Practice Plus Group Hospital, Southampton

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

At our last assessment we rated this key question good. At this assessment the rating has remained the same. This means we looked for evidence that people were protected from abuse and avoidable harm.

Staff generally provided safe care and treatment. Staff understood their safeguarding responsibilities, managed environmental risks, followed established pathways and monitored infection risks to support patient safety. However, we identified some areas for improvement. Learning from significant risks was not always consistently shared across staff groups, and some safety-critical training, risk management and medicines processes were not always completed in line with local requirements.

The service was in breach of Regulation 12 (Safe care and treatment).

We have not awarded this service a score for Safe.

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

We scored the service as 2. The evidence showed some shortfalls. Learning from significant incidents and emerging themes was not always consistently shared across staff groups. However, staff used established processes to report, investigate and review safety incidents and took action to reduce the risk of recurrence.

Learning from incidents and safety reviews was not always embedded consistently across the service. Leaders identified an increase in surgical site infections and reviewed themes through ongoing investigations. However, some staff we spoke with were not aware of the increase in infections or the actions being taken to address this.

Staff knew how to report incidents and used an electronic incident reporting system to raise safety concerns. During the previous 12 months, staff reported 642 incidents and completed investigations in line with the service's procedures. Managers shared investigation outcomes with the staff involved. Staff described how they raised and escalated concerns appropriately and told us they felt confident using the incident reporting system. The service had not reported any serious preventable safety incidents since January 2024.

Staff reviewed incidents and shared learning to support improvements in practice. Staff discussed incidents and investigations during weekly incident meetings and bi-monthly governance days, which included training. These discussions helped staff understand what had happened, identify learning and agree actions to reduce the risk of similar incidents. We reviewed ward meeting minutes from March to May 2026 and found staff discussed incidents that occurred during this period. For example, staff reviewed 4 incidents in May 2026 and identified learning points and actions. The ward manager and deputy ward manager reviewed incidents relating to the inpatient ward and carried out investigations when required.

Staff used incidents as opportunities to improve care and treatment. Consultants attended meetings chaired by the clinical director where they discussed audits, incidents and transfers of patients. Following discussions about an increase in surgical site infections, consultants agreed to change the drapes used in theatres after identifying these as a possible contributing factor.

Staff understood their responsibilities under the duty of candour. When things went wrong, staff apologised, provided honest explanations and offered appropriate support. For example, a doctor apologised to a patient who had been readmitted with an infection following surgery and explained the likely reasons for the infection.

We scored the service as 3. The evidence showed a good standard. The service had systems and pathways to support safe care, treatment and transitions between teams and services. Staff used assessments, multidisciplinary planning and safety processes to ensure patient’s needs could be met safely throughout their care pathway.

Staff used comprehensive pre-assessment processes to determine whether patient's needs could be safely met by the service. The service operated clear admission and exclusion criteria and reviewed referrals before accepting patients for treatment. Referrals were reviewed by a consultant anaesthetist, who confirmed suitability for treatment and identified any additional requirements. The service did not routinely accept patients whose needs were beyond the scope of care it could safely provide, including some patients with tracheostomies or sleep apnoea. The service generally accepted patients with low anaesthetic risk and considered those with more complex health needs through multidisciplinary discussion and review by senior clinicians.

Staff completed assessments and involved relevant professionals to support safe decision-making before treatment. The service had 6 dedicated pre-assessment rooms and provided face-to-face assessments for patients undergoing major procedures, including hip and knee replacements and hysterectomies. Staff completed telephone assessments for patients having fewer complex procedures. The pre-assessment team used an integrated pathway that included alerts for previous medical history, seizures, learning disabilities and other significant risks. Staff undertaking pre-assessments received dedicated training, including blood result interpretation training, and consultants reviewed investigation results before treatment was confirmed.

Staff worked with patients and partner services to support continuity of care throughout the treatment pathway. We observed patients moving safely through pre-assessment, admission, theatre, recovery and discharge. Staff completed identification checks and shared information between teams at each stage of care. Staff provided patients with discharge information and access to a dedicated 24-hour helpline following discharge. For patients who required onward care or whose condition deteriorated, staff arranged transfers to the local NHS services to ensure they received appropriate treatment.

