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

At our last assessment we rated this key question inadequate. At this assessment, the rating has remained as inadequate. Whilst the practice had responded to the previous assessment and put in place an action plan. The leaders had not fully implemented or embedded the systems for significant events, safeguarding, referrals, safe staffing, storage of prescriptions, risk management, medicines optimisation and storage.

This service scored 38 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

In response to the previous assessment in August 2024, the provider had implemented an action plan. This stated they had commenced a new system in February 2025 to identify, report and learn from concerns, safety incidents and near misses both internally and externally. However, at this assessment we found the system was not fully effective or embedded. For example, the Integrated Care Board (ICB) had requested the practice to raise approximately 8 significant events from 2023 due to delayed patient referrals and look at ways of learning from these incidents. However, our review of patient’s recent referrals records demonstrated that any learning from these incidents had not been followed. In addition, some staff were unsure about what constituted a significant event. This meant there was an ongoing risk that staff may not report incidents or use the learning from previous incidents to deliver safe care and treatment.

The Primary Care Network pharmacist was responsible for the review and action of Medicines and Healthcare products Regulatory Agency (MHRA) safety alerts. The practice submitted a Central Alerting System policy, last reviewed September 2024, and a safety alerts log. We discussed this with the pharmacist who explained they reviewed and actioned all of the events. A review of recent clinical meeting minutes demonstrated safety alerts were not always discussed in line with the practice’s Actioning National Patient Safety Alerts and Drug Safety Alerts Protocol that stated they would be discussed within a week. Discussions with further clinical staff demonstrated that they were unsure of the safety alerts process.

The practice made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. The practice manager stated they had not received any complaints in the last 12 months.

At the previous assessment, between 7 to 12 August 2024, we reviewed patients’ routine and urgent referrals to secondary care and found in six patient records, the reasons for the referral was not fully documented, and two had not been referred to secondary care when recommended. Following the assessment the practice had implemented an action plan which included staff training and a new system to ensure urgent referrals to secondary care (hospital) under the two weeks wait system were actioned and followed up. However, at this assessment 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. This meant that patients might still not have their referrals addressed in an appropriate timescale or be referred to the most appropriate clinician to address their individual healthcare condition.

The practice action plan in response to the previous assessment, stated staff had completed training to ensure test results and clinical correspondence was reviewed and entered onto the patient electronic record system. In addition, a new task management policy was put in place. As part of our assessment, several sets of clinical record searches were undertaken by a CQC GP specialist advisor which demonstrated the pathology results were mostly dealt with promptly. However, we saw there were 56 tasks to complete from 6 March 2025, of these a two week wait referral task was outstanding from 12 March 2024. A further referral was not marked as actioned, and a referral that had been cancelled had no further action taken and an electronic prescription request from 14 March had not been actioned.

The Managing Incoming Pathology Results policy stated a regular audit would be carried out to ensure the pathology correspondence was being managed appropriately, this was not in place at the time of the assessment.

The practice submitted meeting agendas and minutes, which demonstrated they met with local primary care network peers to discuss cases and learning events. In response to this assessment, staff carried out a meeting with the local district nursing team to discuss patients with complex needs.

In response to our previous assessment, the provider had implemented an action plan to improve safeguarding arrangements. The action plan stated staff had completed safeguarding training, all children on the safeguarding register had been contacted and safeguarding had been added as a regular agenda item at clinical meetings. We found the practice systems to identify, review, and safeguard patients were only partially embedded. This meant that children and adults with safeguarding needs might not get the support needed and experience harm.

We were told the safeguarding lead was the lead GP, who had completed relevant training and spoken with the Havering safeguarding lead in January 2025. Clinical meetings in January stated that the lead would continue to update registers of safeguarded patients and continue to review every three months. However, our discussion with the safeguarding lead found the system for reviews planned was yet to be fully implemented. For example, our review of one patient on the safeguarding register found they had joined the practice in November 2023 but had not been seen face to face at the practice. Following the first site visit, the provider submitted information which demonstrated they had commenced a three-monthly review. The practice IT system included an alert that enable staff to identify patients that had safeguarding concerns.

At the time of the assessment, the practice did not have a system to follow up with other agencies when children did not attend appointments at the practice, and staff did not carry out an annual audit of children not brought to appointments, or attendances at accident and emergency services to identify any patterns which may indicate neglect.

The local safeguarding policies for children and adults submitted during the site visit did not have any dates of review, did not contain the correct name of the safeguarding lead, or the computer codes which staff used to alert safeguarding concerns.

Most staff had completed preventing radicalisation, Mental Capacity Act, and deprivation of liberty training. However, at the assessment, the practice did not have evidence that some clinical staff had completed the correct level of safeguarding adults and children’s safeguarding training. This was provided on the second site visit day.

The lead GP had met with a safeguarding lead GP for training. However, leaders had not had any regular meetings with external teams to discuss and improve outcomes for safeguarding within the last year.

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 the time of the assessment staff had commenced 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. Following the previous assessment in August 2024, the practice had increased the hours of the practice manager.

