Limehouse Practice

Updated 5 July 2016

Limehouse Practice is situated at Gill Street Health Centre, 11 Gill Street, London E14 8HQ in purpose built premises with access to 15 consulting rooms. The practice provides NHS primary care services to approximately 10,800 patients living in Tower Hamlets through General Medical Services (GMS) contract (a contract between NHS England and general practices for delivering general medical services and is the commonest form of GP contract).

The practice is part of NHS Tower Hamlets Clinical Commissioning Group (CCG) which consists of 36 GP practices split into eight networks. Limehouse Practice is part of the Poplar and Limehouse Health and Wellbeing Network which comprises of five local practices.

The practice population is in the second most deprived decile in England. People living in more deprived areas tend to have a greater need for health services. A large majority of the practice population are from an ethnic minority, predominantly from the Bengali community.

The practice is registered as a partnership with the Care Quality Commission to provide the regulated activities of diagnostic and screening procedures; treatment of disease; disorder or injury; maternity and midwifery services and family planning.

The practice provides a range of services including maternity care, childhood immunisations, chronic disease management and travel immunisations.

The practice staff comprises of one male and five female GP partners (totalling 44 clinical sessions per week), five female salaried GPs (totalling 18 clinical sessions per week) and one regular salaried locum GP (six sessions per week). The clinical team is supported by one nurse prescriber (36 hours per week), two practice nurses (36 hours per week each) and four healthcare assistants. The administration team consists of a practice manager, reception supervisor, eight receptionists, two secretaries, an IT administrator, a clerical officer, a patient adviser and an apprentice.

The practice is a training and teaching practice and has a practice nurse from the ‘Open Doors’ practice nurse programme (an initiative set up in 2007 in response to practice nurse shortages in Tower Hamlets, the scheme recruits nurses from secondary care and provides them with practice nurse training and undertake secondment in general practices in the area).

The practice telephone lines are open from 8.30am to 1pm and 2pm to 6.30pm on Monday and Wednesday and 8.30am to 6.30pm Tuesday, Thursday and Friday. The practice is open and accessible to patients from 8.50am to 6.10pm on Monday, Tuesday, Thursday and Friday. The practice is closed between 1pm and 2pm on Wednesday. Extended hours are provided every alternate Saturday between 9am and 12 noon.

When the surgery is closed, out-of-hours services are accessed through the local out of hours service or NHS 111. Patients can also access appointments out of hours through several hub practices within Tower Hamlets between 6.30pm and 8pm on weekdays and 8am to 8pm on weekends as part of the Prime Minister’s Challenge Fund (the Challenge Fund was set up nationally in 2013 to stimulate innovative ways to improve access to primary care services).

Updated 5 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Limehouse Practice on 17 March 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.

• Risks to patients were assessed and well managed, with the exception of those relating to some aspects of infection control.

• The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.

• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

• Information about services and how to complain was available and easy to understand.

• Patients said they could make an appointment with a named GP and that 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.

• The provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider should make improvement are:

• Implement and record actions identified from the infection control audits and review the cleaning arrangements for the practice.

• Develop a system to monitor role specific training to ensure the timeframes for updates does not lapse.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 5 July 2016

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

• Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
• Performance for diabetes related indicators was comparable to the national average. For example, the percentage of patients with diabetes, on the register, in whom the last HbA1c was 64 mmol/mol or less in the preceding 12 months was 72% (national average 78%) and the percentage of patients with diabetes, on the register, who have had the influenza immunisation was 99% (national average 94%).
• Longer appointments and home visits were available when needed.
• All these patients had a named GP and 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 ran an anticoagulant clinic.
• The practice engaged with the wider community to promote health and wellbeing through a series of community health events which included a diabetes awareness event in the local street market.

Updated 5 July 2016

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

• There were systems in place 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 A&E attendances.
• The percentage of patients with asthma, on the register, who had an asthma review in the preceding 12 months, was higher than the national average (practice 85%; national 75%).
• The practice’s uptake for the cervical screening programme was 83%, which was comparable to the national average of 82%. There was a policy to offer telephone reminders for patients who did not attend for their cervical screening test and information leaflets were available in languages relevant to the practice population.
• Appointments were available outside of school hours and the premises were suitable for children and babies.
• We saw positive examples of joint working with midwives, health visitors and school nurses.
• The practice held a weekly sexual health and contraception clinic which included implants and intrauterine devices.

Updated 5 July 2016

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

• The practice offered proactive, personalised care to meet the needs of the older people in its population.
• All patients over 75 had a named GP.
• The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
• Patients who were on the avoidable admissions register and integrated care programme were given a separate number to call to enable them to get through to the practice quickly and by-pass the main phone line.
• The practice offered a domiciliary phlebotomy service for housebound patients.

Updated 5 July 2016

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

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
• The practice held an extended hours clinic on alternate Saturdays from 9am to 12 noon and out-of-hours access was available through several hub practices in the CCG area.
• The practice was proactive in offering online services and patients could book and cancel appointments, request repeat prescriptions and update personal information through the practice website. The practice recently undertook a survey regarding accessing healthcare on line with a view to piloting Web-GP (an e-consultations interface).

Updated 5 July 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with 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 97% which was above the national average of 84%.
• The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
• The practice carried out advance care planning for patients with dementia.
• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 5 July 2016

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. The practice had 55 patients on its register and 52 had completed reviews. The practice offered longer appointments for patients with a learning disability.
• The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people and informed patients about how to access various support groups and voluntary organisations.
• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.
• The practice registered patients from a local domestic violence refuge. Staff members had attended Identification and Referral to Improve Safety (IRIS) training. This was 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. The practice had a domestic violence lead and worked closely with the IRIS advocate.
• A benefit advisor held a session every Wednesday afternoon at the practice to assist patients.
• The practice had written information to direct carers to various avenues of support and had identified and recorded 1.5% of the practice list as carers.
• The practice ran a weekly substance misuse clinic for patients on methadone.