The service also worked with NHS providers to optimise patient’s health before treatment where required. For example, some patients requiring treatment for anaemia received optimisation through NHS services before surgery took place.

Staff followed recognised safety processes throughout surgical procedures. During the inspection, we observed staff completing the World Health Organization (WHO) Surgical Safety Checklist. Leaders monitored compliance with surgical safety processes through audit activity. Audit data showed 100% compliance with the "Stop Before You Block" process and 100% compliance with quarterly WHO Surgical Safety Checklist audits since January 2026.

Staff followed national enhanced recovery programmes for patients undergoing planned surgery, including hip and knee procedures. Patients received information before surgery, including educational videos designed to help them prepare for their operation and recovery. Staff encouraged mobilisation on the day of surgery where appropriate and completed post-operative checks before discharge. These included physiotherapy assessments, blood tests and imaging where required.

We scored the service as 3. The evidence showed a good standard. The service worked with people and partner agencies to protect people from abuse, neglect and avoidable harm. Staff understood their safeguarding responsibilities and knew how to identify, report and escalate concerns.

Staff identified safeguarding concerns and worked with relevant agencies to protect patients at risk of harm. Staff described their safeguarding responsibilities and knew how to recognise and report concerns. Teams routinely shared safeguarding information during handovers, multidisciplinary team meetings (MDTs) and safety meetings. During the previous 12 months, the service reported 9 safeguarding concerns to the local authority and commissioners. Staff knew how to make safeguarding referrals and access support when required. The service had a safeguarding lead trained to level 4 who provided advice, supported investigations and delivered safeguarding training. For example, the oral surgery team raised a safeguarding concern relating to a child. The safeguarding lead supported staff to manage the concern appropriately and leaders shared learning from the incident during a governance day to support wider learning across the service.

Staff completed safeguarding training appropriate to their roles and had access to policies and guidance to support decision-making. Training compliance was 100% for adult and children's safeguarding level 2. Compliance was 94% for children's safeguarding level 3 and between 80% and 89% for adult safeguarding levels 1 and 3 and children's safeguarding level 1. Safeguarding policies reflected national guidance, included clear reporting processes and provided information about supporting people with additional vulnerabilities and support needs. The service also achieved 100% compliance with learning disability and autism training at tiers 1 and 2. Staff completed additional training in the Mental Capacity Act (MCA) and Deprivation of Liberty (DoLS), dementia, mental health conditions and female genital mutilation (FGM).

Staff followed procedures to safeguard children and vulnerable people visiting or receiving care from the service. Staff described the arrangements in place for managing visitors to ward areas, including children. Patients we spoke with told us they felt safe while receiving care from the service.

We scored the service as 2. The evidence showed some shortfalls. Systems for identifying, monitoring and managing risks were not always implemented consistently, which meant people were not always protected from avoidable risks. However, staff involved patients in decisions about their care and treatment and generally worked with them to understand and manage risks in a personalised way.

Leaders did not always have effective oversight of venous thromboembolism (VTE) risk assessment processes. Compliance had reduced from 96% in July and November 2025 to 80% in April 2026. Audit findings showed some patients had not received a fully completed VTE assessment or information about anticoagulation prophylaxis before surgery. During the inspection, one patient's VTE assessment had not been reviewed within 24 hours of admission in line with local requirements. Although blood-thinning medication had been prescribed and administered appropriately, the required review had not been completed. When we raised this concern, the deputy ward manager arranged for a further assessment to be undertaken. Leaders had identified the decline in compliance and implemented action plans, increased monitoring and shared learning with staff.

Risk and pre-operative assessments enabled staff to identify individual risks and develop personalised care plans. Patients underwent comprehensive pre-operative assessments where staff discussed health conditions, risk factors and support needs. Staff used this information to develop peri-operative care plans and involved patients in decisions about their treatment, optimisation requirements and post-operative support. Patients we spoke with told us staff listened to them, explained risks and helped them understand their care and treatment. Patients received information before their appointments and felt able to ask questions and raise concerns.

Staff involved patients and multidisciplinary teams in planning care and managing risks. Staff held daily safety brief meetings and multidisciplinary team (MDT) meetings to identify patients who required additional planning and support before admission. Staff used this information to make appropriate arrangements, including increased observations, suitable bed allocation and adjustments to meet individual needs. For example, staff arranged side rooms for patients with learning disabilities who preferred a quieter environment.

