Practice Plus Group Surgical Centre, Devizes

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• 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

At our last assessment we rated this key question good. At this assessment the rating has remained the same. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

We have not awarded this service a score for Effective.

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

The evidence showed a good standard. The centre made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

The service had effective processes to identify and assess patients' individual needs at the earliest opportunity. Care was tailored through comprehensive pre-assessment, clinical risk assessment, peri-operative documentation and discharge planning, rather than through traditional inpatient care plans.

Staff completed an individual support plan to assess and document patients' additional needs, communication requirements, reasonable adjustments and any support required to manage anxiety or distress. Patients requiring additional support, including those living with dementia, learning disabilities, neurodiversity or other vulnerabilities, were identified before treatment and their needs were discussed with the patient and, where appropriate, their carers. Individual requirements and agreed reasonable adjustments were documented within the patient record and highlighted through an alert system to ensure they were recognised throughout the patient's treatment pathway.

Assessment findings informed personalised care planning and the provision of reasonable adjustments. These included flexible appointment times, longer appointments, support from carers during admission, centre familiarisation visits and the provision of information in alternative formats. Patients could also access social stories and pre-visit opportunities, enabling staff to better understand and respond to their individual needs and preferences. This supported the delivery of safe, personalised and accessible care.

Staff demonstrated good practice in meeting the needs of patients with additional needs and were able to access communication support services, including language line, when required. This helped ensure patients received information in a way they could understand and supported equitable access to care and treatment.

We reviewed 11 patient records and found evidence that assessments, risk identification and care planning were used to support the delivery of personalised care. However, pain scores had not been documented in 4 of the 11 records reviewed. Despite this, we observed that pain assessments were undertaken in practice and staff communicated effectively with patients regarding pain management and symptom control.

The evidence showed a good standard. The centre 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. 

The centre delivered care and treatment in line with national guidance and evidence-based practice. 

Prescribing of pharmacological and mechanical VTE prophylaxis was undertaken in accordance with current evidence and NICE guidance. Responsibility for VTE prevention was shared across the multidisciplinary team, including surgeons, prescribers, nursing staff, pharmacists and other clinical staff, supporting a coordinated approach to patient care.

Where specialist input was required, patients were referred through established pathways to community-based specialist services. For example, patients requiring hand therapy could access specialist assessment, splinting, orthotics and complex rehabilitation through community hand therapy services. These arrangements supported continuity of care and ensured patients had timely access to the expertise required to maximise recovery and long-term outcomes.

The quality and effectiveness of care were monitored through a programme of clinical audit, patient outcome measures, patient feedback, incident reporting and compliance monitoring against evidence-based policies and procedures. The service undertook regular audits in key clinical areas, including compliance with the World Health Organization (WHO) Surgical Safety Checklist and adherence to the National Safety Standards for Invasive Procedures (NatSSIPs) and Local Safety Standards for Invasive Procedures (LocSSIPs). These were supported by reviews of incidents, near misses and governance data to provide assurance that invasive procedures were delivered safely, effectively and in line with recognised national standards and best practice. The service also audited areas such as infection prevention and control (IPC) and NEWS2 documentation to monitor the quality of care and identify opportunities for improvement.

The service also monitored compliance with national standards through a programme of audits. This included auditing completion of VTE risk assessments, the appropriateness of prophylaxis prescribing, the use of mechanical prophylaxis and documentation across the peri-operative pathway. Audit activity was aligned to NICE guidance, organisational policy and recognised best practice for elective surgical pathways.

Leaders used audit findings, incident learning and governance processes to identify areas for improvement. Ongoing audit, re-audit and governance oversight were used to monitor progress and provide assurance that care continued to reflect current evidence and best practice.

The evidence showed a good standard. The centre worked well across teams and centres 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 centres.

The service demonstrated effective multidisciplinary working to support the delivery of safe, coordinated and person-centered care. Care was planned collaboratively through a multidisciplinary team (MDT) approach to ensure individual needs, communication preferences and reasonable adjustments were identified, assessed and incorporated into patients' care and surgical planning.

Staff could refer patients for discussion at a weekly MDT meeting, which was attended by an anaesthetist, consultant surgeon, outpatient nurse, ward nurse, pharmacist, theatre representative and administration team member. The MDT reviewed patients' suitability for surgery, considered clinical risks and agreed actions to support safe care. Outcomes and decisions were documented within the patient record to ensure continuity of care.

To support clinical decision-making, staff accessed shared care records, diagnostic systems and information from GPs and other healthcare providers to obtain relevant clinical information. Blood results were reviewed and authorised by an anaesthetist before patients were listed for surgery. Following listing, patients underwent a further review before admission to identify any changes in health status, with concerns escalated to the surgeon and anaesthetist where necessary.

Teams had effective working relationships across the service. Staff told us they worked closely with colleagues from different departments and communicated effectively to coordinate care, respond to changing patient needs and ensure information was shared. This supported timely decision-making, continuity of care and the safe management of patients throughout their treatment pathway.

