Practice Plus Group Hospital - Emersons Green

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We looked for evidence that the service met people’s needs.

At our last assessment we rated this key question as good. At this assessment the rating has remained as good. This meant people’s needs were met through good organisation and delivery. We looked for evidence that people and communities were always at the centre of how care was planned and delivered. We checked that the health and care needs of people and communities were understood, and that people could access care in ways that met their personal circumstances and protected equality characteristics.

We have not awarded this service a score for Responsive.

Find out about when we will not publish a key question score and what we look at when we assess Responsive.

We scored the service as 3. The evidence showed a good standard. The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

All areas of the service were accessible by wheelchair. The reception area had seating, toilet facilities and food and drink availability for patients and visitors. There was lift access available.

Most of the surgery carried out at the service were NHS procedures. However, private patients were informed about fees in advance during telephone calls. Patients received information in the post and again during pre-operative assessment. This gave patients opportunities to consider the cost prior to receiving treatment. Pricing was available to patients on the service’s website.

Plans were made for patients with dementia at pre-operative assessment. Visits to the service could be arranged for patients with additional needs ahead of their surgery date to help people feel safe. There was a dementia friendly room with additional visual aids and signage. Carers or relatives were enabled to stay to support their loved ones when needed.

We observed staff communicating with patients to ensure they understood their care and treatment. This included finding effective ways to communicate with patients with additional communication needs. These were highlighted at pre-operative assessment and documented thoroughly in patient records. Staff had access to interpretation services and could access patient resources in accessible prints for patients with visual impairments. The service had a hearing loop accessible to people who used hearing aids.

We scored the service as 3. The evidence showed a good standard. The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

The service had acceptance criteria so all patients, irrespective of age, gender, race, religion, belief or sexual orientation, could access the service. Patients with learning disabilities, autism and attention deficit hyperactivity disorder (ADHD) were included in this process.

The hospital held daily morning huddles (meetings) to plan care, discuss risks and issues across the service. Staff who were unable to attend received emails with meeting notes.

There were clear pathways for patients to be transferred to local hospitals if they became unwell or in case of an emergency. The admissions and transfer policy presented a clear process for transfer of patients to eternal services and the emergency transfer of deteriorating patients policy followed a doctor-to-doctor referral process. Patients were transferred to local NHS hospital Emergency Departments if they became clinically unwell based on clinical assessment of risks and benefits to individual patients. Policies outlined allocation of staff to accompany patients to the receiving hospital. The service’s transfer packs were accessible to staff and staff understood how to use them.

Leaders and staff told us there were adjustments to care for people with dementia, learning disabilities and anxious patients. These included pre-surgery visits, appointments at quieter times and the opportunity for a carer to stay where appropriate.

We scored the service as 3. The evidence showed a good standard. The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Information governance systems included confidentiality of patient records which were stored electronically. Any paper records on site were stored in lockable cupboard behind a staffed desk. Staff completed training in information security and data protection.

The service complied with the Accessible Information Standard ensuring patients could obtain a range of information on treatments and how to provide feedback. Leaflets could be provided in larger print and the service’s accessible information standards policy outlined information and correspondence could be requested in braille, easy to read formats or audio copies. Patients could access interpretation support to support conversation when receiving information and asking questions about their care. Staff said there were various ways in which they provided information people could understand including interpretation for people who did not speak English as a first language via a translation line. They were also able to obtain support for people who were deaf and used British Sign Language (BSL). Some staff were BSL trained.

Detailed information was provided to patients about what to expect pre and post- surgery with contact numbers available for support and a 24 hour helpline accessible following discharge.

The physiotherapy team provided patients with information following surgery. There was a pocket physio app patients could download to access up to date information. This included general advice, goals, exercises with photographs and how to use equipment, for example crutches. Paper leaflets were also provided for patients who were unable to access the app which were informative and instructive. However, we found several leaflets which were out of date. This meant there was a risk patients did not always received the most up to date advice.

At time of discharge, patients were provided with information about their medication to take home, including contact numbers if they had any concerns.

Staff made notifications to external bodies as needed, for example where incidents required reporting to regulatory bodies or external data systems.

We scored the service as 3. The evidence showed a good standard. The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result.

Patients could raise concerns in a range of accessible ways on the service’s website. There were QR codes available in waiting areas to support patients to provide feedback or make complaints. Patients received patient satisfaction surveys (electronically) to complete which included the friends and family test. Results for these surveys were displayed in the department. For the 12 months before our assessment, results were highly scored between 97 to 100% of patients said they received excellent care. Patients we with spoke with said their overall experience was excellent (one patient said they would have liked more notice before their surgery due to planning). Patients said it was easy to arrange appointments, the service was accessible and staff were responsive when they needed help.

Learning from complaints and concerns were seen as opportunities for improvement. Complaints information was discussed at clinical governance meetings with themes discussed at monthly meetings between the heads of department. Staff told us they received feedback from patients at team meetings and via email. Information from patient complaints shared with the team was anonymised to protect patients who raised concerns or complaints from discrimination and harassment There was evidence change had been made following patient feedback. Patients fed back their GPs did not always receive digital copies of discharge letters. In response, the service provided patients with a hard copy to give to GPs on follow up after discharge.