Staff monitored patients for signs of deterioration and responded appropriately to changes in risk. Staff completed observations using a nationally recognised early warning scoring system and received training appropriate to their role. Staff had access to guidance on recognising and responding to deterioration and completed life support training relevant to their responsibilities. Staff had processes to manage risks when people required care from other services. Staff followed a standard operating procedure for emergency transfers to NHS hospitals when patients required further treatment. The service transferred 14 patients to NHS hospitals during the previous 12 months. Staff recorded these transfers as clinical incidents and reviewed them through incident management processes.

We scored the service as 3. The evidence showed a good standard. The service identified and managed environmental risks and maintained facilities, equipment and resources that supported the delivery of safe care.

Staff maintained clinical environments that were clean and suitable for the delivery of care. Cleaning audit results for theatre and ward areas consistently exceeded 95%. During the inspection, clinical and non-clinical areas were clean, tidy and free from clutter. Accessible facilities, including wheelchair-accessible toilets, were available. Patients also spoke positively about the environment, with one person describing it as "spotless". However, the storeroom had clutter on the floor, which could hinder effective cleaning. This was raised with the leadership team, who ensured that all boxes were removed, leaving the area clear and free from clutter.

Staff followed processes to manage environmental hygiene and equipment safety. Handwashing facilities and hand sanitiser were available throughout the service. Staff managed waste disposal appropriately and most sharps containers were correctly labelled and secured. Equipment appeared clean and was stored appropriately. However, staff did not consistently use labels to identify when equipment had been cleaned and was ready for use. We also found one out-of-service pump that was not labelled and another without a visible service date. Leaders referred these findings to the medical devices team for action.

Staff monitored environmental risks through routine safety checks and maintenance programmes. Staff completed monthly water temperature checks to reduce the risk of waterborne infections and maintained fire safety systems through regular testing and inspection. Records between January and May 2026 showed staff completed fire door inspections, emergency lighting tests and fire extinguisher checks in line with local requirements. Leaders also reviewed environmental risks through health and safety meetings.

Staff followed systems to ensure equipment and emergency resources were available when needed. The service maintained an on-site sterilisation unit and followed procedures for the decontamination and processing of surgical and anaesthetic equipment. Emergency medicines and resuscitation equipment were readily available, appropriately stored and in date. During the inspection, we found a resuscitation trolley had not been secured after checking. Staff took immediate action to complete a further check and secure the trolley.

Staff generally stored hazardous substances safely. We found an unlocked Control of Substances Hazardous to Health (COSHH) cupboard within the theatre sterile services department. As people could access this area, there was a risk of harm from unsafe storage. We raised the concern with leaders, who secured the cupboard and stored the key appropriately.

We scored the service as 2. Compliance with some safety-critical training had not reached the service target. However, the service had systems to recruit, deploy and support staff development.

Compliance with some safety-critical training had not reached the service target. Overall mandatory training compliance across theatres, the day unit and the inpatient ward ranged between 95% and 96%. However, compliance with venous thromboembolism (VTE), National Early Warning Score 2 (NEWS2) and Immediate Life Support (ILS) training ranged from 66% to 86%. These subjects support staff to identify deterioration, manage clinical risks and respond to emergencies. During the inspection, we found one patient's VTE assessment had not been reviewed within 24 hours of admission in line with local requirements. We also found one patient had not received observations between 6am and 1pm despite a documented requirement for four-hourly observations. These findings meant important clinical monitoring processes were not always completed as expected and increased the risk that changes in a patient's condition may not be identified or acted upon promptly.

Leaders used systems to plan, monitor and review staffing levels to support safe care. Staff held daily safety briefings to review planned and actual staffing levels across departments. These meetings enabled staff to identify staffing shortfalls, skill mix concerns and operational pressures that could affect care delivery. Leaders considered the impact on theatre activity, inpatient care and service delivery and acted when required. Staff escalated significant concerns to the senior management team for support.

Staffing levels were adjusted to reflect clinical activity and patient's needs. Leaders used a staffing acuity tool to determine safe staffing levels, and managers prepared rotas in advance. Managers adjusted staffing levels to reflect case mix and activity levels. Staff told us they were able to take breaks during their shifts and felt staffing levels supported safe care. Patients told us staff responded promptly to their needs, and we observed staff providing kind and supportive care.

