ANNUAL REPORT 2018

Caring for our community since 1948

TABLE OF CONTENTS

MISSION AND VISION STATEMENT...... 3

WORKING AT JUBILEE STREET PRACTICE...... 4

HISTORY AND DEVELOPMENT OF THE JUBILEE STREET PRACTICE...... 5

THE PEOPLE AT THE JUBILEE STREET PRACTICE...... 7

JUBILEE STREET PRACTICE PROFILE...... 10

PATIENT SERVICES OFFERED AT THE JUBILEE STREET PRACTICE...... 13

TRANSFORMATION PARTNER REPORT...... 14

PATIENT ASSISTANTS REPORT...... 16

CLINICAL COMMISSIONING GROUP (CCG)...... 17

GENERAL PRACTICE CARE GROUP (GPCG)...... 18

INNOVATIONS AT THE JUBILEE STREET PRACTICE...... 19

GP PATIENT SURVEY 2018...... 20

ANONYMOUS PATIENT COMMENTS...... 21

INCREASE IN SIZE OF CATCHMENT AREA...... 22

QUALITY IMPROVEMENT (QI)...... 23

ALTOGETHER BETTER...... 24

IMPROVING ACCESS USING INNOVATIVE APPROACHES...... 25

PRESCRIBING...... 26

NON-CLINICAL ACTIVITIES...... 27

GP TRAINEE/REGISTRAR REPORT/FEEDBACK...... 30

PATIENT PARTICIPATION GROUP...... 31

ACKNOWLEDGMENTS...... 33 Mission AND VISION STATEMENT

OUR VISION A healthy and well-cared for population by a healthy and fulfilled workforce.

OUR PURPOSE We are an ambitious, passionate, and driven organization which champions equality and the values of the NHS. We look after our community and each other, providing the highest quality comprehensive healthcare. Our Commitment to the local community can trace its history to 1906, when one of the founding GPs came to work in the East End. The current doctors are drawn from different generations, representing a broad spectrum of experience and knowledge. Many partners have been active in the development of general practice, with roles in politics, teaching and research over the years.

Our surgery is open:

Monday: 8:30am - 7:00pm

Tuesday: 8:30am - 7:00pm

Wednesday: 8:30am - 7:00pm

Thursday: 8:30am - 7:00pm

Friday: 8:30am - 12:30pm, 1:30pm - 7:00pm (closed for one hour practice-wide meeting)

Phone: 0207 780 8000

Email: [email protected]

3 WORKING AT JUBILEE STREET PRACTICE

We believe it is important for all partners, and all other staff, to understand and appreciate the values which underpin our work, as they form the basis of our identity as a practice.

Commitment to General Practice as Free at the Point of Need: We are committed to providing high quality services with access for patients on an equal basis regardless of race, gender or economic circumstance.

Commitment to Continuity of Care and ‘Relationship-based’ Medicine: We practice with a personal list system, but include flexibility to allow for patient preference.

Commitment to the Local Community: The practice can trace its history to 1906 when one of the founding GP’s came to work in the East End of London. The current doctors are drawn from different generations, representing a broad spectrum of experience and knowledge. Many partners have been active in the development of general practice, with roles in politics, teaching and research over the years.

Commitment to Excellent Care in an Area of Economic and Social Challenge: We place a high priority on continuing professional development, and practice based education, for which we provide protected time.

Commitment to Undergraduate and Postgraduate Teaching: This keeps us in touch with the new generation of doctors and helps maintain our own skills and knowledge. We find it rewarding to inspire doctors in training with a vision of what being a “good” doctor is all about and encourage enthusiasm for good inner city general practice. We have trained GP’s since 1980, many of whom have stayed to work in East London.

Commitment to Research: The practice has built up a strong research base, through links with QMUL, and a portfolio of studies in which we are involved. This keeps us interested in asking questions and challenging our practice. Not all partners will be directly involved in teaching or research, but we need a collective commitment to the practice’s emphasis on these activities as a way of achieving our goals and maintaining our ethos as a practice.

Commitment to Each Other: Having doctors at varied stages of their careers, we recognize the differing needs at different phases of professional lives. We work hard to support each other and to be accommodating as far as possible, without compromising the needs of the practice.

Commitment to Our Staff: We have an excellent, highly committed staff team, and it is a high priority to promote staff development and recognize their expertise. We have a high staff complement for our list size, which reflects our commitment to quality care.