For the year from August 2025 to July 2026 the provider received 78 formal complaints, 37 were upheld and 26 were partially upheld. 7 were not upheld and 8 remained open at the time of assessment. In the most recent staff survey, 75% of staff responding said they felt the service made positive changes in their area of work based on patient feedback.

If NHS patients were dissatisfied with responses to complaints, they could contact the parliamentary health service ombudsman (PHSO), or private patients could contact the provider’s Chief Operating Officer and an independent sector complaints service. This information was made available to patients as part of the complaint response process. We saw evidence showing patients making a complaint received feedback. In the last 12 months none of the complaints made to the service had been submitted to the PHSO.

All patients we spoke with had received information on how to provide feedback or make a complaint if they needed to and all patients knew who to contact if they had any problems. There was a feedback board displaying thank you letters and cards from patients.

We scored the service as 3. The evidence showed a good standard. The service made sure that people could access the care, support and treatment they needed when they needed it.

Patients could access the service through several routes, including GP referral, health insurance, self-pay or through their NHS hospital. Most patients said it was easy to arrange their appointments or surgery. If there were cancellations due to, for example, staff sickness, patients were rebooked as soon as possible. Staff told us this was a rare occurrence. However, between March 2026 and May 2026 data showed there had been 137 cancellations on the day of surgery. This included service led and patient led cancellations and the majority of cancellations were recorded as unavoidable. Cancellations were recorded as incidents and themes were reviewed at governance meetings to ensure learning and action plans were implemented.

Waiting lists were managed through aligning patient bookings to available capacity, allowing patients the option to choose surgery at a time to suit them. Patient choice of dates extended to both private and NHS patients. Patients in the department during our assessment told us they had not had long waits for surgery. The service monitored referral to treatment (RTT) rates and monitored the number of patients who were treated within the target 18 weeks of referral. Gastroenterology and ophthalmology and had higher rates of patients being treated within the 18 week target. However, oral surgery, ENT (ear, nose and throat) surgery, trauma and orthopaedics surgery and gynaecology surgery had more delays to waiting lists. Data showed in June 2026 oral surgery had 483 patients, of which 385 had waited over 18 weeks for treatment. We did not see evidence of an improvement action plan to improve the process for NHS patients being treated and RTT was not recorded as discussed during clinical governance meetings.

Staff made reasonable adjustments for patients, for example patients who had mobility problems. Patients with additional needs or requirements were offered appointments at quieter times. Patients told us they found the service’s signage and parking accessible.

There was an on call doctor for the service who could be contacted out of hours and attended the ward quickly in an emergency.

Physiotherapists provided a 7-day service for inpatients and a 5 day service for outpatients. There was no difference in provision of equipment for private or NHS patients. Following discharge, the physiotherapy team provided a telephone number for patients to access support.

There was a discharge policy including guidance on information to be given to carers. Staff planned for patients’ discharge, including liaison with care managers/co-ordinators. Staff said discharge was never delayed other than for clinical reasons.

We scored the service as 3. The evidence showed a good standard. Staff and leaders actively listened to information about people who are most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this.

The pre-operative assessment process highlighted patients who needed extra support. People’s needs and preferences were understood by staff. They were treated with equality and in a non-discriminatory way. Staff said they ensured people’s needs were met and the service planned in advance with staffing levels changed to support patients’ needs. Acceptance criteria did not exclude patients in relation to protected characteristics.

Staff completed training in equality, diversity and inclusion (EDI). The service had an EDI policy which outlined the organisation’s prioritisation of a fair and equitable workplace. Staff within the service and the wider organisation promoted a culture in which the people using the service felt empowered to give their views.

The provider had undertaken equality impact assessments of their policies and procedures to ensure they did not place vulnerable people or people with protected characteristics at a disadvantage.

Data supplied by the service regarding incidents and complaints did not identify adverse outcomes or inequalities for people with protected characteristics.

We scored the service as 3. The evidence showed a good standard. People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Staff support patients to make decisions about their care and treatment and their future. Patients’ wishes on resuscitation were assessed as part of the pre-operative process. This was recorded in patients’ records. Staff knew how to identify patients’ wishes. Copies of Recommended Summary Plans for Emergency Care and Treatment (ReSPECT) forms and advanced decisions patients had completed in the community were kept in patient notes and discussions around these decisions happened with the patient at pre-assessment and discussed at multidisciplinary team meetings. Staff ensured all relevant healthcare professionals and other relevant bodies are involved in planning the care and treatment of people with complex needs.

Discussions were communicated in a sensitive and dignified way. Staff created personalised care plans to account for the patient’s needs, wishes and feelings.

Staff provided patients with leaflets including information regarding ongoing care or treatment needs. Patients we spoke with were all clear on the plan for their care following surgery. At time of discharge, patients were provided with information about their medication to take home and a hard copy of their discharge letter to take with them to community care provider appointments. A digital copy of this letter was also available for external providers to access.

Detailed information was given to patients about what to expect pre and post-surgery with contact numbers for support.