Practice Plus Group - NHS 111 Devon

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture

This is the first inspection for this service since its registration with CQC. This key question has been rated as good.

Leaders and staff had a shared vision and culture based on listening, learning and trust. Leaders were visible, knowledgeable and supportive, helping staff develop in their roles. Staff usually felt supported to give feedback and were treated equally, free from bullying or harassment. Staff understood their roles and responsibilities. There was a culture of continuous improvement with staff given time and resources to try new ideas.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Staff interviewed expressed enjoyment in their roles and valued the collaborative environment. Regular meetings were held to share updates and promote open communication across the service.

Staff described a friendly and supportive culture, with strong teamwork and a positive working environment. Staff were supported in their professional development and encouraged to keep their skills up to date.

An annual all staff survey was carried out between September and October 2025 by the provider. There was an 82% response rate, up by 1% from the previous year.

The top 3 positive findings included that staff knew where to get help at work if they felt their wellbeing was suffering (98%); Practice Plus Group embracing diversity (94%); and staff were treated fairly regardless of protected characteristics (94%). (Protected characteristics include race, religion or belief and disability.)

There were also positive responses for having access to information to do the job (91%, this was 2 percentage points lower than 2024); access to support and coaching required for development (81% this was 6 percentage points lower than 2024); and being aware of the overall goals and objectives of Practice Plus Group (89% this was 2 percentage points higher than 2024).

The bottom 3 negative findings were related to pay not being considered fair for the work a member of staff did (49%); senior management encouraging staff to discuss service line goals (49%); and support to achieve career aspirations (55%).

The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Staff survey results from the annual staff survey were positive about staff’s line managers. For example, 92% of respondents (out of an overall response rate of 82%) said that their line manager allowed them to make their own decisions; and 85% considered they received feedback to improve their performance.

However, 56% of respondents considered they had input into work related decisions which affected them (12 percentage points down from 2024).

Results from the provider’s staff survey were mixed on leadership. For example:

• 60% of respondents had confidence in the leadership provided by the executive team, (down 8 percentage points from 2024); 57% considered senior management were visible (no change from 2024).
• A total of 81% of respondents considered the executive team had clear set goals and objectives (up 5 percentage points from 2024). A total of 79% of respondents (up 9 percentage points from 2024) considered that teams worked together to achieve goals and objectives.

The provider had developed an action plan to work on areas which required improvement.

Staff interviewed reported that they felt leaders treated them with care and compassion. Support for staff was provided through regular appraisals, check-ins and open communication via meetings, messaging systems and emails.

Staff described a strong team culture, feeling respected, valued, and inspired by the leadership team and considered the network of peers within team and local operations was strong.

Comments included ‘that there is always room for improvement, and the organisation was good at listening to these and taking action – our voices, views and ideas are heard.’

The service fostered a positive culture where people felt they could speak up and their voice would be heard.

The Freedom to Speak Up (FTSPU) Guardian had received appropriate training to carry out their role. Staff could report concerns anonymously if they were concerned about being identified. Members of staff had been trained as freedom to speak up champions and wellness champions to support staffs’ wellbeing and enable them to raise any concerns or issues. Contact details of the FTSU Guardian were accessible for staff on the service’s systems and posters displayed in the call centre.

The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

Policies and procedures to promote diversity and equality were in place. We saw senior leaders had addressed concerns related to discrimination. Adjustments had been made to ensure all staff were valued, for example we saw adjustments to support disabled staff were in place. However, we received concerns from some staff that there were delays in getting equipment to assist them.

The service had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They act on the best information about risk, performance and outcomes, and share this securely with others when appropriate.

Practice Plus group had a nationwide contact centre network, which meant that at peak times calls could be re-directed to centres with available capacity. This assisted in minimising delays and helped to ensure that all people using the service received timely assistance, regardless of the caller’s location.

Leaders and managers supported staff, and staff we spoke with were clear on their individual roles and responsibilities. Managers met with staff regularly to complete appraisals and performance reviews. Staff could access all required policies and procedures. The provider had established governance processes that were appropriate for their service.

The service carried out a range of audits of service provision. This included clinical and operational work, staff had regular audits of telephone consultations. Audit tools were in line with requirements for audit of NHS Pathways users.