4 HISTORY AND DEVELOPMENT OF THE JUBILEE STREET PRACTICE

There are four threads that make up the Jubilee Street Practice, which occupied Steels Lane Health Centre from 1982 – 1998, and moved to its current site at 368 – 374, Commercial Road in 1999, when the building was opened by Professor Wendy Savage. HARFORD STREET SITE Dr. Harry Roberts laid the first strand of the partnership in 1906. He started medical practice in West Cornwall. His daughter writes: “Medical Practice in Stepney in 1906 was at an extremely inefficient level; with few exceptions it was staffed by seriously underpaid doctors who had been unsuccessful in obtaining more lucrative posts elsewhere. Dr. Roberts was deeply involved with a passionate desire for justice to the underdog, and said he felt he could at least be of some help as a doctor in the slums of East London if he could find a practice there. So in 1906, to Stepney he went. Those of us who remember Stepney in the early nineties will recall the incredible poverty and hardship that most people had to face; especially women. For the first year as a doctor in Stepney, my father never left the practice for a single hour. Medical fees were sixpence, to include medicine, and one shilling if you were visited on the round. It is on record that in the first year he attended over 500 confinements and never lost one mother. By the time the Health Insurance Act came into force in 1911, his practice was by far the largest and best run in East London. It had four doctors, one a woman, two qualified nurse midwives, a dentist and a masseur.” After Dr. Roberts’ death in 1946 the practice continued to be run by Dr. Lottie Weihermann and Huxley Fernando, and then by Dr. Harold Claff, who practiced from 66 Jubilee Street until he joined the Jubilee St Practice until his retirement in 1996. CABLE STREET SITE Another outstanding doctor who started in practice in Cable Street in 1927 was Hannah Billig. She was awarded the George Medal for exceptional bravery during the Blitz on London in 1941, and later in 1945 was made an MBE whilst serving in the Indian Medical Service. An exhibition of her life and work was shown at the Ragged School Museum Stepney, in 1996. Her successor was Doctor Katarina (Katherine) Schopflin, medically trained in Budapest (the capital of Hungary) and Scotland, whose pioneering work in women’s medicine brought her an OBE shortly before her retirement in 1980. Dr. Schopflin opened Steels Lane Health Centre in January 1982. ARBOUR SQUARE SITE Dr. Louis Jaffe came to the London Jewish Hospital and took over a small practice in Stepney Way after the First World War, and later moved to Arbour Square to make it a large thriving practice. Despite considerable physical disability as a result of childhood polio, Dr. Jaffe continued in practice until his eighties and a Medical Research Fund was established in his memory. Dr. Brian Harris joined him in 1963. METHODIST MISSION BROMLEY STREET SITE During the years of the depression, the Methodist Church ran a Medical Mission for the wives and children of workers who were covered by the ‘stamp’, the forerunner of the National Health Service. The Mission Practice was housed first at the Castle, an ex-pub on the site of the present east London stadium and then in Bromley Street, employing a number of young women doctors. In 1948 this service was taken over by the NHS and Dr. McGill, who had worked many years in Sierra Leone as a missionary, was both the last of the mission doctors and the first to run it as an NHS practice. She retired in 1958 and the practice was taken over by Erica Jones. In the early 1970’s Dr. Schopflin and Dr. Jones revitalized the domiciliary obstetric service in Stepney.

5 ESTABLISHMENT OF THE JUBILEE STREET PRACTICE These four strands came together to form the Jubilee Street practice in 1978. The practice started its work from port-a-cabins in Musbury Street from 1978-81. The partnership expanded with the appointment of Mary Edmondson (trained by Dr. Schopflin), Mike Young (one of the first doctors to go through the VTS at the London Hospital, trained by Brian Harris) and Sally Hull (who joined the partnership in 1980, from the vocational training scheme at St Thomas hospital, with a particular interest in developing undergraduate teaching for general practice.)

In 1982 the practice moved into the renovated Steel’s Lane Health Centre on Commercial road. This building was originally bought in 1889 to form the East End Mothers’ Home – with 13 beds – a development of the Glamis Road Mothers’ Lying-in Home for the treatment of poor married women during childbirth. The Regional Health Authority in the late 1970s was keen to develop health centres, and bought and renovated the building to house general practice and community services on a joint site.

When Erica Jones retired from General Practice in January 1992, a notable chapter in the life of the Jubilee Street Practice came to a close. Erica brought to the practice not only her lively and distinctive personality but also a great wealth and breadth of personal and medical experience which benefited the practice and the many young GP’s she nurtured in her capacity as trainer. Since the 1990s there has been a greater turnover of principals in the partnership. In 1992 Naomi Beer and Rebecca Viney joined, both had been on the London Hospital VTS and trained at Jubilee Street Practice. Rebecca Viney left in 1994 to be replaced by Jane Edge, who moved to Bristol in 1999 to be replaced by Nicola Hagdrup. In 1997, Dr. Nicola Cowap, who had also been on the London Hospital VTS joined the practice, she has since relocated to Watford.

Brian Harris retired in 2002 after a tremendous career spanning 35 years work in east London General Practice. He played an important role in developing and steering the vocational training scheme in its formative years, and was medical director of the centre for primary care from 1985 to 1995. This was developed following the 1981 Acheson report into inner city practice on which Brian was a working member. Salma Ahmed joined in 2002, taking over Brian Harris’ list. Previously a registrar in the practice (trained by Sally Hull), she has interests in training and research. Robin Cartwright, from Cambridge and then Nick Silberstein from Australia were each with the practice from 2002-7. Since then we have recruited Jens Ruhbach who has a special interest in dermatology, and Emma Ovink who leads on prescribing for the practice who also trained at the practice.

In 2010 Mary Edmondson retired after a career of over 31 years. Alongside the important contribution she made to continuing and truly personal care of her list over these years, and her championship of women’s medicine, she also developed the role of undergraduate teaching in the practice, and became vice chair of Tower Hamlets LMC (local medical committee).

By 2011 the partnership had six clinical partners and for the first time in its history recruited a non-clinical partner. Virginia Patania has been the practice manager since 2007, and has brought a new and welcome range of management skills into the partnership. Virginia is now called the “transformation partner” rather than the older term practice manager.

In 2016, Dr. Naomi Beer retired after 28 years at the practice (25 as a partner). Her patients and the practice were heartbroken to lose her, but her influence on the practice lives on. Alongside taking excellent care of her patients and colleagues and representing the practice at the LMC, she was voted one of the 50 most influential GPs in the country, following her blisteringly successful campaign to Save Our Surgery.

