Practice Plus Group Hospital - Barlborough

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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

We looked for evidence that patients had good outcomes because their needs were assessed, planned for and reviewed. We checked that patient’s care, support and treatment reflected their individual needs, including protected equality characteristics, and that they were involved in decisions about their care. We also looked for evidence that leaders promoted a culture of improvement, where understanding outcomes, using audit and benchmarking information, and applying best practice informed everyday clinical work.

At our last inspection, we rated this key question as good. At this inspection, the rating has remained good because people’s outcomes were consistently positive. Care was delivered in line with national guidance and evidence‑based practice, multidisciplinary working was well coordinated, outcomes were monitored and benchmarked, and people’s feedback supported our findings.

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.

We scored the service 3. The service usually made sure patient’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them

Staff shared key information to keep patients safe during handovers. During the handover between the night and day teams, staff discussed each person’s needs, including those prescribed critical medicines such as oral diabetic medicines, recent pain assessments and pain relief given overnight, and mobility status. Staff also highlighted emotional wellbeing needs, such as a person with depression and anxiety who required reassurance during the night.

Staff assessed patient’s pain effectively and used recognised tools to do so. During the medicines round, staff asked people whether they were experiencing pain and offered appropriate analgesia. Patients told us their pain was well managed and that staff responded promptly when they requested pain relief. One patient said, “Yes, this was well handled. I struggled with the first type of tablets as they were making me nauseous, but they tried a few and found painkillers which suited me. I was given a supply to take home and a note for the GP, should I require more.”

Patients’ nutritional and hydration needs were supported as part of their overall care. Staff explained they used a “sip til send” protocol for patients who were nil by mouth before procedures, encouraging small sips of fluids when appropriate. Staff accommodated special dietary requirements, such as vegan or Halal meals, and sample menus were available in different languages. Staff tried to meet requests for items not listed on the menu and checked whether people staying longer needed alternatives. Modified diets were rare but planned for in advance, and the catering manager was trained in the International Dysphagia Diet Standardisation Initiative (IDDSI).

Patients were placed on appropriate pathways for their procedures, ensuring their pain and other perioperative needs were assessed and managed in line with their planned care.

We scored the service 3. The service usually planned and delivered patient’s care and treatment with them, including what was important and mattered to them. Staff did this in line with legislation and current evidence-based good practice and standards.

Staff followed up‑to‑date policies to plan and deliver high‑quality care in line with best practice and national guidance. All policies we reviewed included clear creation and review dates and referenced current national standards. Examples included the Sepsis Recognition and Response Policy and the Infection Prevention and Control Policy, both of which aligned with recognised guidance.

Staff had access to current clinical guidance. Noticeboards in clinical areas displayed up‑to‑date information for staff, such as Martha’s Rule, a patient safety initiative that supports early detection of deterioration by ensuring that concerns raised by patients, families, carers and staff are heard and acted upon.

The service contributed to national benchmarking and quality monitoring. It reported data to the Private Healthcare Information Network (PHIN), including patient activity volumes, length of stay, never events, Patient Reported Outcome Measures (PROMs), infection rates and levels of data submission. This supported transparency and enabled monitoring of performance against national indicators.

We scored this service 3. The service usually worked well across teams and services to support patient. Staff made sure patient only needed to tell their story once by sharing their assessment of needs when patient moved between different services.

Staff worked collaboratively across professional groups to support good outcomes for people. Doctors, nurses, allied health professionals and other healthcare staff communicated well and demonstrated mutual respect during ward rounds and daily activities. Staff described positive working relationships between medical and nursing teams, and several staff we spoke with commented positively on the strong teamwork on site and how this contributed to consistent, safe care.

Leaders delivered Civility Saves Lives training for all staff, this helped strengthen relationships between consultants, anaesthetists and theatre staff and reduced unhelpful behaviours and tensions. Positive cultural changes were reported within the theatre department and across professional groups.

Allied health professionals made a meaningful contribution to people’s care, particularly in supporting mobility, recovery and rehabilitation. Physiotherapy staff were actively involved in daily clinical decision making, including attending ward rounds and helping shape people’s rehabilitation plans.

Allied health professionals gave input when needed, so patients moved through care without delay. Dedicated discharge and rehabilitation coordinators worked closely with clinical teams and physiotherapists to ensure assessments were timely and that plans were communicated clearly across disciplines.

Multidisciplinary discussions supported decision making, particularly for patients identified as higher risk for procedures. Staff held multidisciplinary reviews and meetings where required to discuss treatment options and ensure continuity of care across teams and services. Ward rounds included the consultant, resident doctor, ward lead, pharmacy lead and physiotherapy lead, demonstrating a collaborative approach to planning and coordinating patients’ care.

We score the service 3. Staff supported patients to manage their health and wellbeing so they could maximise their independence, choice and control. Staff helped patients live healthier lives and, where possible, reduce their future need for care and support.