Audits included one on communication between health advisors and clinical advisors to assist with safe and appropriate flow of information. These audits also formed part of clinical supervision of clinical advisors

Another audit was carried out using end to end patient reviews to assess service provision; and audits were carried out in response to significant events and complaints.

Audits carried out were reported on in monthly quality assurance meetings to ensure management teams had oversight. When needed additional training and support were provided to address any shortfalls.

Teaching sessions focused on areas which affected service provision, such as updates on sepsis; safety alerts; and care and treatment. The sessions were held regularly and at set times to allow staff to make plans to attend. Staff received certificates following attendance at these sessions which t supported appraisal preparation and evidence of continued professional development. All teaching sessions provided an opportunity for case discussion and supervision

A range of meetings were held for clinicians bi-monthly which focused on case-based discussions gathered from interesting cases across all services the provider was registered to provide. The meetings were recorded for staff who were unable attend in person. Examples of cases discussed included compliance with 'No reply to a Triage/Advise telephone' protocol.

Clinical case discussion had recently been introduced to provide further opportunities for clinical supervision, support, guidance and education focusing on the NHS 111 clinical workforce. Clinicians were able to highlight cases they would like to discuss and provided an opportunity to share learning effectively.

There was a corporate Health Care Divisions Governance, Risk and Compliance Committee who monitored aspects of service performance, such as incident, complaints and supervision of staff. The committee also looked at staffing levels, recruitment and retention, and staff absence.

There was a business continuity policy in place. When we reviewed this, we found that it did not detail that the Care Quality Commission should be contacted in the event of an interruption to service provision. In line with the requirements of their registration providers are required to inform CQC of any event which stops the provision of a service.

Options were available should there be an interruption to service provision, such as if telephony systems failed. In which case calls could be diverted to other NHS 111 providers. Paper pathways could be invoked whilst awaiting activation of national contingency.

Managers had access to an incident response plan, which detailed actions to take dependant on the situation. This was supported by a command and control structure to mitigate the length of time it took to request national contingency if needed. Action cards were available at the call centre, which covered areas such as loss of the premises and system failures.

The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

The provider collated performance reports and met with commissioners on weekly and monthly meetings to discuss this information.

Performance date was submitted as required to NHS England through monthly Integrated Urgent Care (IUC) data collections, which track call volumes, speed of answer, and abandonment rates to measure efficiency, particularly during high-demand periods.

The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

Staff were supported to develop in their roles and take on new responsibilities. Learning needs were discussed in team meetings and identified in annual appraisals. The service encouraged professional development and career progression. Staff had completed training such as moving from Health Advisor to Coaches, management or training roles.

Throughout all pilots and projects, the service aimed to focus on the process and not the staff. This was because they had found it was not suitable to ask staff just to work faster, it was more the need to address the process that was preventing them from doing the process as effectively as possible.

Examples of learning and innovation included the introduction of a process in December 2025 for managing callers who were abusive, which included transferring to a recorded line informing the person that the call will be terminated.

The service was part of a pilot organised by NHS England to the uses of Natural Language Processing. This project aims to implement a Natural Language Processing (NLP) solution that accurately interprets user queries, enhances response relevance, and reduces the need for manual intervention. This should help to avoid delays and inaccuracies when interacting with digital systems which rely on rigid keyword-based searches or rule-based logic. NLP should have the ability to recognise different accents, enabling systems to interpret and respond to queries more effectively and intuitively, improving overall usability and operational efficiency.

The first part of the pilot focused on the reason for the call. People were asked the reason for their call, and the system routed them based on their response, for example: dental, repeat prescription, injury, or new symptoms.

The second part of the pilot, which has completed alpha testing (the initial phase) and is currently in the beta planning phase (the next stage before a product or service is released), focuses on demographic information of people who call the service. People will be asked whether they are calling for themselves or someone else, followed by their name, date of birth, and postcode.

Other areas included changing when their clinical workforce work times are to align with periods where activity is predicted to be higher; and removing people’s names from clinical queues so that decisions are based on presenting symptoms and priority to ensure people are assessed based on their condition, and not whether they need extra support such as translation services, as some times these types of calls were not always reviewed due to this.