6 THE PARTNERS THE PEOPLE AT THEJUBILEESTREET PRACTICE -GP trainer Student Teacher -Undergraduate Medical -Minor Surgery Lead Qualified: 1995 MD DCHDRCOG Dr. JensRuhbach Partner Practice Manager/Transformation Virginia Patania -GP Trainer -PGEA Leadfor thePractice Student Teacher -Undergraduate Medical Qualified: 1987 MBBS MRCGP MPH Dr Nicola Hagdrup -Researcher Student Teacher -Undergraduate Medical -GP Trainer Qualified: 1991 MBBS MScDCHMRCGP Dr SalmaAhmed Student Teacher -Undergraduate Medical Qualified: 2003 MBBS MRCGP DCHDFSRH Dr EmmaOvink 7 Dr. Ali Klaber MBChB MRCP MRCGP

Dr. Sian Jones MBBCh DFSRH

Dr Tom Margham MBChB, MRCGP, MSc

Dr. Natalie Symes MRCGP BC MBBS DRCOG

Dr. Zahra Husain DHMSA BSc MBBS MCEM MRCGP I T ONERS I ED G ENERAL PRACT T H E SALAR 8 OTHER STAFF MEMBERS

REGISTRARS PHLEBOTOMISTS PRACTICE COORDINATOR Melvyn Adjei Nicola (Nikki) Cyprien Lyn Owens Laura Lee-Rodgers Fahmida Khanum Elizabeth (Lizzie) Morris Ayesha Khatun

PHYSICIAN ASSOCIATE PSYCHOLOGIST HEALTH VISITORS Tabana Gohar Michaela Galea Bonavia Jennifer Beech Kehinde Idahosa Josephina Walker

HEALTHCARE ASSISTANTS PRACTICE NURSES COORDINATORS Kamal Uddin Elizabeth (Liz) Hands Rukshana Muquit Maria Rodrigues Rachael Sheehan Nicola Cyprien Subarana Barua Ruthlyn (Ruth) George-Mason Yasmin Rahman Albab Chowdhury Lauryn Murdoch

PATIENT ASSISTANTS ADMINISTRATORS BENGALI ADVOCATES Rajna Begum Christine Hulbert Kamal Uddin Sultana Begum Majeda Khanum Amina Shimi Valentina Bettozzi Ayesha Khatun Anisuzzaman Syed Danielle Bramble Helen Olajorin (finance) Nipa Khanum Asma Begum (HR) Fahmida Khanum Marjia Sultana Imane Saidani Rahima Begum Faridah Jannat Tahmid Hussain

9 JUBILEE STREET PRACTICE (JSP) PROFILE

The JSP serves Tower Hamlets. Named after the Tower of London, it is a borough that currently has a population of about 317,200 and that could increase to 370,700 in the next decade. The borough has experienced rapid population growth over the last few decades, and it is one of the areas with highest population densities in London.

The population is quite young, with a median age of 30.6 years. 41% of people in Tower Hamlets are aged 20-34, compared to just 20% across England. Future population change is uncertain due to the impact of Brexit and other migration changes.

Very ethnically diverse, Tower Hamlets has a large immigrant population. According to the NHS clinical commissioning group (CCG), 69% of residents belong to minority ethnic groups, such as black African or Indian. More than 40% of the practice list is from Bangladesh (also known as East Bengal); the Bangladeshi community accounts for about 32% of the borough population. Religion, especially Islam, continues to play a prominent role in the lives of many local people, with 66% having a religious belief.

Although Tower Hamlets contains Canary Wharf, the financial district of London, it is still one of the most deprived communities in England, with about 95% of the population classified as “Most Deprived” using the Townsend score. Also, Tower Hamlets has the highest percentage (25.3%) of income deprivation of the London Boroughs. Substantial health inequalities exist within the borough. Life expectancy is 8.8 years lower for men and 3.9 years lower for women in the most deprived areas of Tower Hamlets than in the least deprived areas.

A significantly higher percentage of people in Tower Hamlets live in social housing (54%) compared to the rest of London (37%) and, despite the substantial housing growth, high levels of overcrowding persist. The borough also has less green space than the national average, with 1.1 hectares per 1000 people compared to 2.4 nationally. Unemployment remains an issue and 10.3% of the working age population is jobless, compared to 7% across London. Just over 3% of the borough’s population provide more than 20 hours of unpaid care per week and, of that group, more than half provide more than 50 hours (taken from the CCG report).

34% of children are living in poverty, although after adjusting for housing costs the figures rise to 49%. Premature death rates from circulatory disease, cancer and respiratory disease are very high compared to other parts of the country.

10 11 12 PATIENT SERVICES OFFERED AT THE JUBILEE STREET PRACTICE

DAILY SERVICES

Advice on sexual health Advice

Chronic disease Women’s health

Healthy lifestyle advice Travel advice and immunizations

Pre-conceptual Psychology advice

Repeat prescription Blood pressure monitoring

Childhood immunizations Management

Phlebotomy Family planning

NETWORK DIRECT ENHANCED SERVICES

Extended hours Learning disability health check

Minor surgery Childhood immunizations and vaccinations

NETWORK IMPROVED SERVICES Latent TB NDPP- NHS diabetes prevention program

Integrated clinical and commissioning quality Nursing home care (ICCQ) NIS Alcohol screening Drugs misuse

Sexual health Prescribing

Childhood immunization Anticoagulation ICCQ NIS- clinical delivery: CVD, CKD Phlebotomy diabetes, COPD, mental health Smoking cessation Surgical aftercare

