Spitalfields Medical Centre - Health E1

Updated 23 November 2016

Spitalfields Medical Centre – Health E1 provides primary medical services in the London Borough of Tower Hamlets to approximately 1260 patients and is one of 36 member practices in the NHS Tower Hamlets Clinical Commissioning Group (CCG). It is a specialist service providing GP services to street homeless people or those in temporary or hostel accommodation in the borough of Tower Hamlets. Spitalfields Medical Centre - Health E1 is a nurse-led service which means that the patient’s first point of contact may be with a Nurse Practitioner.

Spitalfields Medical Centre – Health E1 provides a specialised service dedicated to the needs of people who are street homeless and those in temporary or hostel accommodation in the borough of Tower Hamlets. It does not register children or young people.

The practice population is in the most deprived decile in England. Income deprivation within Tower Hamlets affects 50% of older people, compared to a national average of 16%. Ninety-eight percent of patients of the practice are unemployed. The practice has surveyed the ethnicity of approximately 59% of the practice population and has determined that 44% of patients identified as having white ethnicity, 24% Asian, 26% black and 6% as having mixed or other ethnicity.

The practice operates from a purpose built property with all patient facilities on the ground floor that are wheelchair accessible. There are offices for administrative and management staff on the ground floor.

The practice operates under an alternative provider medical services contract (APMS) contract. APMS contracts allow the provision of primary care medical services under local commissioning arrangements.

The practice team at the surgery is made up of one part-time female clinical lead GP, one full-time male GP and one part-time male GP working between them a whole time equivalent (WTE) of just under three GPs. The nursing team comprises: a full-time lead nurse practitioner, a full-time nurse practitioner, three full-time substance misuse nurses, and a full-time mental health nurse (between them working a WTE of five nurses). There is also a full-time healthcare assistant (HCA). In addition, there are three administrative staff including a full-time practice manager, and a full-time receptionist.

The practice is open between 9.00am and 5.30pm Monday and Tuesday, and between 8.00am to 6.30pm on Wednesday to Friday.

Appointments are available for the following clinics:

General Clinic (GP’s & NP’s):

• Monday to Thursday: 9.00am to 11.00am walk-in clinic, and booked appointments.

• Friday: 9.00am to 11.00am walk-in clinic, and 2.00pm to 3.30pm walk-in clinic.

Substance Misuse Clinic:

• Monday to Thursday: 9.00am to 1.00pm booked appointments.

• Friday: 9.00am to 10.00am booked appointments.

• Monday to Friday: 2.00pm to 3.30pm walk-in clinic.

Mental Health Clinic:

• Monday: 9.00am to 1.00pm booked appointments, and 2.00pm to 3.30pm walk-in clinic.

• Tuesday: no clinic.

• Wednesday: 9.00am to 1.00pm booked appointments (dual diagnosis clinic), and 2.00pm to 5.00pm booked appointments (dual diagnosis clinic).

• Thursday: 9.00am to 1.00pm booked appointments, and 2.00pm to 3:30pm walk-in clinic.

• Friday: 9.00am to 10.00am booked appointments, and 10.00am to 11.00am smoking cessation clinic (for mental health patients), and 2.00pm to 5.00pm booked appointments.

When the practice is closed it directs patients to the OOH provider for NHS Tower Hamlets CCG.

Spitalfields Medical Centre – Health E1 is registered as part of East London NHS Foundation Trust with the Care Quality Commission to provide the regulated activities of treatment of disease, disorder or injury; and diagnostic and screening procedures.

Spitalfields Medical Centre – Health E1 has not been previously inspected by CQC.

Updated 23 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Spitalfields Medical Centre – Health E1 on 16 June 2016. Overall the practice is rated as good.

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

• The practice asked all new patients about their caring responsibilities, but no patients with caring responsibilities had been recorded.

• The practice had carried out one complete two-cycle audit in the last two years. It also monitored 29 key performance indicators every month.

• The practice used innovative and proactive methods to improve patient outcomes. For example the practice ran dual-diagnosis clinics to enable mental and physical health issues to be addressed within the same consultation.

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

• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with 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. Improvements were made to the quality of care as a result of complaints and concerns.

• Patients said they found it easy to make an appointment with a named GP or nurse practitioner and there was continuity of care, with urgent and routine appointments available the same day.

• 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:

• To review how patients with caring responsibilities are identified and recorded on the patient record system to ensure information, advice and support is made available to all.

• To introduce safeguarding training and updates for all staff at the appropriate level.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Updated 23 November 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.

• 87% of patients with diabetes, on the register, had a last blood pressure reading (measured in the preceding 12 months) of 150/90 mmHg or less, compared to a local average of 91% and a national average of 87%.

• 82% of patients with diabetes, on the register, had had an influenza immunisation in the preceding 1 August to 31 March (local average 81% national average 78%).

• 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.

Updated 23 November 2016

The practice is rated as good for the care of families.

• Children and young people were referred to other local GP services.

• The practice’s uptake for the cervical screening programme was 82%, which was comparable to the CCG average of 73% and the national average of 82%.

• We saw positive examples of joint working with midwives and health visitors.

Updated 23 November 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.

• It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

• The practice carried out NHS health checks for patients aged 40–74.

• When families had suffered bereavement, if there were contact details, the practice would send a letter expressing their condolences, and advising them how to access support services.

Updated 23 November 2016

The practice is rated as good for the care of working age people:

• 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 was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

• The practice provided a room for weekly clinics run by a social justice charity that advised patients about education, housing and legal advice.

Updated 23 November 2016

The practice is rated as good for the care of people experiencing poor mental health:

• 90% of patients with schizophrenia, bipolar affective disorder and other psychoses had a record of their alcohol consumption in the preceding 12 months compared to a local average of 86% and a national average of 80%.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice carried out advance care planning for patients with dementia.

• 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.

• The practice provided treatment and support for patients experiencing poor mental health. This included nurse led clinics and access to specialist consultant psychiatrist run clinics held at the practice.

Updated 23 November 2016

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

• The practice provided specialist care to adult homeless people.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.

• 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.

• The practice informed vulnerable 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 worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. The practice ran nurse led dual diagnosis clinics enabling patients with mental health and substance misuse problems to be seen for all of their issues at the same time.