St Andrews Health Centre

Updated 26 January 2017

St Andrews Health Centre is located at 2 Hannaford Walk, London, E3 3FF in a two-storey purpose built modern medical centre with access to 11 consulting rooms on the ground floor and five consulting rooms on the first floor. The first floor is accessible by lift. There is an independently-operated pharmacy within the building. The practice moved to the premises in 2012. The property is managed and maintained by NHS Property Services.

The practice provides NHS primary care services to approximately 10,600 registered patients and a GP-led walk-in centre (WIC) for non-registered patients with approximately 30,000 attendances per annum. The practice holds a combined Alternative Provider Medical Services (APMS) contract for its registered and WIC patients (a locally negotiated contract open to both NHS practices and voluntary sector or private providers e.g. many walk-in centres). We inspected both the service provided to registered patients and walk-in patients in the WIC.

The practice is part of Tower Hamlets Clinical Commissioning Group (CCG) which consists of 36 GP practices split into eight networks. St Andrews Health Centre is part of network six (Mile End East and Bromley by Bow Health Network) which includes four neighbouring practices.

St Andrews Health Centre is part of Bromley by Bow Health Partnership (BBBHP) which runs two other practices in Tower Hamlets serving around 27,000 patients in total.

The practice population is in the first most deprived decile in England. People living in more deprived areas tend to have greater need for health services. The borough has the lowest male life expectancy rate of any London borough (77.5 years) and almost half (49%) of children are living in poverty, the highest rate in London. The practice catchment area has a large Bangladeshi population and a proportion speak English as a second language. The practice has a much larger than average proportion of young adults on its patient list, particularly in the age ranges 20-24, 25-29 and 30-34.

The practice is registered as an individual 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; family planning and surgical procedures.

The practice staff comprises of two male and two female GP partners and three female and two male salaried GPs. They were supported by two advanced nurse practitioners, four practice nurses, two healthcare assistants and a phlebotomist. The non-clinical team comprised of a practice manager, an assistant practice manager, a surgery co-ordinator, an administrator, a secretary and 13 patient assistants (receptionists).

The practice is a training and teaching practice and at the time of our inspection had two GP registrars at the practice. The practice also participates in 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 was open between 8am and 8pm Monday to Friday for its registered patients and from 8am to 8pm Monday to Sunday, 365 days of the year for walk-in patients.

St Andrews Health Centre serves as one of four hubs in Tower Hamlets set up 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) to provide extended primary care access. Patients could access bookable appointments at the hub located at the practice on Saturday and Sunday from 8am to 8pm. We did not inspect this service.

When the surgery is closed, out-of-hours services are accessed through the local out of hours service or NHS 111.

Updated 26 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at St Andrews Health Centre on 14 September 2016. The practice provides NHS primary care services to registered patients and a GP-led walk-in centre (WIC) for non-registered patients. Overall the practice is rated as outstanding.

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

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.
• The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice.
• There was evidence of quality improvement including clinical audit. We saw that the practice had put in place a comprehensive audit programme which was driven by the needs of the practice population in order to improve patient outcomes.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Registered and non-registered patients said they could get an appointment with urgent appointments available the same day. The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group.
• The practice had modern facilities and was well equipped to treat patients and meet their needs.
• The practice actively reviewed complaints and how they are managed and responded to, and made improvements as a result.
• The practice had strong and visible clinical and managerial leadership and governance arrangements. The provider was aware of and complied with the requirements of the duty of candour.
• Leaders had an inspiring shared purpose and a clear vision which had quality and safety as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff. Staff felt supported by management.
• There was a strong focus on continuous learning and improvement at all levels. The practice took pride in its role as a teaching and training practice and we saw that a learning and reflection culture was embedded in the organisation.

We saw several areas of outstanding practice:

• The practice had empowered its patients to help them self-manage their health in partnership with the practice through a free tele-health ‘app’. Approximately 100 patients with high blood pressure (one sixth of the hypertension register) were home-monitoring their blood pressure and using the technology to submit readings to their doctor. The practice shared several case studies and positive patient outcome data from a pilot study which was presented at the Royal College of General Practitioners Annual Conference in 2016.
• The practice embraced social prescribing recognising that many patients attending the surgery had non-medical conditions and linked patients with sources of support in the community. Over 200 patients had been referred of which approximately 84% had engaged with a service, such as, the Young Carers Project, English language classes, craft groups, walking clubs, bereavement support group. We saw several case studies of very positive outcomes and improved wellbeing for patients.
• The practice had developed and piloted, as part of the Bromley by Bow Health Partnership, the educational programme ‘DIY Health’ for parents to improve their skills, knowledge and confidence in managing minor health concerns in children under the age of five. The 12-week programme covered topics such as fever, feeding, gastroenteritis, cold and flu and ear pain. One of the practice GPs had run an event for parents of children with eczema and created an illustrative book ‘Sharing Stories with Itchysaurus’. Children had an opportunity to bathe a toy dinosaur in emollients, practice applying bandages and created posters which the practice had displayed in the surgery.
• The practice, as part of its Well Community initiative had started the social group ‘Chatter Natter’ which offered support for older and potentially isolated people to meet and have some refreshments and friendly conversation.