13 THE TRANSFORMATION PARTNER’S REPORT

The most obvious difference between the previous reports I wrote for Jubilee Street Practice and this one is my title change. No longer a practice that supports the role of Practice Manager (in many ways outdated, I would suggest), this report is signed by yours truly, the Transformation Partner. This reflects our practical efforts to move away from management, and toward a world of empowered, self-managing staff, allowing more vision and time to focus on real transformation. Mine is not the only title that reflects this. Our receptionists are now Patient Assistants, reflecting their true value as enablers to our citizens. Our assistant practice manager is now a coordination manager (because, in Lyn’s own words, how can you have an assistant practice manager but no practice manager??), and our jack of all trades Kamal Uddin has given himself my favorite of all titles, transformation coordinator. No one needs to remember all these quirky, brow-furrowing titles – they are good for us, define what we feel we are each doing, and that should be what a title does. To the outside, we hope we look like a closely knit team that all sits on the same boat, each holding his/her own very separate but race-determining oar. What we are called changes because we change – as people and as a practice. And this is what the past years have been all about: change. (Note to self – change all name badges with outdated titles!!) The major transformations we have been working through are around four areas: our Quality Improvement (QI) work, the development of the Patient Triage Centre (PTC), our co-production work with citizens and Altogether Better, and our work to develop a holacratic leadership model, which we call Circles. And if these four were pillars for change, they would all be underpinned by a common foundation which is (prepare to gag) JOY. We are unabashedly, openly celebrating and seeking joy in all the ways that our working together allows.

Quality Improvement (QI) is our most seasoned innovation. We started our QI efforts about four years ago, and welcomed our coach, Obi James, in April of last year. Obi has led the practice from strength to strength in terms of both consolidating successful changes, and spreading the QI love across our staff members. On this note, two of these are now training as coaches, while we prepare to welcome new coach in training Dr. Isabel Hodkinson, who will be sharpening her teeth on improving our prescribing hygiene.

The Patient Triage Centre (a better version of “rooming”, for anyone familiar with transatlantic healthcare delivery models), is what puts the jazz in my dancing shoes. This involves all of our staff, clinical and non-clinical, sitting together in the same room and managing patient need and demand together, sharing conversations and learning, maximizing opportunities for best use of skill mix. It means that GPs are supported in real time with their work, in hopes that as much work as possible is delegated to other staff. And the more clinical time we free up, the more patients we can help. A by-product of this, of course, is learning by observing how others work, and an increased sense of camaraderie and belonging, aka joy.

14 But, speaking of managing demand and need, we are working creatively with our best allies, local citizens, to think of ways to do this outside the box. The language matters a lot, here. Working in the liminal space between work and life, we are engaging as equals with citizens registered with the practice, removing them of their passive role as “patients”, and inviting them to join us as authors of innovation and change, where we share responsibility for the future and sustainability of the practice. Exciting days ahead.

These non-hierarchical relationship structures are coming to profoundly define us. And nowhere more so than in Circles, where each member of staff is freed from his/her job description, and is asked to choose a number of services to manage and run within a small team. The talent and engagement we have seen from this exercise is exceptional. It has led to the practice winning two prestigious awards at the 2018 UK Employee Experience ceremony, spectacularly presented by, in true Circle spirit, patient assistants Valentina Bettozzi and Fahmida Khanum. Amongst other things, all this self-empowerment has done me out of a job. And that is ace, because now we all have better jobs, including me.

Even as I write about these experiences, these paragraphs really do not do justice to the seismic revolution that the practice is experiencing. Hard targets are being met and exceeded, as we treat more patients and answer more calls than ever before, whilst at the same time living our values and mission in the truest way, on a daily basis. Watching staff develop, thrive, trust, risk, try in the way they do is absolute testament to the power of investing in individual and collective potential, and in the power of enabling freedom. Our work is stressful, intense, and often grinding. Yet we continue to cherish our time together, value one another’s strengths, and serve our patients – sorry, registered local citizens – as we ourselves would like to be served. Year on year, writing this report feels more and more like a privilege. The greatest difference being that this year the privilege feels shared most widely, which makes it the most humbling, and the most precious yet. Watch this practice – it’s blazing a trail.

Virginia Patania Transformation Partner JSP July 2018

15 THE PATIENT ASSISTANTS REPORT

The Jubilee Street Practice reception has gone through major changes in the last 18 months. Firstly, we have abandoned the term ‘receptionist’ to describe our front staff as we do more than just book patients. We are now called Patient Assistants. This simple change has empowered both patients and staff to confidently signpost and triage patients needing care.

Secondly, we now operate in a multi-disciplinary setting. As a practice, we planned and designed a working room called the Patient Triage Centre (PTC), where, as mentioned before, all incoming calls are answered and triaged in a multi-disciplinary fashion, improving the care our patients receive. Since the PTC room has been active, staff members have reported that they feel more engaged, happier and content in their day-to-day duties. This has had a knock-on effect on the patients as it has vastly improved the quality of care that they receive from each member of the practice team.

Yasmin Rahman & Nicola (Nikki) Cyprien Reception Managers JSP July 2018

16 CLINICAL COMISSIONING GROUP (CCG)

Rossi’s iron law has given me much to think about this year. This states that the expected value of any net impact assessment of any large scale social program is zero. Meaning that, the bigger the scale of any intervention, the less likely it is to yield measurable benefits. Might the message behind Rossi’s law be, just do it? Don’t wait, just get on with it? The jury’s not out. But read on.

The practice continues to offer input into local commissioning as one of us (me!) has been on the Clinical Commissioning Group board since CCGs were set up in 2012. And some things appear to never change. From our last report, please see, copied and pasted, our updates around urgent care developments locally: “We are looking at re-procuring 111 services across the whole of East London, merging the 111 telephone number with our local OOH providers, to be joined within one hub that would include urgent care services, and act as a single point of access within the Royal London.” In the two years since I shared that update, our new 111 provider was only recently confirmed, and details around the rest continue to be worked on.