Patients received clear, practical information that helped them prepare for surgery, understand their recovery, and make decisions that supported better long‑term outcomes. Staff also provided procedure‑specific written guidance. We reviewed the total hip replacement booklet, which explained what to expect before and after surgery, gave mobility and exercise advice, advice on how people can manage their daily activities, and highlighted signs of concern to monitor.

Patients received tailored support to promote safe recovery and independence. We saw a nurse‑led discharge letter in the day case unit that included advice on wound care and pain relief. The lead physiotherapist told us they encouraged early mobilisation and aimed to avoid the routine use of mobility aids, where safe, to reduce the risk of people becoming dependent on them. The physiotherapy team also showed us the patient information booklets they issue to service users.

The discharge and rehabilitation coordinator showed us a set of leaflets outlining community support available in each county, and confirmed these were offered to patients on discharge to help them access appropriate services close to home.

We scored the service 3. The service monitored patient’s care and treatment to continuously improve it. Staff ensured outcomes were positive and consistent, and they met both clinical expectations and the expectations of patient themselves.

The service monitored the effectiveness of care and treatment through a structured programme of audit, benchmarking and routine performance reporting. Leaders used these findings to assure quality, identify risks and drive improvements, and the service achieved consistently good outcomes for patients.

The service had a comprehensive clinical audit programme that supported continuous monitoring of outcomes and improvement in care. Recent audit results showed consistently high compliance, with several areas scoring 98% to 100%, including consent, antimicrobial prescribing, aseptic non touch technique (ANTT) and WHO checks. Leaders reviewed audit outcomes, and any shortfalls triggered action plans and repeat audits to ensure improvements were implemented.

Performance checks with commissioners showed strong results for the level of activity. Regular reports showed the provider consistently sent high‑quality data, including incidents, cancellations, readmissions, infection control information, complaints and patient feedback. Stakeholders said performance was positive, with low unplanned returns to theatre, low transfers and readmissions, and high Friends and Family Test scores across all surgical services. They also said the service worked well with them, communicated openly and responded quickly to requests.

Readmissions and unplanned returns to theatre were low. Between January 2025 and January 2026, the service reported 46 unplanned returns to theatre out of 6,095 procedures (0.75%), which was low relative to the volume and complexity of elective activity undertaken.

The service participated in the national Surgical Site Infection (SSI) Surveillance Service. SSI rates were low. Although the service was the only NHS treatment centre with inpatient SSIs, it also performed the highest volume of hip and knee replacement surgery nationally, increasing the likelihood of SSIs due to activity scale. Surveillance was completed across four consecutive quarterly periods, exceeding the minimum requirement. Leaders monitored SSIs closely and acted promptly to reduce risk.

The hospital participates in National Joint Registry (NJR) and achieved Gold status in the 2025, demonstrating sustained standards of patient safety in joint replacement surgery.

We scored the service 3. The service told patient about their rights around consent and respected these when delivering person-centred care and treatment.

Staff supported patients to make informed decisions about their care and treatment. They followed national guidance on consent and understood their responsibilities under the Mental Capacity Act 2005 (MCA). Staff knew how to support people who lacked capacity to make their own decisions.

Staff understood how and when to assess whether a patient had capacity to make decisions about their care. They told us concerns relating to mental capacity were usually identified during the preoperative assessment, and the consultant performing the procedure completed the assessment when needed. Staff followed the service’s policies on consent and mental capacity.

Consent was gained in line with legislation and national best practice. Consent for surgery was obtained by the most appropriate doctor and included discussion about the benefits, risks, potential complications and alternative options. Consent was treated as a continuous process rather than a single signature, and patients had opportunities to ask questions at several points before surgery. Consent was confirmed again on the day of the procedure, and staff checked this immediately before patients went to theatre. We saw consent forms in patients’ medical records, and staff confirmed these during their pre‑procedure checks.

The service had an updated consent policy that reflected national best practice and the requirements of the Mental Capacity Act 2005. The policy set out a two‑stage consent process for planned procedures and described what constituted valid consent, including the need for information to be accessible and easy to understand. It made clear that delegated consent was only permitted for staff who were trained, competent and authorised, and that the clinician performing the procedure remained responsible for ensuring consent was valid. Governance arrangements included mandatory training, audit, incident monitoring, complaint review and a two‑year policy review cycle. Staff compliance with consent training was high, at 98%.

Patients were involved in decision making at all levels. We observed staff seeking verbal consent before providing any care or intervention, including when taking observations and inserting cannulas.

Patients told us they were involved in decisions about their care and could describe the risks and benefits discussed with them before surgery. One patient told us they were “kept informed at all stages of the procedure, from the consultations to just before and after the op. Doctors explained things in layman’s terms, and they answered any questions I had.”

Communication support was accessible. The service supported patients who could not speak or who spoke very little English by using alternative communication methods and professional interpretation to help them understand their care and treatment. Leaders told us the service used professional interpreters, including telephone and face‑to‑face interpretation, to ensure patients could give informed consent. Professional interpreters were used for British Sign Language when needed. The service had patient information leaflets available in its most used languages, and staff did not rely on relatives to interpret during consent discussions.