the letter was from 2023. The advanced nurse practitioner explained they carried out mental health reviews and saw patients with depression and suicidal risk, however the training record submitted by the practice did not contain evidence of training in these areas.

At the previous assessment in March 2025, we found a review of a job description for a GP assistant, that was not specific enough to ensure the member of staff worked within their competency. At this assessment we found that the job description had been reviewed.

We found the provider had a system in place to supervise and review the competency of clinical staff. A sample of clinicians’ patient consultation notes and referrals were reviewed monthly, and any issues were followed up. This included the provider who had agreed to regular supervision and a review of consultation notes by an independent GP from the practice.

At the previous assessment in March 2025, the clinical supervision policy did not reflect the practice arrangements for staff supervision and auditing of clinical staff patient consultations. Although, it had been reviewed in July 2025 continues to not fully reflect the practices process.

At our previous assessment in March 2025, the practice did not have a system in place to ensure they met the guidance of the Green Book regarding the immunisation of healthcare staff. At this assessment we found there were partial records for the completion of some staff immunisation history. For example, we reviewed 5 staff records and found none had completed or risked assessed against all of the possible vaccinations.

At our previous assessment in March 2025, we found no COSHH risk assessments were in place to identify, assess, and control risks related to the use of chemicals such as for cleaning. We also saw that the practice had used fabric curtains in the GP consultation room, which did not have a date they were previously cleaned. At this assessment we found the staff effectively assessed and managed infection risks. They promptly identified and controlled potential spread, sharing concerns with relevant agencies. A designated infection prevention and control lead was in place, and all staff received appropriate training. Cleaning schedules were followed, and regular audits and risk assessments were completed with actions taken to reduce risks. In addition, the practice no longer used fabric curtains.

As part of this assessment a number of set patient clinical record searches were undertaken by a CQC GP specialist adviser. These searches were visible to the practice. Overall, this assessment found the processes to manage medicines safely had improved. Patients administered disease-modifying antirheumatic drugs (DMARDs methotrexate) commonly used in people with rheumatoid arthritis were monitored appropriately. For example, the search identified 10 patients prescribed this medicine and 3 patients were overdue the 3 month check all 3 patients had been appropriately identified and offered appointments by the practice. In addition, mitigating actions were in place, including reduced prescribing for 1 patient to minimise risk. However, documentation of the recommended day of the week for methotrexate administration was not used consistently across the 3 prescriptions. This prevents patients from taking the medicine too often.

We reviewed patients who received medicine to prevent blood clots (Direct oral anticoagulants) found that of 45 prescribed the medicine, 9 may not have had the correct monitoring. We reviewed a sample of 5 of these patients and found that all required further intervention, such as blood tests and the patients had been identified and contacted in December 2025 and January 2026 to have the interventions. The practice had completed 61 medicines reviews in the last 3 months, and we sampled 5 of these patient records and found no issues.

Medicines and emergency medicines were stored, administered, and recorded securely.

At our previous assessment in March 2025, we found the practice did not have a safe system in place for the storage of prescriptions. At this assessment we found a new system was in place to ensure safe storage.

At the previous assessment in March 2025 the NHS Business Services Authority medicines data in January to December 2024, indicated the prescribing of antibiotics was above the national average, which was also observed whilst carrying out a review of patient records. At this assessment we found the data from the 1 April to 30 September 2025 the prescribing of nitrofurantoin, pivmecillinam and trimethoprim for uncomplicated urinary tract infections was still above the expected level. However, the provider submitted two antibiotic audits carried out in December 2025 and January 2026 which demonstrated an improvement in the prescribing of antibiotics.

At the time of the assessment the practice did not have any independent prescribers.