• Doctor
  • GP practice

Phoenix Surgery

Overall: Good read more about inspection ratings

Dunwich Drive, Toothill, Swindon, Wiltshire, SN5 8SX (01793) 600400

Provided and run by:
Dr Humaira Ramzan

All Inspections

During an assessment under our new approach

Date of Assessment:19 January to 20 January 2026.

Phoenix Surgery is a GP service that delivers services to 4,361 people under a contract held with NHS England.

Information published by Office for Health Improvement and Disparities shows that deprivation within the service population group is in the 5th decile (5 of 10). The lower the decile, the more deprived the population is relative to others. This assessment considered the demographics of the people using the service, the context the service was working within and how this impacted service delivery. Where relevant, further commentary is provided in the quality statements section of this report.

The service had a good learning culture and people could raise concerns. Leaders investigated incidents thoroughly. People were protected and kept safe. Staff understood and managed risks. The facilities and equipment met the needs of people, were clean and well-maintained and any risks mitigated. There were enough staff with the right skills, qualifications and experience. Leaders made sure staff received training and regular appraisals to maintain high-quality care. Staff managed medicines well and involved people in planning any changes.

People were involved in assessments of their needs. Staff reviewed assessments taking account of people’s communication, personal and health needs. Care was based on latest evidence and good practice. Staff worked with all agencies involved in people’s care for the best outcomes and smooth transitions when moving between services. Staff made sure people understood their care and treatment to enable them to give informed consent. Staff involved those important to people took decisions in people’s best interests where they did not have capacity.

People were treated with kindness and compassion. Staff protected their privacy and dignity. They treated them as individuals and supported their preferences. People had choice in their care and treatment. The service supported staff wellbeing.

People were involved in decisions about their care. The service provided information people could understand. People knew how to give feedback and were confident the service took it seriously and acted on it. The service was easy to access and worked to eliminate discrimination. People received fair and equal care and treatment. The service worked to reduce health and care inequalities through training and feedback. People were involved in planning their care and understood options around choosing to withdraw or not receive care.

Leaders and staff had a shared vision and culture based on listening, learning and trust. Leaders were visible, knowledgeable and supportive, helping staff develop in their roles. Staff felt supported to give feedback and were treated equally, free from bullying or harassment. Staff understood their roles and responsibilities. Leaders worked with the local community to deliver the best possible care and were receptive to new ideas. There was a culture of continuous improvement with staff given time and resources to try new ideas.

1 December 2022

During an inspection looking at part of the service

We carried out an announced focused desk-based review of Phoenix Surgery on 1 December 2022 to follow up on the Warning Notice issued to the provider following our inspection in September 2022 in regard to a breach of Regulation 12: Safe care and treatment.

This inspection was not rated therefore the ratings from our last inspection in September 2022 remain the same.

Safe - Requires Improvement

Effective - Requires Improvement

Caring - Good

Responsive - Good

Well-led - Requires Improvement

Following our previous inspection in September 2022, the practice was rated Requires Improvement overall.

We also issued the provider with a requirement notice for breach of Regulation 17: Good Governance, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Phoenix Surgery on our website at www.cqc.org.uk

Why we carried out this inspection

We undertook a desk-based review to monitor the provider’s progress against their action plan to confirm the practice had met the legal requirements in relation to the Warning Notice served at our previous inspection in September 2022.

How we carried out the inspection

This remote desk-based review included:

  • Conducting staff interviews using video conferencing facilities.
  • Completing clinical searches on the practice’s patient records system. (This was with consent from the provider and in line with all data protection and information governance requirements).
  • Reviewing patient records to identify issues and clarify actions taken by the provider.
  • Requesting evidence from the provider.

Our findings

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations.

We found that:

  • The provider had implemented an action plan in response to our Warning Notice and was making progress to achieve all of its identified actions.
  • The practice had made improvements to how it provided care in relation to high-risk medicines and long-term conditions, for example, we found all patients prescribed DOACs had received their required monitoring.
  • Patients with long-term conditions were being contacted by the practice and invited to attend their review.
  • We found improvements to the practice’s safeguarding register and how patients on the register had been reviewed.

We found no breaches of regulations. However, the provider should:

  • Continue to implement the action plan so all patients receive appropriate monitoring in line with national guidance.

Details of our findings and the evidence supporting our ratings are set out in the evidence table.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services

7 September 2022

During a routine inspection

We carried out an announced comprehensive inspection Phoenix Surgery on 7 September 2022. Overall, the practice is rated as requires improvement.

Safe - requires improvement,

Effective - requires improvement,

Caring - good,

Responsive - good,

Well-led - requires improvement.

This was the first inspection of the Phoenix Surgery under this provider – Dr Humaira Ramzan since their registration on 31 July 2020.

The full reports for previous inspections can be found by selecting the ‘all reports’ link for Phoenix Surgery on our website at www.cqc.org.uk

Why we carried out this inspection

We carried out this inspection in line with our inspection priorities.

How we carried out the inspection

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site.

This included:

  • Conducting staff interviews using video conferencing.
  • Completing clinical searches on the practice’s patient records system. (This was with consent from the provider and in line with all data protection and information governance requirements).
  • Reviewing patient records to identify issues and clarify actions taken by the provider.
  • Requesting evidence from the provider.
  • A short site visit.

Our findings

We based our judgement of the quality of care at this service on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations.

We found that:

  • The practice provided care in a way that was not always safe for patients and did not protected them from avoidable harm.
  • Patients with some long-term conditions and/or on high-risk medicines were not reviewed and followed-up as indicated in national guaidance.
  • Staff dealt with patients with kindness and respect and involved them in decisions about their care.
  • Patients could access care and treatment in a timely way.
  • The way the practice was led and managed did not always promote the delivery of high-quality, person-centre care.

We found two breaches of regulations. The provider must:

  • Ensure care and treatment is provided in a safe way to patients.
  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Hospitals and Interim Chief Inspector of Primary Medical Services