The areas where the provider should make improvement are:

• Consider implementing a system to advise patients when consultations were running late.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Updated 26 January 2017

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

• All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. Longer appointments and home visits were provided.
• The practice had developed a ‘micro-team’ approach to the co-ordination and continuity of care for this cohort of patients which enabled patients with co-morbidities to be seen once and avoid multiple appointments. The practice liaised with relevant health and care professionals to deliver a multidisciplinary package of care. Patients at risk of hospital admission were identified as a priority. Data for emergency admissions showed the practice was lower than the CCG and national averages per 1,000 population (practice 10%; CCG 12%; national 15%).
• The practice had empowered its patients to help them self-manage their health in partnership with the practice through a free tele-health ‘app’. Approximately 100 patients with high blood pressure (one sixth of the hypertension register) were home-monitoring their blood pressure and using the technology to submit readings to their doctor. The practice shared positive patient outcome data from a pilot study which was presented at the Royal College of General Practitioners Annual Conference in 2016.
• The practice ran a coffee morning for patients with hypertension. The event was open to registered and non-registered patients and offered advice on monitoring blood pressure at home, how to improve blood pressure, blood pressure checks and an opportunity to chat to others who had hypertension.
• 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 71% compared to the national average of 78% (practice exception reporting 6%; CCG 7%; national 12%) and the percentage of patients with diabetes, on the register, who have had the influenza immunisation was 97% compared to the national average of 94% (practice exception reporting 14%; CCG 14%; national 18%).
• The practice ran an insulin initiation clinic for patients with type two diabetes and held joint clinics with secondary care clinicians to manage complex diabetes patients.
• The practice ran an in-house anticoagulation clinic to monitor and manage patients on medication that prevented blood clots.

Updated 26 January 2017

The practice is rated as outstanding 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 practice had systems in place to follow-up on persistent non-responders for childhood immunisations and those not attending child health appointments including secondary care appointments. Childhood immunisation rates were comparable with national averages.
• The practice had developed a ‘micro-team’ for the co-ordination of new births which enabled the six to eight week baby check, health visitor review, post-natal check and the first schedule of childhood immunisations to be arranged on one day to avoid multiple visits to the surgery.
• We saw positive examples of joint working with midwives, health visitors and school nurses. The practice referred to the Tower Hamlets Gateway Perinatal Midwifery Team supporting vulnerable women during pregnancy.
• The practice’s uptake for the cervical screening programme was 80%, which was comparable to the CCG average of 79% and the national average of 82%.
• The practice provided an in-house intra-uterine device and sub-dermal contraceptive implant service.
• The practice had been awarded the ‘You’re Welcome Award’ (a scheme designed to act as a quality mark for providing safe, confidential and appropriate services to young people).
• The practice ran ‘DIY Health’ a 12-week participatory learning model aimed to empower parents to manage minor ailments in children up to the age of five. Topics included fever, feeding, gastroenteritis, cold and flu, ear pain and skin conditions.
• The practice had hosted several health awareness and promotion sessions which included a children’s day and a women’s day.

Updated 26 January 2017

The practice is rated as outstanding 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 utilised a ‘micro-team’ approach to co-ordinate the care of its housebound, frail and elderly patients which included proactive home visits to avoid crisis and regular review of hospital admission and accident and emergency attendance data. Patients were called within three days of discharge to follow-up and a home visit arranged if required. We saw evidence that patients within this cohort were discussed at clinical meetings and multi-disciplinary meetings with the community team.
• There was a system in place to ensure patients on the end of life register were visited every two weeks by their named GP and family and carers were given access to a by-pass phone number to ensure immediate access to the team.
• The practice ran a weekly in-house social group ‘Chatter Natter’ for older and potentially isolated people to meet and have some refreshments and friendly conversation.
• The practice supported ‘The Loneliness Project’ which is a community research programme to find out how loneliness affects older people in Tower Hamlets.

Updated 26 January 2017

The practice is rated as outstanding 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 was open between 8am and 8pm Monday to Friday for its registered patients and from 8am to 8pm Monday to Sunday, 365 days of the year for walk-in patients.
• 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. Patients also had access to e-consultation through the practice website and patients with high blood pressure the free tele-health technology that allowed patients to home-monitor their health, submit readings through an ‘app’ and communicate with the practice’s clinical team. We saw positive feedback regarding the convenience of the ‘app’ for those who work and found it difficult to regularly attend the practice for appointments.

Updated 26 January 2017

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

• Performance for mental health related indicators was comparable to the national average. For example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 86% compared to the national average of 88% (practice exception reporting 7%; CCG 7%; national 13%).
• 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% compared to the national average of 84% (practice exception reporting zero per cent; CCG 6%; national 8%).
• 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 signposted patients experiencing poor mental health to support groups and voluntary organisations through its social prescribing referral programme.
• 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 collaborated within its network and organised a mental health awareness day in conjunction with MIND charity. The event had over 60 attendees.

Updated 26 January 2017

The practice is rated as outstanding 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 and had alerts on the clinical system for patients with autism, hearing and sight impairment.
• The practice had developed its cultural competence to address the needs of its diverse patient population. For example, ensuring timely completion of documentation following a patient death to facilitate some religious burial timeframes, medicines and blood test advice during periods of fasting and health and immunisation advice for pilgrimage.
• The practice offered longer appointments for patients within this cohort who required them which included those with a learning disability and those requiring an interpreter.
• The practice regularly worked with other health care professionals in the case management of vulnerable patients and signposted vulnerable patients through its social prescribing referral system to 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.
• Clinical and non-clinical staff members had undertaken 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. The practice hosted in-house domestic violence clinics.
• The practice participated in research that helped identify patients with unknown chronic active hepatitis. The practice was awarded star GP practice of the month in May 2016 by the “HepFree” team for high rates of testing and identification.
• The practice provided a substance misuse clinic for its patients.