Martin Cusack is probably one of the few London primary care trust managers to see off the NHS star ratings with a tinge of regret. "If we had another year we would have got three stars," he says.

The deputy chief executive of Tower Hamlets' primary care trust is delighted that the trust rose from zero to two stars in just 12 months.

The PCT received praise from the Healthcare Commission yesterday, which commended the east London trust for bucking a trend in a region where not one PCT managed to secure three stars.

The picture overall for PCTs was disappointing. Only 19% of the country's 303 PCTs were awarded a three-star rating this year, far lower than any of the other NHS organisations under scrutiny.

One of the problems is that while other NHS organisations are assessed against key targets and indicators delivered in-house, PCTs are assessed not only on their own performance but also on aspects of performance assessments delivered by acute, ambulance and mental health trusts in their area.

Unveiling the results yesterday, Healthcare Commission chief executive Anna Walker also acknowledged that London PCTs were facing particularly tough challenges in meeting certain targets and standards because of the mobility and deprivation issues facing most London boroughs.

But she used Tower Hamlets to signal the fact that while the slope may be steeper in London, it is not impossible to climb. The east London trust rose from a zero to a two-star rating in just one year.

"Tower Hamlets showed what trusts can do even when there are complex populations within the current arrangements," Ms Walker said. The population of Tower Hamlets is just under 200,000 and covers an area of nearly 20 square miles.

The borough boasts the largest percentage of Muslim residents of any local authority in the country. Just under half (49%) of the population is black or minority ethnic, around a third of the population is Bangladeshi and there are growing numbers of east Europeans in the borough.

Mr Cusack cites the arrival of Alwen Williams as a pivotal influence that changed fortunes. "When we got a zero rating last year, she said we would get two stars this year," he said.

The PCT's secret ingredient was reaching out to the community to improve the health of the population. This has included a sexual health mobile texting service for youngsters wanting advice or information, and reducing the high level of teenage pregnancies by working with schools and faith and community groups.

"We focused on involving the local community and organisations like the mosques and the voluntary sector to help us meet targets," he explains.

"For example, with flu vaccinations, we went from being quite poorly performing for flu to becoming an example of best practice. We are going out to community areas and doing vaccinations in different ways."

The PCT met seven of the eight targets laid out in its performance assessment, having missed the four-hour waiting target delivered by its two local acute hospital trusts.

Tower Hamlet residents are now guaranteed a GP appointment within 48 hours or primary care professional, such as a nurse, within 24 hours.

An innovative community dental health access project is allowing many more local people to have their teeth checked and treated. Other improvements include more advice available from pharmacists, an end to physiotherapy waiting lists for people with conditions such as low back pain and joint injuries, and the best record in London for helping people give up smoking.

Mr Cusack cites joint working with the local authority as another plank to success. The organisations have jointly produced a strategy on improving health and wellbeing to take the health of resident to the next level. "It is a general strategy with social services to address lots of issues that affect health like housing, education, safety and health."

For all that, it is clear Mr Cusack feels that a two-star rating fails to reflect the service the PCT delivers. "Star ratings do not give credit for how much you are improved," he says.

On this sentiment, he is probably not alone.