These arrangements enabled effective multidisciplinary collaboration, ensured clinical risks were reviewed by the appropriate professionals and supported safe, informed and coordinated decision-making throughout the patient journey.

The evidence showed a good standard. The centre supported people to manage their health and wellbeing to maximise their independence, choice and control. The centre supported people to live healthier lives and where possible, reduced their future needs for care and support.

The service supported people to prepare for treatment, recover effectively and achieve the best possible outcomes following surgery. Patients received pre-operative information explaining what to expect during their surgical journey, how to prepare for their procedure and any requirements relating to diet, hydration and recovery. This helped patients understand their treatment, participate in decisions about their care and prepare appropriately for surgery.

Patients undergoing orthopaedic procedures were supported through a structured pathway that included pre-operative education, joint school sessions and health promotion activities. Group teaching sessions provided information about recovery timescales, rehabilitation, dietary supplements and other supportive measures to help optimise recovery and promote independence following treatment.

Care was goal-oriented and focused on supporting patients to regain function and improve their health and wellbeing. Staff worked with patients to develop personalised pacing plans and identify activity goals that were meaningful to them. This enabled patients to take an active role in their recovery and supported gradual and sustainable improvements in function and mobility.

Patients received ongoing support following surgery through coordinated rehabilitation pathways. This included timely post-operative reviews, physiotherapy follow-up at key stages of recovery and consultant review where appropriate. Rehabilitation was supported by objective outcome measures, such as muscle strength testing, to monitor progress and inform decisions about ongoing treatment and recovery goals.

The organisation also demonstrated a commitment to supporting the mental health and wellbeing of both patients and staff. Trained Mental Health First Aiders were available within the workplace to provide support, recognise when individuals may require additional assistance and signpost them to mental health and wellbeing services. While primarily focused on staff well-being, these skills also enabled staff to provide compassionate support and guidance to patients, helping them access relevant local services and resources to support their mental health and wellbeing.

The evidence showed a good standard. The centre 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 centre used a range of outcome measures to monitor the quality, safety and effectiveness of care. Performance information was routinely reviewed and shared through quality and governance dashboards, ensuring that the monitoring of outcomes and the measurement of service performance were embedded within day-to-day practice and informed quality improvement activities.

Leaders maintained oversight of key clinical quality and patient safety indicators through the governance dashboard. This included the monitoring of deaths, never events, surgical site infections (SSIs), returns to theatre and other performance metrics. The regular review of outcome data enabled trends, risks and areas for improvement to be identified, investigated and acted upon appropriately.

The centre also used patient experience information to evaluate outcomes and drive improvements in care. Patient feedback, compliments and complaints were routinely reviewed and shared with individual staff members and teams to support learning and service development. Patient experience data was reported quarterly through clinical governance structures and to the Board, providing organisational oversight of emerging themes and areas for improvement.

Complaints and feedback were analysed and incorporated into an annual complaints report, which the centre used to identify learning, monitor trends and implement service improvements. This supported a culture of continuous improvement and ensured that patient experiences informed the ongoing development of services.

The evidence showed a good standard. The centre told people about their rights around consent and respected these when delivering person-centred care and treatment.

The centre had systems and processes to ensure consent to care and treatment was obtained lawfully and in accordance with the Mental Capacity Act (MCA) 2005. Staff had access to an up-to-date consent policy that reflected the requirements of the MCA and supported the delivery of person-centred care. The policy provided guidance on obtaining, recording and reviewing consent, ensuring people were supported to make informed decisions about their care and treatment.

Staff also had access to MCA and deprivation of liberty safeguards (DoLS) policies and practice guidance. These documents outlined the legal framework and procedural requirements for assessing and presuming capacity, documenting assessment outcomes, recording the rationale for decisions made on behalf of a person who lacked capacity, and applying the principles of least restrictive practice.

Staff received training on the MCA and demonstrated a good understanding of its key principles. They understood the importance of supporting people to make their own decisions wherever possible and recognised the need to provide information in a way that enabled people to understand their options, choices, risks and benefits.

We observed staff seeking consent before providing care and treatment. Staff carefully explained procedures and treatment options, ensuring people understood their rights and were able to make informed choices about their care. Consent was recorded and reviewed, and staff respected people's decisions throughout their care journey.

Where people required additional support to make decisions, staff adapted their approach and involved those important to the person where appropriate. Where a person lacked capacity to make a specific decision, decisions were made in accordance with legal requirements and in the person's best interests, with appropriate involvement of family members, carers or legally appointed representatives.

Leaders monitored consent practices through audit and oversight processes to provide assurance that consent procedures were effective, proportionate and consistently applied. These arrangements supported people's rights, promoted shared decision-making and ensured consent to care and treatment was obtained in line with legislation and best practice.