Dr I K Babar & Partners

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

We did not assess all quality statements in this key question. We only assessed the parts of the quality statements that were included in the warning notices we issued to the provider on 18 December 2025.

We looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment, we rated this key question as inadequate. At this assessment, the rating remains the same.

The service was in breach of legal regulation in relation to safe care and treatment and fit and proper persons employed.

This service scored 34 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The assessment of December 2025 found that there was no monitoring of significant events (SEAs), and they had not been collated to show what had been received and when any actions were completed until we announced that inspection.

The service did not always have a proactive and positive culture of safety based on openness and honesty. They did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

During this assessment the provider showed us the system that they had put in place to deal with SEAs, however, this was not effective and robust. In the time since the last assessment there had been 2 SEAs documented and discussed, but only 1 had been appropriately documented and disseminated to staff.

Not all people felt supported to raise concerns and they did not feel staff treated them with compassion and understanding. Representatives from the Patient Participation Group (PPG) felt the provider took concerns seriously and proactively made improvements to the service. Managers encouraged staff to raise concerns when things went wrong. During staff meetings, the whole team discussed clinical issues.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

The service did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

There was a range of clinical and non-clinical roles within the practice. We found that the monitoring of staff training had improved since the last assessment in December 2025. Most of the staff had completed all mandatory training as required, however there were some gaps in training modules being completed by some locum staff. There was 1 member of staff employed since November 2014 that the provider was unable to provide any training records for. Staff were working within their agreed areas of competence.

The service had implemented a recruitment policy. The policy was robust but was not being followed correctly. Some new starters to the service since the last assessment in December 2025 had started roles before all recruitment checks had been completed. There was a long standing (prior to December 2025 assessment) member of staff that the provider had failed to complete a Right to Work check for. During the assessment the provider did complete the appropriate check for this member of staff.

During the assessment in December 2025, the governance system for managing infection prevention and control (IPC) was not effective.

During this assessment there had been some improvements to the governance around IPC. The provider had completed hand washing audits and IPC audits but there was missing information on both audits. When looking at the hand washing audit it was not clearly documented who was being assessed. It was not obvious that the provider managed the risk of infection as there was little evidence of risk assessments being completed and no record that actions had been taken to mitigate risks, stop the spread of infection or sharing of concerns with appropriate agencies promptly.

The practice had a designated infection, prevention and control lead. Not all staff had undertaken relevant IPC training.

The service did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. People were not always involved in planning.

The assessment of December 2025 found issues with medicines optimisation. Although the provider had taken action to resolve the issues we highlighted, further issues were found during this assessment.

As part of this assessment a CQC GP Specialist Advisor (GP SpA) conducted a series of remote clinical searches of patient records. Patients taking high risk medications that required regular monitoring were not always called or recalled where required in line with guidance. The process in place for call/recall/identifying these patients was not robust.

Records showed us that some patients did not receive information that needed to be shared with them once they had been started on a medication that had a Medicines and Healthcare products Regulatory Agency (MHRA) alert attached to it. This put patients at risk of harm.

The GP SpA advised that medicine reviews reviewed during the inspection were inconstant. The Registered Manager advised that they would be discussing this with the pharmacist that completed the monitoring.

The practice held all the recommended emergency medicines.

The practice had made improvements to manage prescription stationery securely since the assessment in December 2025. However, there were still some concerns with regards to the way prescription stationary was being stored. This was not in line with their own prescription security policy or in line with national NHS guidance. For example, we found some prescription pads in an office draw and there was no record of serial numbers stored anywhere. This could increase the risk of misuse or prescription fraud.

Not all emergency equipment needed by the provider to respond effectively to medical emergency within the practice was available on this inspection. For example missing items including items to assist in resuscitation.