Ruston Street Clinic

Updated 4 August 2016

Ruston Street Clinic is located in Bow in east London. It is one of the 36 member GP practices in NHS Tower Hamlets CCG. It is also one of the five practices forming the Bow Health Network (BHN) Community Interest Company. The aim of the BHN is to work together with partner constituents and local stakeholders to engage and provide high quality, holistic and integrated care to the patients whilst maintaining individual practice autonomy.

The local community is ethnically diverse with just over half the population comprising of Black, Asian and minority ethnic groups. The largest of these is the Bangladeshi community (32%). The practice is located in the second most deprived decile of areas in England. At 75 years, male life expectancy is less than the England average of 79 years. At 81 years, female life expectancy is less than the England average of 83 years.

The practice has approximately 2,900 registered patients. Services are provided by the Ruston Street Clinic partnership under a General Medical Services (GMS) contract with NHS England. The partnership is made up of three GPs. The provider is in the process of adding the third partner to its CQC registration.

The practice is in purpose built health care premises owned by NHS Property Services. All patient areas are accessible to wheelchair users and there is a disabled toilet. The practice has three consulting rooms and shares two further rooms with district nursing, audiology, podiatry, midwifery, psychology and health visiting healthcare professionals. This gives the practice’s patients more ready access to these services.

The practice is close to public transport. There is no car parking.

The two male and one female GP partners work 15 sessions per week between them, making up 1.7 whole time equivalent (WTE) GPs. There is part time nurse practitioner (4 sessions, 0.4 WTE) and a part time healthcare assistant (three sessions, 0.3 WTE). There is a team of reception, administrative and secretarial staff led by a senior receptionist and practice manager.

The practice is an accredited GP training practice and one the GP partners is an approved trainer. There were no GP in training doctors attached to the practice at the time of our visit.

The practice’s opening times are:

• 8.30am to 1.00pm and 2.00pm to 6.30pm every weekday except Thursday.

• 8.30am to 1.00pm on Thursday.

Outside these times patients are directed to an out of hours GP service.

GP consultation times are:

• 9.00am to 12.00pm and 4.30pm to 6.00pm every week day except Thursday.

• 9.00am to 12.00pm on Thursday

• Appointments are also available until 8.00pm each week day and between 8.00am and 8.00pm on Saturday and Sunday under GP hub arrangements in Tower Hamlets.

Ruston Street Clinic is registered with the Care Quality Commission to carry on the following regulated activities at Ruston Street, Bow, London E3 2LR: Diagnostic and screening procedures; Family planning, Maternity and midwifery services, Surgical procedures and Treatment of disease, disorder or injury.

Updated 4 August 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Ruston Street Clinic on 16 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, recording and learning from significant events.

• Risks to patients were assessed and well managed.
• 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. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they were able to 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. There was no written policy and procedure in place to ensure notifiable safety incidents were always handled in accordance with the duty of candour, however.

The areas where the provider should make improvement are:

• Put in place a written policy and procedure to ensure notifiable safety incidents are always handled in accordance with the duty of candour.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 4 August 2016

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

• The nurse practitioner had a lead role in areas of chronic disease management including asthma and chronic obstructive pulmonary disease (COPD).

• Patients at risk of hospital admission were identified and given priority access to see the GP.

• The practice’s performance for diabetes indicators was comparable to national averages.

• Longer appointments and home visits were available when needed.

• Patients with long-term conditions 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, including a diabetes hospital consultant, to deliver a multidisciplinary package of care.

Updated 4 August 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 in families affected by domestic violence. Immunisation rates were similar to or above the CCG average for most standard childhood immunisations and the practice worked hard to continue to improve performance in this area.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we heard evidence to confirm this.

• The percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years was 82% which was the same as the national average.

• 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.

Updated 4 August 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. Every person aged over 75 years had a named accountable GP.

• It was responsive to the needs of older people, and offered home visits and same day access and telephone consultations to those who needed them. The practice also carried out proactive home visits to older people that had not been seen by the GP or nurse practitioner in a while.

• The practice provided enhanced services to meet the needs of patients with dementia and those at higher risk of avoidable unplanned admission to hospital.

• It worked with other services to ensure patients with complex needs were cared for appropriately, for example a Care of the Elderly hospital consultant, social services and befriending services.

Updated 4 August 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 was proactive in offering online services, including GP consultations, as well as a full range of health promotion and screening that reflects the needs of this age group.

Updated 4 August 2016

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

• 92% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average of 84%.

• 84% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in the record, in the preceding 12 months, which is comparable to the national average of 88%.

• 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 told patients experiencing poor mental health about how to access various support groups and voluntary organisations. In house psychology appointments were offered once a week.

• 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. For example they helped book appointments with other services and transport where appropriate.

Updated 4 August 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 priority access to disabled patients.

• The practice informed vulnerable patients about how to access specialist and support services, for example the specialist GP service for homeless people in Tower Hamlets.

• 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.