The service had processes to recruit, induct and develop staff. New staff completed a corporate induction followed by a role-specific induction before commencing work. Induction packs and competency checklists supported this process. Bank staff completed a local induction and mandatory training appropriate to their role. The service also provided a preceptorship programme to support staff transitioning into new roles. Leaders completed recruitment checks, including Disclosure and Barring Service (DBS) checks and professional registration monitoring.

The service monitored workforce stability, staff development and professional competence. Staff turnover reduced from 18.3% to 10% during the previous 12 months, while sickness absence increased slightly from 2.5% to 2.8%. Staff received annual appraisals and had opportunities to discuss performance, learning and development needs with appraisal compliance at 82%. The service used competency frameworks and scope of practice documentation to support staff development and provide assurance that staff were working within their competencies. This included competency assessments for Surgical First Assistants. However, we found the theatre healthcare practitioner first assistant policy was overdue for review, with a review date of August 2025.

We scored the service as 3. The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Leaders monitored surgical site infections and took action when infection rates increased. Between July 2025 and June 2026, the service reported 15 surgical site infections, including 10 superficial and 5 deep tissue infections. Leaders identified an increase in infections from April 2026 and completed a thematic review to understand contributing factors and develop actions to reduce the risk of recurrence. The service had an action plan at the time of inspection and leaders continued to review infection trends. However, not all staff we spoke with were aware of the increase in surgical site infections or the actions being taken in response.

Staff followed infection prevention and control procedures and had access to guidance to support safe practice. Staff had access to infection prevention and control policies, decontamination procedures and theatre cleaning guidance. The service had a designated infection prevention and control lead who provided oversight and support to clinical teams.

Staff maintained a clean environment and followed processes to reduce the risk of infection. Clinical areas were visibly clean and well maintained. Cleaning records were up to date and staff had access to handwashing facilities and hand sanitiser throughout the service. During the inspection, we observed appropriate use of personal protective equipment and suitable isolation arrangements for a person with a surgical site infection.

Staff monitored infection prevention practices through audit and routine checks. The service completed hand hygiene, aseptic non-touch technique and theatre asepsis audits. Staff checked sterile packs before use and surgical instruments were decontaminated and sterilised on site.

We scored the service as a 2. The evidence showed some shortfalls. Systems and processes did not always ensure medicines were managed safely and in line with current guidance. However, staff generally followed medicines management processes, involved people in decisions about their medicines and took prompt action to address concerns identified during the inspection.

Staff stored medicines, including controlled drugs and medical gases, securely. Controlled drug records, Home Office registrations and Environment Agency documentation were complete and well maintained. Fridge temperature records showed medicines requiring refrigeration were stored within manufacturers' recommended temperature ranges. Where temperatures fell outside the expected range, staff recorded and implemented appropriate actions. However, room temperature monitoring did not demonstrate medicines stored in areas that were not staffed every day remained within manufacturers' recommended storage conditions. We also found a piped medical air outlet without a protective cover. Staff addressed this immediately following inspection feedback.

Staff did not always have access to up-to-date medicines information and guidance. We found some paper-based medicines references were out of date and multiple versions of guidance were available. In addition, an emergency hypoglycaemia box contained expired medicines. These issues were raised during the inspection, and staff took prompt action to replace expired stock and review medicines reference materials to ensure current guidance was available.

Leaders did not always have sufficient oversight that pharmacy processes aligned with current recommendations. The service used pre-prepared over labelled medicines packs to support access to discharge medicines when the pharmacy was closed. However, the pharmacy team could not demonstrate why these products could not be sourced from approved suppliers and were unable to provide records relating to the assembly and governance of these packs in line with current recommendations. Leaders were aware of these concerns and provided a policy following the inspection; however, further information relating to operational processes and records was not available.

Staff involved people in planning and managing their medicines. Staff completed pre-operative assessments and provided advice on medicines that should be stopped before surgery and when these should be restarted following procedures. Patients were encouraged to bring their medicines into hospital, which staff reviewed on admission. Medicines charts were completed for patients admitted to the service and discharge medicines were supplied to support a safe discharge process.