In the world of general practice, however, things move a bit more speedily. We have “just done it” – where doing it means entering each and every practice with an offer to enable changes meaningful to the practices, with the help of a coach who visits practices regularly. We asked practices what they wanted this programme to be called, and they chose EQUIP: Enabling Quality Improvement in Practice. In a nutshell, EQUIP wants to make Tower Hamlets the best place to work and to receive care in the country, and in that order. We focus on bringing joy back to the workplace, because we know that joyful staff will mean happier and healthier patients. Our ingredients to do this are mainly five: 1) a coach who works with practices regularly, using a standard methodology to achieve, measure and sustain change; 2) shared IT platforms to understand baseline data, and share successful changes with other teams; 3) lots of soft skill development, where we build on relationships to enable change; 4) oodles of training and education (over 300 people in Tower Hamlets have been trained in Quality Improvement or QI – almost 10% of these from Jubilee Street!); 5) learning systems and collaborative for at-scale change and learning opportunities.

EQUIP is a bit of a jewel in the Tower Hamlets crown– we are proud that its seeds sprouted in Jubilee Street many years ago, and hope that its effects will be enjoyed by patients and staff for many years. We are also hopeful that the lesson might be applied widely, and not only by folks selling running shoes – just do it. More just do it, and the better our chances, according to Rossi, of meaningful social impact. Now all that’s left is the teensy issue of scaling….

Virginia Patania Transformation Partner JSP July 2018

17 GENERAL PRACTICE CARE GROUP (GPCG)

The practice has helped the continuing establishment of the GP Care Group through Dr. Nicola Hagdrup’s and now Virginia Patania’s involvement as the main Board directors. Since Dr. Hagdrup’s last updates, the Care Group has: Increased its annual income from contracts from £11m to over £20m • Led the Tower Hamlets Alliance Partnership which holds the contract for community • health services Directly run several community health services including: • — The GP Out of Hours Service, significantly increasing the number of local GPs who do shifts by buying medical indemnity for them — The Single Point of Access — The Health Advocacy and Interpreting Service — The patient experience team Established a borough-wide social prescribing service

• Taken on the employment of all the network management teams • Run the Network Improvement Schemes on behalf of the networks and practices • Been awarded the P-Reset (Primary Care Drug and Alcohol Support Service) contract • Recently been awarded a contract to run school health services, starting in September 2018 • Continued to run the health visiting service • Set up the Primary Care Development Committee in conjunction with the Clinical Commissioning Group (CCG) • Supported struggling practices

• Been a leading member of Tower Hamlets together with representatives on its Board and chairing some of its key committees • Been a member of the Tower Hamlets Health and Wellbeing Board

• Been a founding member of a national organization for GP Federations • Tower Hamlets continues to lead a strong group of providers to be influential in the redesign of primary care, to make sure that local general practice remains sustainable. Jubilee Street is proud to contribute to the Care Group’s success and development, conscious that the keys to its own sustainability lay in a robust system around the practice.

Chris Banks, Chief Executive, Tower Hamlets GPCG CIC Virginia Patania, Transformation Partner JSP July 2018 18 INNOVATIONS AT THE JUBILEE STREET PRACTICE

PATIENT TRIAGE CENTER (PTC) In January 2018 we launched a new room in the practice, and a whole new way of working. Our purpose built “Patient Triage Centre” (PTC) is now where our GPs, most patient assistants, and sometimes our nurses and pharmacist are based.

GPs work from this room while taking calls from patients via Doctor Direct, returning to a clinical room when they have a face to face patient to see. Other than the patient assistants working on the front desk, all other patient assistants are now also based in this room, taking calls from patients as well as doing their other admin work. Our nurses and pharmacist also work from this room when they are taking calls from the Doctor Direct list.

Working in one room enables much better communication between members of the team, with GPs able to get a rapid second opinion from each other, and doctors, nurses, pharmacists and admin staff all able to ask each other questions quickly and easily. An unexpected benefit is that it has also taught us all a huge amount from listening to each other’s’ consultation styles, as well as our clinical advice and management. The room also has tea and coffee facilities which make it even more appealing to work in! The team is able to have huddles throughout the course of the day, using more of a team approach, and this has made us much more efficient in dealing with calls and queries from patients. Our patient assistants now deal with a much greater proportion of the calls we receive, which is made possible by such close working with other members of the multidisciplinary team. And all of this means that we are able to continue to deliver fantastic access despite an ever increasing list size.

Dr. Emma Ovink General Practitioner JSP July 2018

19 GP PATIENT SURVEY 2018

Our results show that we score higher than our local average on every question.

68%, national average: 71%. 85% of patients find it easy to get through to our surgery by phone (clinical commissioning group) CCG average

89%52% findusually the getreceptionists to see or speak at the to surgery their preferred helpful. (CCG GP (CCG average: average: 82%, 50%, national national average: average: 87%). 56%). This is up from 41% last year. 96% were able to get an appointment to see or speak to someone the last time they tried (CCG average: 79%, national average: 84%). This is up from 92% last year. 92% say the last appointment they got was convenient (CCG average: 74%, national average: 81%). This is up 2% from last year. 87% describe their experience of making an appointment as good (CCG average: 67%, national average: 73%). This, again, is an increase of 5% from the previous year, against unchanged national and local outcomes. 71% usually wait 15 minutes or less after their appointment time to be seen (CCG average: 60%, national average: 64%). This is up from 59% the previous year. 65% feel they don`t normally have to wait too long to be seen (CCG average: 47%, national average: 58%). This is up from 57% last year. 91% say the last GP they saw or spoke to was good at treating them with care and concern (CCG average: 79%, National average: 86%) – this is up from 88% the previous year.

