Practice Plus Group Hospital - Barlborough

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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 of an inclusive and positive culture of continuous learning and improvement that focused on meeting the needs of patients who used services and the wider community. We checked that leaders supported staff, promoted openness and transparency, and worked in partnership with others to deliver care that was safe, integrated, person‑centred and sustainable, while taking action to reduce inequalities.

At our last inspection, we rated this key question as good. At this inspection, the rating has remained good because leadership, governance and culture were effective. Leaders understood the challenges facing the service, supported staff well and encouraged learning and improvement. Robust governance arrangements, clear accountability, effective use of data and partnership working supported the good organisation, oversight and delivery of care.

We have not awarded this service a score for Well-led.

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

We scored the service as 3. 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 patient and their communities.

The service was focused on meeting the needs of patients receiving care and staff worked within an open and supportive culture. Patients, their families and carers, as well as staff, could raise concerns without fear. Staff we spoke with said they felt respected, supported and valued. They described an inclusive leadership culture and told us they felt listened to and treated fairly. Relationships between staff of all grades were positive, with strong teamwork and collaboration evident across the service.

Leaders and staff described a shared vision and strategy which had been developed locally to strengthen culture, communication and leadership. These principles were created following multidisciplinary engagement and focused on what mattered most to staff and patients.

Staff were kept informed and supported during organisational change. Staff told us the provider’s hospitals were acquired by a new healthcare group in November 2025. Leaders described how early feedback from staff about the acquisition had been positive. Staff we spoke with reported minimal anxiety about the change and said they felt reassured by the clear communication.

People’s views were valued and used to inform improvement. The service had multiple ways of gathering patient feedback, which supported an open and responsive culture. Leaders described how feedback from people using the service was encouraged and used to help inform learning and improvement.

Staff knew how to raise concerns and felt able to do so. Staff we spoke with were aware of how to raise concerns if needed. This included speaking with their line manager or using the freedom to speak up (FTSU) guardian. Staff told us they felt confident that concerns would be listened to and addressed appropriately.

We scored the service as 3. The service had leaders 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 and understood the impact their behaviours and leadership had on patient outcomes and experience.

Leaders had the skills, knowledge and experience to lead the service effectively and understood the priorities and pressures it faced. Staff and managers told us leaders were visible in clinical and non‑clinical areas and were approachable. Staff said they felt able to speak with leaders openly, raise concerns and seek guidance when needed.

Leaders understood the impact of their behaviours and leadership on staff culture and patient experience. Staff described leaders as supportive and respectful, which contributed to a positive working environment.

Leaders supported staff development and promoted inclusive leadership practices. Staff told us they were encouraged to discuss their learning and development needs with managers and were supported to access additional training or courses where appropriate. Staff said managers supported them to develop professionally and, where appropriate, to take on more senior roles.

Feedback from staff and people was used to inform leadership decisions and improvement. We saw feedback from patient surveys was reviewed and acted on, with actions shared through “you said, we did” boards displayed in the service. This showed leaders valued feedback and used it to improve people’s experiences.

The 2025 “Over to You” staff survey showed generally positive responses across leadership themes. Staff reported confidence in their line managers, felt encouraged to contribute ideas for improvement, and said they received feedback that helped them improve performance. Staff also reported feeling treated with respect and fairness, and survey results reflected confidence in senior leaders setting clear organisational goals aligned with the organisation’s values.

We scored the service as 3. The service fostered a generally positive culture where people felt they could speak up and their voice would be heard.

Staff and leaders acted with openness, honesty and transparency. Staff were encouraged to raise concerns and offer ideas, and the culture supported staff to be confident their voices were heard.

Staff told us they felt able to raise concerns with their managers and were confident these would be listened to and acted on. Staff said they could speak up without fear of detriment.

Leaders created an environment where staff felt supported to raise concerns, and they demonstrated appropriate oversight of how these were managed.

The service had clear mechanisms to support staff to speak up, including access to Freedom to Speak Up (FTSU) roles. Leaders told us 3 FTSU related matters had been raised in the past 12 months. Two concerns were addressed locally, and one progressed to a formal grievance following discussion through the FTSU process. Leaders said they had not identified any recurring themes, and no concerns had required escalation beyond the service during the past year.

