Downham Health & Leisure Centre

Updated 20 November 2023

Downham Health & Leisure Centre head office address is located at Downham Health & Leisure Centre, 7-9 Moorside Road, Bromley, Kent BR1 5EP. One Health Lewisham Limited (OHL) provided some services which are not regulated by the CQC. Therefore, at Downham Health & Leisure Centre, we were only able to inspect the services which were subject to regulation.

Downham Health & Leisure Centre is registered with the CQC to provide the following regulated activities; treatment of disease, disorder or injury and diagnostic and screening procedures, diagnosis and screening procedures and family planning.

CQC inspected Downham Health & Leisure Centre on 21 and 22 June 2023 and on 11 July 2023. As part of this inspection, we visited the south-east London Special Allocation Service (SELSAS) at the main base at Rushey Green Group Practice and visited one of the SAS satellite host practices, to inspect the premises and understand arrangements for the provision of services regulated by CQC including arrangements for emergencies. We did not inspect the NHS GP practices who own or use the premises. We also inspected the Respiratory hub and the Community Dermatology Services (CDS) hub at Marvels Lane Surgery in Lewisham, south-east London.

• The main SAS site is based at the Novum Health Care Partnership Rushey Green Group Practice. SAS care is currently provided from three satellite clinics in Southwark, Bromley and Bexley;

• Dulwich Hospital, Tessa Jowell Health Centre, 72H East Dulwich Grove, East Dulwich, Southwark, London SE22 8EY
• Orpington Health & Wellbeing Centre, 19 Homefield Rise, Orpington, Bromley BR6 0FE
• Queen Marys Hospital, Frognal Avenue, Sidcup DA14 6LT

• The Special Allocation Scheme (SAS) service provided by Downham Health & Leisure Centre (DH&LC) is delivered from dedicated host satellite sites run by NHS GP providers. Leaders at DH&LC told us they do not use any staff at the satellite sites who are employed by the host GP providers. Downham Health & Leisure Service told us they hire a clinical room at the SAS host satellite sites where SAS patients can only be seen by clinical staff who are directly employed by the provider, One Health Lewisham. The SELSAS service is open from 8.30am to 6.30pm, Monday to Friday and provides medical primary care services to people who have been removed from their mainstream GP practice list. When the SAS service is closed patients who need out of hours help can telephone NHS111.

• The Respiratory Hub is delivered across two sites - Marvels Lane Surgery and the Waldron Health Centre in Amersham Vale. The Respiratory Hub provides remote assessment, diagnosis and management of patients with a variety of respiratory needs. It provides spirometry delivered by Association for Respiratory Technology & Physiology (ARTP) trained and trainee spirometry technicians, alongside a specialist respiratory nurse. The Respiratory Hub also provides FeNO breath tests which helps doctors tell if a patient has inflammation in their airways. FeNO stands for fractional exhaled nitric oxide.

• Community Dermatology Services (CDS) is a GP led service delivered across two sites in Lewisham, by a team of locum GPwER (General Practitioners with Extended Roles). It does not currently offer minor surgery. At this inspection, the dermatology service was not providing any minor surgery but planned to employ a dermatologist to undertake minor surgery procedures. Patients registered with a Lewisham GP practice can be referred to the community dermatology service.

The provider website is https://www.onehealthlewisham.co.uk/services

How we inspected this service

Before we inspection we reviewed information already held by CQC and information submitted by the provider for the inspection. We spoke to stakeholders who commission the service.

During the inspection, we received feedback from people who used the service, interviewed staff, made observations and reviewed documents.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs?
• Is it well-led?

These questions therefore formed the framework for the areas we looked at during the inspection.

Updated 20 November 2023

This service is rated as Requires improvement overall.

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires improvement

We carried out an announced comprehensive inspection at Downham Health & Leisure Centre. This was the first rated inspection for the service that was registered with the Care Quality Commission (CQC) in 2017. During this inspection we inspected the safe, effective, caring, responsive and well-led key questions.

Downham Health & Leisure Centre is an independent healthcare organisation run by One Health Lewisham (OHL), an integrated community service provider which delivers a number of services for NHS GP practices, across south-east London.

Downham Health & Leisure Centre is registered with CQC under the Health and Social Care Act 2008 in respect of some, but not all, of the services it provides. There are some exemptions from regulation by CQC which relate to particular types of regulated activities and services and these are set out in Schedule 1 and Schedule 2 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Therefore, we did not inspect or report on these services.

The Chief Operating officer of One Health Lewisham is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Our key findings were:

• The service delivered care and diagnostic procedures from health hubs and from satellite clinics, in spaces run by NHS GP providers.

• There were systems to assess, monitor and manage risks to patient safety. Where these were managed by the service, they generally worked well but they were not consistently effective. For example, not all staff had completed required training to maintain knowledge and skills. We found three members of staff had not completed safeguarding training.

• There was no effective system to ensure that staff employed by host community services, that patients interacted with, had the appropriate skills, knowledge and experience and there were no checks to verify the effectiveness of the system.
• The service had systems and processes to ensure that the premises used to provide services were safe. We visited three host community service sites and looked at equipment and premises, and at documents and found these were generally well managed. However, the provider had no written agreements in place for monitoring host community service risk assessments.
• There were safe procedures for managing medical emergencies including access to emergency medicines and equipment.
• The service routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence based guidelines.

• We found most recruitment checks were carried out in accordance with regulations (including for agency staff and locums). However, we found some gaps in recruitment records. The provider did not have a written agreement with the host community services that described the recruitment checks expected for staff that interacted with the patients at host clinic sites. There was no mechanism to ensure that this process for ensuring appropriate recruitment checks was effective.

• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Patients were able to access care and treatment from the service within an appropriate timescale for their needs.
• The service took complaints and concerns seriously and responded to them to improve the quality of care.
• Leaders had the capacity and skills to deliver high-quality, sustainable care. The provider was aware of areas of weaknesses and worked to improve them.
• The service had a culture of high-quality sustainable care.

The areas where the provider should make improvements are:

• Carry out an annual appraisal for all staff.
• Train all staff who act as chaperones.

• Continue to ensure policies and procedures are followed, for example the appraisal policy.

Dr Sean O’Kelly BSc MB ChB MSc DCH FRCA

Chief Inspector of Health Care