Broadly unchanged from last year (97%). 98% had confidence and trust in the last GP they saw or spoke to (CCG average: 93%, national average: 95%). 94% say the last nurse they saw or spoke to was good at giving them enough time (CCG average: 83%, national average: 92%). This is up 8% from last year. 95% say the last nurse they saw or spoke to was good at listening to them (CCG average: 83%, national average: 91%). This is an increase from 84% last year (when we scored below national average), and again testament to the hard work that takes place in our nurse team. 94% say the last nurse they saw or spoke to was good at explaining tests and treatments (CCG average: 82%, national average: 90%). This is a spectacular increase, from 78% last year, when were below national and local average, as opposed to this year, when we score above both. 88% say the last nurse they saw or spoke to was good at involving them in decisions about their care (CCG average: 77%, national average: 85%). Increase of 7% from the year prior. Nurses clearly have much to celebrate this year. 91% say the last nurse they saw or spoke to was good at treating them with care and concern (CCG average: 81%, national average: 91%). This is an 11% increase from last year, when we scored below local and national average.

This is absolutely our top scoring question, and marks a 7% increase compared to last year’s results. 99% had confidence and trust in the last nurse they saw or spoke to (CCG average: 93%, national average: 97%). from last year. 89% are satisfied with the surgery`s opening hours (CCG average: 76%, national average: 76%). This is up 10% 87% describe their overall experience of this surgery as good (CCG average: 78%, national average: 85%). This is broadly in line with last year (88%). 84% would recommend this surgery to someone new to the area (CCG average: 72%, national average: 77%). No previous year’s data to compare this to, but reassuring that the outcome is above local and national average.

20 ANONYMOUS PATIENT COMMENTS

Excellent Service From Staff Who Clearly Enjoy Their Work

I’ve been to Jubilee Street Practice a number of times over the 6 years that I’ve lived in Stepney and each time has been an excellent experience.

The staff are helpful, diligent and seem to be so passionate about their job and working at JSP. I felt the need to write the review following my last two trips. One to get vaccinations from the Nurse and the other for a checkup on my jaw from the doctor. Both made me feel comfortable and at ease, by being very friendly but attentive to the job in hand - Thank you!

Visited in July 2018. Posted on 06 August 2018

Excellent service

I find the GPs here to be friendly, helpful and practical. I was able to telephone this morning to ask to see a doctor; received a callback an hour later, and an appointment for the following hour, which meant I was all sorted in time to be at work for 11:00am. Thanks very much!

Visited in February 2018. Posted on 22 February 2018

MY LOVELY NURSE

I have been visiting my nurse for years and she is incredible - quirky, compassionate and clever! So clever I cannot get an appointment with her as I have been told she is on a nurse practitioner course. Always pleased to be seen by the professional team at Jubilee Street Practice but MY nurse stands out and pushes that extra mile and has bought me back from very low points within my life. Not many surgeries have that within a team but Jubilee Street Practice does. Thank you

Visited in May 2018, posted on 19 May 2018

THE BEST GP IN TOWER HAMLETS!

I have been with this practice since they have opened and after being diagnosed with being chronically ill, every single member of staff has been excellent! The doctors, especially two in particular have been there for me. I felt like I wasn’t treated by doctors but by friends.

The atmosphere in the consultations to the treatment is exceptional! Even if I were to move to Timbuktu I would not change my practice, I will fight to stay. This is the BEST PRACTICE IN TOWER HAMLETS! Thank you all for your support and working so hard to provide the most efficient service anyone could ever provide! Keep up the excellent work! If there’s an award going, you guys deserve it! X

Visited in March 2018, posted on 15 March 2018

21 INCREASE IN SIZE OF CATCHMENT AREA

We have recently reviewed our practice catchment area, and have made the decision to extend this slightly. We have listened to feedback from patients who live just outside our previous catchment area who are keen to register with us, and those who had moved from inside to just outside our catchment area and did not want to have to deregister. We have also discussed the proposed new catchment area with our neighbouring practices.

We have traditionally had a relatively small catchment area for a practice of our size, and so we felt it was reasonable to increase this somewhat. Here is our new updated practice catchment area:

22 QUALITY IMPROVEMENT (QI)

We at Jubilee Street Practice love innovation and improvement; we are always looking at doing things better, faster, safer and in a way that brings joy to our colleagues and our patients. Therefore we have a few different programmes going on at any given time such as Circles, Altogether Better and quality improvement (QI).

QI is a systemic and formal approach to the analysis and improvement efforts within an organization. We have been using the QI model for a few years now, and at this very moment have several successful projects running off the back of it. These include document workflow project, which looks at safely reducing the number of documents that end up with a GP; streamlining results access process, which will better enable patients to access their results Online safely and conveniently; and new patient check process, which radically changed the process for a new patient registering with us by making it super streamlined and at the same time eliminating inappropriate clinician face to face appointments by 100%. These are but a few examples of some of the excellent work that the practice is currently working on.

The QI model is rapidly growing within Tower Hamlets, and as such JSP is currently developing two of its colleagues to not only carry forward this model within JSP but to also coach other practices in Tower Hamlets to benefit its colleagues and patients in the art of Quality Improvement!

Kamal Uddin Transformation Coordinator JSP, July 2018

23 ALTOGETHER BETTER

This summer we have begun an exciting new project working with a company called Altogether Better. It has helped us identify a group of patients who are willing to gift their time to the practice and the community, known as Patient Champions. We hope to usher in an era of truly collaborative working with our patients and our wider community, empowering our champions to set up groups and activities that will improve the wellbeing of all. Watch this space!

Dr. Emma Ovink General Practitioner JSP July 2018

24 IMPROVING ACCESS USING INNOVATIVE APPROACHES

This year we have continued to look at how we can improve access to appropriate health care for those patients who may find it difficult to manage our usual appointment options and have continued with some old schemes as well as introducing some new approaches.