Leaders supported staff engagement with FTSU through regular meetings, where learning was reinforced using scenario‑based discussions. We saw information displayed across the service regarding FTSU, and staff were signposted to the FTSU Champion during daily operational meetings.

The FTSU Champion attended quarterly FTSU meetings, where mock scenarios were reviewed to support ongoing learning. We observed FTSU posters were displayed throughout the service, and during the daily manager’s meeting FTSU Champions were identified for the day.

We scored the service as 3. The service valued diversity in their workforce. Staff work towards an inclusive and fair culture by improving equality and equity for everyone.

The service valued diversity and promoted an inclusive and fair culture for its workforce. Staff we spoke with told us that, although they did not currently require workplace adjustments, they were confident managers would support them with reasonable adjustments if these were needed in the future.

Results from the 2025 staff survey showed that most staff felt diversity was actively embraced and that people were treated regardless of protected characteristics. Staff reported that reasonable adjustments were made for disabled colleagues and that line managers were inclusive in their approach. Many staff described a strong sense of belonging within the service.

Staff we spoke with told us they had not experienced bullying, harassment or discrimination. Survey results showed staff felt confident to report concerns about bullying and harassment if these arose. However, not many staff had reported incidents of bullying or harassment. Whilst this could be seen as positive, it may also indicate an opportunity for leaders to continue strengthening psychological safety and staff confidence in reporting outcomes.

Clear policies supported equality, diversity and inclusion. The service operated in line with a corporate equity, diversity and inclusion policy. This set out expectations for fair treatment, dignity and respect, the prevention of discrimination, harassment and victimisation, and the responsibilities of leaders and staff. The policy included processes to support reasonable adjustments, address concerns and monitor workforce equality. Leaders described how this policy underpinned inclusive behaviours and decision‑making within the service.

We scored the service as 4. The service had clear responsibilities, roles, systems of accountability and effective governance. Staff used these to manage and deliver high-quality, sustainable care, treatment and support. Staff always acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.

The service had a local governance framework to support oversight and accountability. The service was supported by a range of governance and operational groups, including clinical governance, health and safety, infection prevention and control, patient experience, weekly multidisciplinary meetings to review complex patients, consultants’ specialty meetings, the senior management team, heads of department meetings and departmental meetings.

These groups met regularly to review incidents, risks, audit findings, patient feedback and performance information. Leaders ensured learning was shared within the service and monitored actions to confirm improvements were sustained.

Every two months, the service held a clinical governance day. No scheduled clinical activity took place during this time, which created protected time for governance meetings, departmental discussions, consultants’ specialty meetings and staff training.

Staff at all levels were clear about their roles and accountabilities, and leaders supported effective governance and oversight. Staff we spoke with understood their responsibilities and role expectations. Senior staff with designated responsibilities for audit and quality monitoring were clear about what was required of them and how they contributed to oversight of the service.

Leaders used accurate information to support safe and effective care. The service consistently submitted required data and notifications to external organisations. This included contributions to national data collections such as NHS England’s Learning from Patient Safety Event system, the Private Healthcare Information Network and the National Joint Registry.

Leaders shared key information with staff through regular meetings, daily huddles, unit briefings and internal communications. This helped ensure staff were kept informed about performance, risks and areas for improvement.

Risks were identified, monitored and managed. The service maintained a formal risk log, which supported oversight, mitigation and resolution of risks.

Managers used audit and quality monitoring to improve quality and safety. For example, results from the infection prevention and control ward environment and practice audit improved from 87% in September 2025 to 96% in December 2025, demonstrating effective action and monitoring.

Leaders maintained oversight of policies and governance arrangements. We reviewed a selection of service‑level and provider policies and found these were up to date. Leaders had oversight of the accuracy and validity of policies, including the clinical governance policy. This described a clear governance framework from frontline services to board level and set out roles, responsibilities and committee structures that supported learning, risk management, audit, patient safety and regulatory compliance.

