Jubilee Street Practice

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that staff involved people in decisions about their care and treatment and provided them advice and support. Staff regularly reviewed people’s care and worked with other services to achieve this.

At our last assessment, we rated this key question as Outstanding. At this assessment, the rating remains the same.

This service scored 88 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service made sure people’s care and treatment was effective by thoroughly assessing and reviewing their health, care, wellbeing and communication needs with them.

Feedback from people using the service was positive. Patients told us they felt involved in assessments of their needs and were confident that staff understood and respected their individual and cultural requirements. Patients reported being given information about their health conditions in their preferred language, supported by interpreters to aid discussions, and were invited to return after having time to fully digest the information. Patients also shared examples of how cultural sensitivities were considered in practice, including the provision of female-only exercise sessions to support reductions in BMI and blood pressure.

Reception staff were aware of the needs of the local community and used digital flags within the care records system to highlight individual requirements, such as the need for longer appointments or for a translator to be present. Staff at all levels had access to the business continuity plan via an app on their personal mobile devices and were involved in its development, ensuring it reflected the needs of the practice population and how the practice could support them, which informed comprehensive assessments of relevant clinical assessments.

Staff checked people’s health, care, and wellbeing needs during health reviews. Clinical staff used templates when conducting care reviews to support the review of people’s wider health and wellbeing. We were shown a range of standard clinical templates that had been adapted by the practice to maximise the capture of relevant clinical information, supporting effective care delivery and informed clinical decision-making and auditing.

The provider had effective systems to identify people with previously undiagnosed conditions. Staff could refer people with social needs, such as those experiencing social isolation or housing difficulties, to a social prescriber. In addition, the practice facilitated social groups that met at the practice for tea, cake, and informal conversation, open to isolated patients registered at the practice and other Tower Hamlets practices, to encourage social interaction and reduce isolation.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Systems were in place to ensure staff were kept up to date with evidence-based guidance and legislation. This included a fortnightly practice newsletter highlighting updates in clinical practice, changes within the practice, and key learning points. Daily staff huddles, along with monthly training sessions and staff meetings, reinforced these updates and provided opportunities to share learning. The practice also held regular staff quizzes, with prizes, to reinforce learning, training, and updates in information in an engaging way. Clinical records we reviewed demonstrated that care was provided in line with current guidance, and patients with long-term conditions were appropriately monitored and managed.

The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff had access to the information they needed to appropriately assess, plan, and deliver people’s care, treatment, and support. The practice worked with other services including the Primary Care Network and other local practices to ensure continuity of care, including where clinical tasks were delegated to other services.

The service supported people to manage their health and wellbeing to maximise their independence, choice, and control. The service supported people to live healthier lives and, where possible, reduce their future needs for care and support. This was demonstrated through the practice’s Wellbeing Hub, which delivered 14 structured wellbeing initiatives, including a weekly walking group and a weekly in-house cooking programme run from a purpose-built, approved kitchen. Between December 2024 and December 2025, the programme supported 179 patients and achieved strong clinical outcomes, with 58% of participants showing improvement in at least one clinical area, including reductions in weight (43.5%), HbA1c (31.3%), and cholesterol levels (15%). Sustained improvements were seen across multiple clinical measures for some patients. Patient-reported outcomes were also positive, with 60–90% improvements across wellbeing indicators and 73% of participants reporting overall improvement with no deterioration. The programme demonstrated wider system impact, receiving 328 referrals from other Primary Care Network practices within one year.

Staff focussed on identifying risks to patients’ health, including those in the last 12 months of their lives, patients at risk of developing a long-term condition and those with caring responsibilities. Staff supported national priorities and initiatives to improve population health, including stopping smoking and tackling obesity.

The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The practice had not met national targets for screening and immunisations but had implemented a range of working groups, plans, and patient pathways tailored to different demographic groups. Information about the benefits of screening and the risks of not participating was provided to patients in their spoken language, including videos produced by the practice in multiple languages. Patients were proactively contacted when their screenings, such as breast screening, were due, and discussions were conducted in their native language. The practice also held education sessions to address common myths and provide clear information about screening and immunisations. In addition, the practice’s work to promote immunisations had been published in the BMJ (formerly the British Medical Journal) and included community outreach, such as events at the local mosque and public awareness campaigns on the sides of local buses.

From the clinical notes we reviewed, we found that people who used the service experienced positive outcomes as set out in legislation, standards, and evidence-based clinical guidance.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff understood and applied legislation relating to consent. Capacity and consent were clearly recorded. Do not attempt cardiopulmonary resuscitation (DNACPR) decisions were appropriate and were made in line with relevant legislation.