1. Extended access hub appointments – we continue to offer appointments on weekends and some evenings at our extended access hub which is managed by the GP care group and run out of a local practice on Deancross street. These appointments can be accessed for some acute problems via usual calls to the practice.

2. Online consultations – we are increasing our use of Online consultations, which can be accessed via the website www.jubileestreetpractice.nhs.uk and completing an Online form. A response will be received usually within 2-4 hours or the next working day, which might include a prescription sent to your chemist or a form completed or an appointment booked. This is a convenient way to contact the practice and we are encouraging this as a first approach.

3. Email correspondence – we are increasingly encouraging patients to contact the practice via email at [email protected] in order to receive information via email and also to send in photographs or simple skin rashes to save having to attend the practice for an appointment.

4. Online access to patient records – we are encouraging patients to sign up to get access to their own medical records online so that they can see results and also consultations, and in future we hope to enable email conversations with the clinicians in the practice via this route. This is a secure and safe route. Please ask at reception to get a pin code to access your records (you will need to show some photo id or be vouched for by one of the staff for security purposes)

5. Use of Apps – we are encouraging patients to access the practice and book telephone appointments and appointments for long term condition reviews via the my GP app. Please ask at reception about this.

6. Virtual consultation – we are looking into this and hope to be able to offer Skype consultations in the near future to save patients having to travel to the practice.

7. Pod in waiting room – we now have a Pod in the waiting room near reception to enable patients to check their own blood pressure and weight either before an appointment or as part of self- monitoring.

We will continue to look at any new options that become available to improve our care and options.

Dr. Nicola Hagdrup General Practitioner JSP July 2018

25 PRESCRIBING

The issuing of prescriptions is a central function of any GP practice and constitutes a major part of our work at JSP. This year we have continued to strive for excellence in our prescribing practice and have recently overhauled our Repeat Prescribing Policy to ensure its relevance to current guidance, recent system changes and the increasing prominence of electronic repeat dispensing and Online ordering.

Prescribing leads Dr. Emma Ovink and Harriet Abbiss (the practice pharmacist) keep a close eye on prescribing trends at the practice and ensure that our whole team is kept up to date on local and national prescribing guidance. Areas of focus in the past year have included reducing long-term use of unnecessary indigestion & heartburn medications, changing to more cost-effective brands of creams and ointments and educating our patients around self-care and over the counter treatments for minor ailments. A major change this year was the new guidance around inhalers for COPD which the respiratory circle (in particular nurses Rachael and Liz) worked hard to educate our patients about.

As part of the local Network Prescribing Incentive Scheme, we undertook two reviews aimed at improving the safety and effectiveness of our prescribing for some of our most at-risk patients. The first of these looked at our prescribing of pain medications and the second focused on reviews of our ‘polypharmacy’ patients (those taking a high number of prescribed medications). The de- prescribing record was six medicines stopped in a single consultation (with the agreement of the patient, of course)!

There are challenges ahead with new restrictions on the prescribing of over the counter and limited value medications but we are excited that our prescribing team at JSP is growing. The Care Group has recently recruited twelve network pharmacists across Tower Hamlets and we are pleased to welcome Simon Phillips to JSP one day a week. This means an in-house pharmacist is now available four days a week to assist patients with medication-related queries, conduct reviews and provide prescribing advice to the team. Simon is also the first non-medical prescriber at JSP, soon to be followed by Rachael, who is currently completing her advanced nurse practitioner course and Harriet, who will soon undertake her independent prescribing qualification. We are also developing a prescribing support role, training members of the administrative team to assist with wider prescription activities.

Our next big project is tackling medical waste; with an estimated £300 million going to waste every year in the UK, we are driven to find ways we can do our bit to help at JSP.

Harriet Abbiss Practice Pharmacist JSP July 2018

26 NON-CLINICAL ACTIVITIES

RESEARCH AT JUBILEE STREET PRACTICE Jubilee Street Practice continues to be involved in local research as a Royal College of General Practitioners (RCGP) research interested practice. Dr. Salma Ahmed continues to vet research proposals which arrive at the practice. Out of named drug company sponsored research principlerequests. Shewe dohas notan MSccollaborate in Primary with Care specific and General Practice. Our aim is to be involved with projects that directly or indirectly help the local population. Dr. Tom Margham worked with Arthritis Research UK and has been sharing his knowledge on patient education and literature to help our patients with arthritis and MSK (musculoskeletal) problems. He has worked with the RCGP. He has bid successfully for innovative projects such as trigger tools and recently published a paper with Dr. Symes and Dr. Hull titled “Using the electronic health record to build a culture of practice safety: evaluating the implementation of trigger tools in one general practice.” It was published online on 13 March 2018 in the British Journal of General Practice. Projects previously involved with • test to see if they needed antibiotics PACE- a project for patients with chronic obstructive airways disease, who got a small finger prick • HEPFREE study with Bart’s Health- this study aimed to perform a blood test for people at risk of carrying hepatitis B or C, to detect the condition. We launched this at the JSP and the MP John Biggs attended. We are also opportunistically screening patients who attend our community drugs team clinic. • Dr. Salma Ahmed is an advisory member on the East London Genes and Health Community Advisory Group. Many of our patients have been swabbed and the genes will be helpful in detecting conditions for the future. • illness. Qualitative study with Queen Mary and Westfield College on asthma and cultural beliefs around the Dr. Salma Ahmed General Practitioner JSP July 2018

27 UNDERGRADUATE TEACHING Jubilee Street continued to be a teaching practice for the Barts Health NHS Trust and the London School of Medicine this year. As well as the modules that we are experienced in teaching, such as Human Development (child health and obs & gynae) in Year 4 and General Practice in Year 5, we took on a new module teaching year 3 students this year, which was exciting.