The service demonstrated a clear commitment to environmental sustainability and reducing its carbon footprint. Leaders told us the hospital was moving towards being paper‑light, with longer‑term ambitions to further reduce paper use in line with the organisation’s future direction. The service had an established Net Zero Group, led by a designated lead and supported by representatives from multiple departments, which oversaw sustainability initiatives. Over recent years, the service had implemented a wide range of environmental improvements. These included replacing plastic carrier bags with reusable canvas bags for linens. The service also ceased the use of desflurane anaesthetic gas due to its high greenhouse gas impact, and upgrading lighting to energy‑efficient LED systems. The service had reduced single‑use plastics in catering areas by introducing paper cups, recyclable foil containers, and limiting cling film use. Kitchen waste was actively managed through food waste recycling, separation of plastics, and recycling of items such as yoghurt pots and jam portions. Staff were issued with reusable water bottles, encouraged to bring their own cups through incentive schemes, and supported to adopt environmentally responsible behaviours through initiatives such as recycling education, ‘switch it off’ campaigns for lighting and heating, sourcing catering supplies locally, and participation in the corporate Cycle to Work scheme.

We scored the service as 3. The service understood their duty to collaborate and work in partnership, so services worked seamlessly for patient. Staff shared information and learning with partners and collaborate for improvement.

Leaders understood their duty to work in partnership and collaborated with commissioners, providers and local authorities to support coordinated and safe care for patients.
The service worked with NHS and independent partners through regular contract and governance meetings. These arrangements supported shared oversight of activity, quality and access, and helped services work together to manage waiting times and patient pathways.

The service worked with local authority teams to support continuity of care and patient safety in the community. Staff told us they referred people to social services when required and liaised with relevant local authority teams. This helped ensure people received appropriate support following discharge and that concerns about safety or wellbeing were shared and managed appropriately.

The service shared learning with partners and worked collaboratively to support improvement. Joint governance meetings were used to review incidents, infection prevention and control, and quality matters. Partners described open discussions and agreed actions, which helped address issues and monitor improvement.

Partnership working supported continuity of care for people. Partners described clear patient pathways, effective multidisciplinary working and established escalation and emergency transfer arrangements with nearby acute hospitals. These arrangements supported safe transitions and coordinated care for people.

We scored the service as 3. The service focused on continuous learning, innovation and improvement across the organisation and local system. Staff encouraged creative ways of delivering equality of experience, outcome and quality of life for patient. Staff actively contribute to safe, effective practice and research.

Staff and leaders were committed to continual learning and improving services.
There were clear processes in place to support learning when things went wrong and to share good practice. Staff we spoke with told us they were provided with feedback following incidents, including learning identified and changes made to improve practice.

Leaders actively supported innovation and improvement that benefited patients’ experiences and outcomes. Leaders and staff explored the Magnet model, commonly used in acute hospitals to improve staff engagement and patient outcomes. The service developed its own adapted approach, known locally as the “Five I’s” and “We Will” principles, to reflect the service’s context and values.

Leaders and staff held multidisciplinary meetings to understand what mattered most to staff when they, or their loved ones, were receiving care in hospital. Feedback gathered from these discussions was analysed and developed into shared core principles focused on improving communication, compassion and leadership across the service.

To support this cultural change, leaders delivered Civility Saves Lives training for all staff. Leaders told us this training strengthened working relationships between consultants, anaesthetists and theatre teams by reducing unhelpful behaviours and professional tensions. Leaders described positive cultural changes within the theatre department and noted more respectful, collaborative working across different professional groups.

Staff told us these improvements led to a more cohesive and supportive working environment. Leaders reported that patient outcomes and patient feedback had improved as a result, demonstrating a clear link between leadership‑led improvement activity and patients’ experiences of care.

Staff were supported to develop their skills and contribute to improvement and innovation. Staff told us they were encouraged to develop professionally and pursue areas of interest within the service. This was supported through clear objectives set at annual appraisals and ongoing managerial support to achieve these goals. Staff described being given time and encouragement to reflect on practice, learn from improvement work and contribute ideas to enhance the service.