The practice manager explained they were working towards a member of reception staff being able to cover for them when on annual leave.

The practice manager explained they required further staff to ensure continuity of tasks, as at present they had staff who worked mornings only and afternoons only.

The practice had mostly detected and controlled potential risks in the care environment. The practice had a fire risk assessment in place which was dated 17 September 2025. The report had several issues which were identified as medium risk, and most had been followed up apart from weekly fire alarm testing. We saw fire equipment had been maintained.

The practice had a health and safety policy, and a risk assessment completed for 2024 to 2025. In addition, the practice had completed a legionella risk assessment in July 2023, this had some recommendations and although some had been met, the practice did not have an action plan in place to respond to all the recommendations.

The provider 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.

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

The front of the building was well maintained but there were steps and uneven surfaces at the back of the building which was also a fire escape route. The practice had carried out some repairs to the pathway at the back of the building and told us about the gate at the side of the building would be replaced with a more suitable gate to facilitate safety in the event of a fire.

The national GP patient survey carried out from January to March 2024 had 90 responses which were positive. For example, 91% stated the healthcare professional was good at treating the patient with care and concern and 96% had confidence and trust in the healthcare professional they saw or spoke to.

At the previous assessment in August 2024, we found the practice manager had started to put in place new systems and processes to ensure safe recruitment and staff competency. At this assessment we found the practice had not directly recruited new permanent staff following the last assessment. 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. The practice had engaged a locum paramedic and advanced nurse practitioner through the primary care network. The practice did not have references, or immunisation status for the paramedic. The paramedic was carrying out long-term condition patients’ health reviews, however the practice did not have any records of a scope of practice or evidence of their appropriate training. The lead GP had completed supervision and review of their clinical records., which had not indicated any issues.

The practice did not have records of a scope of practice, recruitment or training to provide assurance of the advanced nurse practitioner’s competency. The advanced nurse practitioner explained they had regular supervision and review of their clinical records by the lead GP, which had not raised any issues. However, a review of five patient’s records found improvements were required in three of the records.

The practice did not have the full recruitment details of a locum GP. The lead GP had completed regular supervision; however, the review notes were brief. A review of patient records during the CQC remote searches found that prescribing patients with antibiotics was not always appropriately optimised, and patient consultation records did not always record decisions and actions clearly.

The practice had a clinical supervision policy that was last reviewed August 2024, but it did not reflect the practice arrangements for staff supervision and auditing of clinical staff patient consultations.

At the previous assessment in August 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, the job description had not been changed and included areas that the role had not completed appropriate formal training for, or did not have guidance to follow, such as taking a brief medical history and managing clinical correspondence.

The practice mostly assessed and managed the risk of infection. The practice had a risk assessment carried out in July 2024, and we saw that actions had been taken in response to its findings and the staff lead for infection and prevention and control had also carried out quarterly audits.

We saw appropriate standards of cleanliness and hygiene were being met during our site visit. However, 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. Fabric curtains can harbour bacteria, viruses, and other pathogens. Without regular cleaning, these microbes can accumulate and potentially spread infections to patients and staff. In addition, the practice did not have the orange bins for non-medical sharps or the purple bins for cytotoxic waste which increased the risks such as of needlestick injury and hazardous waste exposure.

Staff had completed infection prevention and control training.

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. The Green Book provides guidelines for the immunisation of healthcare staff to protect them from occupationally acquired infections and ensure patient safety

At the previous assessment in August 2024, we found the processes to ensure the safe prescribing of medicines was not always effective and we did not have assurance that medicines were consistently being prescribed safely. The practice did not have a system in place at the time of the assessment to ensure the safe management of prescriptions. The practice had an action plan, where they had implemented new systems to monitor the prescribing of high-risk medicines.

As part of this assessment a number of set patient clinical record searches were undertaken by a CQC National 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) commonly used in people with rheumatoid arthritis were monitored appropriately. For example, the search identified 9 patients prescribed this medicine and only one patient was overdue the three-month period who was now treated via secondary care (hospital). We reviewed patients who received medicine to lower their blood pressure and found that of 279 prescribed the medicine, 7 may not have had the correct monitoring. We reviewed a sample of 5 of these patients and found that 3 were overdue having a blood test, however there was evidence the practice had tried to contact those patients. The practice had completed 419 medicines reviews in the last 3 months, and we sampled 5 of these patient records and found no issues.

Although their clinical management of beta antagonists, (inhalers to dilate the airways and relieve constriction for asthma) had improved, overuse had continued for some patients and there was no evidence of a working system in place 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) was in line with the national average. However, the prescribing of antibiotics was above the national average, which was also observed whilst carrying out a review of patient records. During the site visit the lead GP was unable to find a recent copy of any antimicrobial audits to ensure the provider was meeting national and local prescribing guidelines. The audit submitted was from January and June 2023.

The practice did not have a safe system in place for the storage of prescriptions.

We were told by the lead GP and practice manager that the practice nurse, advanced nurse practitioner and the paramedic, did not prescribe medication.