We were also a host practice for an external GP tutor teaching year 2. We plan to teach all these modules again in the forthcoming academic year. Teaching continues to be something that the whole practice gets involved in, whether giving a tutorial to students, having students sit in on an appointment, or shadow on a home visit, to making them feel welcome, and helping them to learn about the truly multidisciplinary team that is General Practice at JSP.

Dr. Emma Ovink General Practitioner JSP July 2018

28 GP TRAINING AT JUBILEE STREET PRACTICE AND IN TOWER HAMLETS

The Jubilee Street Practice has trained GPs since 1976. The Practice provides training for Junior Doctors who are recently qualified and have been accepted onto the Tower Hamlets GP training scheme. We currently have three GP trainers in the Practice: Dr. Nicola Hagdrup, Dr. Jens Ruhbach and Dr. Salma Ahmed, but we view GP Training as a practice task, with all clinicians and practice staff involved in their training.

After studying Medicine at Medical School for 5 or 6 years, all newly qualified doctors have to complete two Foundation years as doctors. These two years are spent in various hospital specialties and sometimes for four months in General Practice. Doctors usually apply then for ‘Specialist Training.’ If they choose General Practice as their specialty, they join a training scheme for three years. If accepted onto the Tower Hamlets Training Scheme, they work for a total of 16 months in Hospital posts and 20 months in General Practices around Tower Hamlets.

Currently there are over 50 GP Training posts filled on the Tower Hamlets Training Scheme, for which I am one of three Programme Directors. I will organise the exact rotation of their training posts and regular training sessions. These training sessions usually involve improving consultation skills and discussing medical as well as ethical and medico-political topics. I also supervise the educational progress of the trainees to ensure their satisfactory learning experience.

Since August 2017, the trainee doctors at Jubilee Street Practice have been Dr. Laura Naidoo, Dr. Alexander Pinder, Dr. Melvyn Adjei, Dr. Elizabeth (Lizzie) Morris and Dr. Laura Lee-Rodgers.

Teaching GPs has many benefits for our practice; GP trainees have recently been in hospital posts and can update us on the latest management strategies for specific problems. They provide additional appointments for our patients and fill our practice with some youthful enthusiasm.

We have been delighted with the Junior Doctors who we teach and are proud that many have gone on to be GP’s in the local area; some have become valued doctors at Jubilee St Practice.

Dr. Jens Ruhbach General Practitioner JSP July 2018

29 GP TRAINEE/REGISTRAR REPORT/FEEDBACK

I am one of the GP trainees at Jubilee Street Practice (JSP). I am 6 months into an 8 month post here. The ethos here at JSP is second to none! Everybody is driven to provide the best service possible and the atmosphere is such a friendly and inspiring one. Furthermore there is a never ending drive to explore new ideas and innovate at any opportunity. Every single member of staff is a pleasure to work with especially my own supervisor who is always on hand to teach and support me whenever I need it. This alongside the wonderfully diverse patient population makes JSP a pleasure to work at. I’ve thoroughly enjoyed my time here! Melvyn Adjei

Thank you so much for being an absolutely fabulous place to work. I am a GPST1 and this is my first GP placement as a doctor. I can’t imagine liking another practice so much. I have really enjoyed my time here; I have felt much supported and have been made to feel like a member of the Jubilee Street family. Lizzie Morris

I’m a doctor training to be a fully qualified GP. I was at JSP for 4 months in early 2017. I received brilliant training throughout my time at JSP. The work ethic and dedication to patient care made this a great place to work and learn. I’ve worked in many hospitals and departments and I can honestly say that what they are doing at JSP is second to done. Their drive to achieve excellence for their patients is clear in everything they do. I was struck by how they are always looking to innovate to deliver better care - the Doctor Direct telephone system is remarkable. My clinical supervisor went above and beyond every single day for me and her patients. An inspirational place to work. Liam O’Driscoll

30 PATIENT PARTICIPATION GROUP (PPG)

Our aim is to ensure that patient health is the priority despite monetary pressures within the National Health Service. We need our patients to help us. This year, we have invited all our patients via a text to become involved with Altogether Better. They are an innovative team who are helping us recruit patient champions and community involvement that will help both the practice and the patient population’s needs. The first meeting was held in July 2018.

Last year, we invited the Parkinson’s disease society to run sessions for our patients and their careers for patients with Parkinson’s disease. This was successful. We also invited different professions such as a physiotherapist; diabetes specialist nurse [Bonnie]; cardiovascular nurse; psychologist and pharmacist.

We constantly strive to improve services by asking for feedback from patients through surveys, questionnaires or NHS choices comments. The results of these are shared and discussed with the patient participation group and changes are made following their reflective comments. Our practice values the voices from our patient participation group and implementing feedback continues to make a difference in our practice.

Lyn Owens, Practice Coordinator Salma Ahmed, General Practitioner Ruth George-Mason, Practice Nurse JSP July 2018

31 WHY WE COME TO WORK

32 ACKNOWLEDGEMENTS

Special thanks towards the following who contributed to this Annual Report:

Dr. Salma Ahmed

Nicola (Nikki) Cyprien

Dr. Nicola Hagdrup

Liam O’Driscoll

Dr. Emma Ovink

Lizzie Morris

Dr. Tom Margham

Melvyn Adjei

Dr. Jens Ruhbach

Ruth George-Mason

Virginia Patania

Chris Banks

Harriet Abbiss

Kamal Uddin

Lyn Owens

Yasmin Rahman

33

The Jubilee street practice 368 — 372 commercial road London E1 0LS Tel: 020 7780 8000 Follow us on Twitter: @Jubilee_Street