Archived: East One Health

Updated 4 July 2017

East One Health provides NHS primary care services to approximately 10,650 patients across two sites. The main site operated from 14 Deancross Street, LondonE1 2QA and the branch site from 445 Cable Street, London E1W 3DP. Patients are able to access services at both sites. The practice operates under an Alternative Provider Medical Services (APMS) contract (a locally negotiated contract between NHS England and general practices for delivering general medical services). The practice is part of NHS Tower Hamlets Clinical Commissioning Group (CCG).

The practice population is in the second most deprived decile in England. People living in more deprived areas tend to have greater need for health services. The practice has a much larger than average proportion of young male and female adults on its patient list, particularly in the age ranges of 25-29, 30-34 and 35-39. Conversely the practice has a much lower than average proportion of male and female patients above the age of 50. The practice catchment area has a large Bangladeshi population and a proportion speak English as a second language. The practice has access to Bengali and Sylheti-speaking advocates on the premises.

The practice is registered with the Care Quality Commission (CQC) to provide the regulated activities of diagnostic and screening procedures; treatment of disease; disorder or injury; maternity and midwifery services and surgical procedures. All surgical procedures are undertaken at the Cable Street site which we inspected on the day of our inspection.

The practice staff comprises of two male and two female GP partners (seven clinical sessions each), four female salaried GPs and two male salaried GPs (totalling 32 clinical sessions) and one female GP registrar. The team is supported by six practice nurses and three healthcare assistants, a practice manager, deputy practice manager, facilities manager and a team of administration and receptionist staff.

The practice at Deancross Street is open between 8am and 8pm Monday to Friday and on Saturday from 9am to 1pm. Clinical appointments are available from 8am to 1.30pm and 2pm to 7pm.

The practice at Cable Street is open between 8.30am and 1pm and 3.30pm and 6.30pm on Monday, Wednesday and Friday, on Tuesday between 8.30am and 6.30pm and on Thursday from 8.30am to 1pm. Telephone calls are diverted to the main Deancross Street practice when the surgery is closed.

When the practice is closed, out-of-hours services are accessed through the local out of hours service or NHS 111. Furthermore, patients can also access appointments out of hours through four hub practices within Tower Hamlets between 6.30pm and 10pm on Monday, Tuesday and Wednesday, between 6.30pm and 8pm on Thursday and Friday, between 8am to 8pm on Saturday and from 10am to 6pm on Sunday. East One Health at Deancross Street is a location for one of the hubs. This service is registered separately with the Care Quality Commission and we did not inspect this service.

Updated 4 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at East One Health on 16 February 2016. The overall rating for the practice was requires improvement. The full comprehensive report on the 16 February 2016 inspection can be found by selecting the ‘all reports’ link for East One Health on our website at www.cqc.org.uk.

This inspection was an announced comprehensive inspection carried out on 25 May 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 16 February 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety. Staff demonstrated that they understood their responsibilities and all had received training on safeguarding children and vulnerable adults relevant to their role.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said they found it easy to make an appointment and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
• We found that the practice had taken a systematic approach to review the findings of the previous inspection and implemented actions to rectify all areas that were recognised as requiring improvement.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 4 July 2017

The practice is rated as good for the care of people with long-term conditions.

• Both GPs and nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
• Performance for diabetes related indicators was statistically comparable to the CCG and national averages. For example, the percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) is 5 mmol/l or less was 83% (CCG average 85%; national average 80%).
• The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
• All these patients had a named GP and there was a system to recall patients for a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
• The practice had aligned annual blood recall for each chronic disease for patients with multiple co-morbidities and coordinated the repeat prescribing process which resulted in integrated continuity of care, reduced the frequency of attendance at the surgery and provided better appointment efficiency for the practice.

Updated 4 July 2017

The practice is rated as good for the care of families, children and young people.

• From the sample of documented examples we reviewed we found there were systems to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of accident and emergency (A&E) attendances.
• Immunisation rates were broadly in line with all standard childhood immunisations.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.
• The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.
• The practice had been awarded the ‘You’re Welcome Award’ (a programme aimed to support health services to be more young people friendly).

Updated 4 July 2017

The practice is rated as good for the care of older people.

• There was a GP clinical lead for the care of the elderly. The practice offered proactive, personalised care to meet the needs of the older patients in its population including those in sheltered homes.
• The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs. The practice had access to the Tower Hamlets integrated care team for the management of elderly and frail patients.
• The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care.
• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
• The practice held monthly multi-disciplinary care meetings which included the community health service team, social services, palliative care and mental health team for older people.
• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

Updated 4 July 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours up to 8pm Monday to Friday and Saturday appointments from 9am to 1pm, telephone and on-line consultations.
• The practice was proactive in offering online services which included appointment booking, repeat prescription requests and viewing of medical records.

Updated 4 July 2017

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• The practice carried out advance care planning for patients living with dementia.
• The practice had a GP clinical lead for mental health. We saw there was a system in place for monitoring repeat prescribing for patients receiving medicines for mental health needs.
• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
• Patients at risk of dementia were identified and offered an assessment.
• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
• Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.
• The percentage of patients diagnosed with dementia who had had their care reviewed in a face-to-face meeting in the last 12 months was 94% (CCG average 91%; national average 84%).
• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 95% (CCG average 89%; national average of 89%) and the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption has been recorded in the preceding 12 months was 96% (CCG average 90%; national average 89%).

Updated 4 July 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including those with a learning disability.
• The practice offered longer appointments for patients with a learning disability.
• End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
• The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients and had information available for vulnerable patients about how to access various support groups and voluntary organisations.
• Staff we spoke with knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies.
• The practice had Bengali and Sylheti-speaking advocates on the premises and had access to interpreter services which included British Sign Language (BSL).
• We saw that staff members had attended Identification and Referral to Improve Safety (IRIS) training. This was a is a general practice based domestic violence and abuse (DVA) training, support and referral programme for primary care staff and provided care pathways for all adult patients living with abuse and their children.