Dr Rana Chowdhury

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

At our last assessment we rated this key question inadequate. At this assessment, the rating has changed to requires improvement. This was because the practice had responded to the findings of the previous assessment, but the systems for assessing needs, delivering evidenced based guidelines and the management of patient long term health conditions remained either not fully effective or embedded.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The GP survey carried out from January to March 2024 found over 90% of patients stated the doctors treated them with care and concern, and they had confidence in the health care professional, and their needs were met.

At the previous assessment in August 2024, we found patient records did not include sufficient information to understand clinical assessment and management of the patient’s condition. In response the practice implemented an action plan; to improve the monitoring and treatment of patients and it had employed a member of the clinical team to carry out patient long-term health condition reviews.

At this assessment we found some improvements had been made. As part of the assessment a number of set patient clinical record searches were undertaken by a GP National Professional Adviser. These searches were visible to the practice. We reviewed both asthma and diabetes patient records and found for diabetes, all patients had been identified and reviewed. For asthma, we identified 211 patients; of these, 4 had been prescribed 2 or more courses of rescue steroids. A review of these records found 2 had no evidence of follow up of the patients, which may put patients at risk. Our search found there was no missed diagnosis of kidney diseases. However, in all the records we reviewed, the quality of the information recorded continued to require improvements.

We also reviewed the patient consultation records of the practice nurse, advanced nurse practitioner and the paramedic, who did not prescribe medication. The review of their consultation records found some records had not been coded correctly on the computer system to enable staff to identify a review had been carried out. A patient with mental health issues who presented with possible risk, staff had not completed the assessments fully. And for a patient who had been visited at home for blood tests, and was not at home, the blood tests were posted through the patient’s letter box with no action plan regarding follow up.

At the previous assessment in August 2024, the review of patient records by the GP National Professional Adviser found the clinicians had not consistently followed evidence-based care and treatment guidelines. At this assessment, although we found improvements in the patient records and staff following evidence-based guidelines. We also found some areas that best practice could have been improved. For example, reasons for referrals were not always fully documented, a mental health assessment was not fully completed, there was evidence of overuse of beta antagonists with no evidence of a system to ensure beta antagonists were not overused.

The NHS Business Services Authority medicines data in January to December 2024, which reviews hypnotic and multiple psychotropics were in line with the national average. However, the prescribing of antibiotics was above the national average. This was also observed whilst carrying out a review of the patient records and can create risks. For example, overuse of antibiotics can promote the development of drug-resistant bacteria, making infections harder to treat. During the site visit we asked for a copy of any antimicrobial audits to ensure they were meeting the national and local guidelines, the practice submitted one for 2023.

Staff said learning occurred through clinical and primary care network meetings and National Institute for Health and Care Excellence guidance was available to all the clinicians.

The practice had a small staff team, who stated they worked well together. Following the previous assessment in August 2024 the practice had commenced clinical and governance meetings once a quarter which they had recently agreed to increase to monthly.

The leaders had commenced making improvements to external communication, however at the time of the assessment this was not yet fully embedded. For example, although, the practice had identified 53 carers, staff explained they did not offer any extra support or advice at present but were working towards a monthly carer focus group to identify carer’s needs.

The practice submitted agendas and minutes, which demonstrated the provider met with their local primary care network peers to discuss cases and experience learning. Also, in response to this assessment they had carried out a meeting with the local district nursing team in April, to discuss patients with complex needs.

The practice supported a residential care home, we spoke with staff who stated the lead GP responded promptly to their needs and visited weekly.

The practice supported people to live healthier lives and where possible, reduce their future needs for care and support. Staff said patients had access to social prescribers, health and wellbeing coaches, mental health specialist nurses, and dieticians.

In March 2024, they had sent out a text to patients who smoked, to offer help with cessation.

At the time of the assessment, staff explained the practice did not offer adult health assessments.

Although we were told the recall of patient long-term health conditions was carried out in an ad hoc way, staff told us they were looking at making improvements and putting a system in place. The unverified data for 2024/25 demonstrated, they had completed approximately 198 out of 224 asthma reviews, 74% of diabetes reviews and 80% of hypertension reviews.

The practice nurse was responsible for the recall of patients for childhood vaccinations and cervical screening, unverified data demonstrated the practice had almost met the world health organisation targets of 90% for childhood vaccinations and completed approximately 71% of cervical screening for patients under the national screening program. The provider had carried out four audits in the last 12 months, these covered medicines administration, mental health appointments, and the management of hospital letters. The practice had completed 18 out of 30 mental health and 12 out of 16 learning disability care plans.

The practice told people about their rights around consent. Most clinicians understood the requirements of legislation and guidance when considering consent and decision making. We saw that consent was documented. Clinicians supported patients to make decisions. We reviewed a sample of patients Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions and found they were made in line with relevant legislation and were appropriate.