Practice Plus Group Hospital, Shepton Mallet

We carried out an announced comprehensive inspection of the services on 12 and 13 April 2023 with further telephone interviews on 25 April 2023.

Practice Plus Group Hospital, Shepton Mallet is an independent hospital that employs around 167 clinical and support staff plus 43 administrative staff on both full and part time basis and provides care to patients in the South West of England.

The hospital provides the following services: surgery (predominantly knee and hip replacement), general surgery, ophthalmology, gynaecology, ear, nose and throat (ENT), pain management, endoscopy, outpatients, and diagnostic imaging.

The service is registered with CQC to provide the following regulated activities:

• Diagnostic and screening procedures.

• Surgical procedures.

• Treatment of disease, disorder, or injury.

At the time of inspection, the hospital had a registered manager.

A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The hospital was previously inspected on 11, 12, 13 and 26 October 2016 when the hospital was operated by a different legal entity and managed by a different organisation. It was rated as outstanding overall with ratings of outstanding for all five key questions.

Following this inspection our overall rating of this service was good.

Surgery:

Our rating of this service went down. We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff understood how to protect patients from abuse. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept accurate care records. Staff knew how to report patient safety incidents.
• Staff provided good care and treatment and gave patients enough to eat and drink. Managers monitored the effectiveness of the service. Staff worked well together for the benefit of patients. Surgical services were routinely available six days a week. Audits were comprehensive, meaningful, and acted on.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait for treatment. Staff went above and beyond to make adjustments to help meet the needs of individual patients.
• Leaders had the skills and abilities to run the service and were visible and approachable. They supported staff to develop their skills and take on more senior roles. The service had a vision for what it wanted to achieve. Staff at all levels were clear about their roles and accountabilities. Risks were recorded effectively and monitored. Governance systems worked well.

However:

• Data used to give assurance of overall mandatory training compliance was incomplete.
• Staff competencies were monitored using a spreadsheet and it was not clear when staff had undergone their competency checks or when they were due to be re-checked.
• Patient feedback response rates from some areas, including post anaesthetic care, was poor.
• Staff were not always made aware of all relevant information about patients before admission to help facilitate safe and effective care and treatment.
• Not all patients received a Malnutrition Universal Screening Tool (MUST) assessment as part of their preoperative and preadmission assessments.
• Some staff felt meetings could be intimidating and centred around a blame culture when changes to processes had not gone smoothly.

The previous rating included a joint rating for outpatients and diagnostic imaging service, we have rated them independently as part of this inspection.

Outpatients:

Outpatients is a large proportion of hospital activity. The main service was Surgery. Where arrangements were the same, we have reported findings in the Surgery section.

We rated this service as good because it was safe, caring and responsive. We rated well led as requires improvement. We do not rate effective.

Our rating of this location went down. We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff understood how to protect patients from abuse. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. Staff knew how to report patient safety incidents.
• Staff provided good care and treatment and gave patients enough to eat and drink. Managers monitored the effectiveness of the service. Staff worked well together for the benefit of patients. Services were routinely available six days a week. Audits were comprehensive, meaningful, and acted on.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders had the skills and abilities to run the service and were visible and approachable. They supported staff to develop their skills and take on more senior roles. The service had a vision for what it wanted to achieve. Staff at all levels were clear about their roles and accountabilities.

However:

• Not all staff within the Ophthalmology and Outpatients Department were compliant with mandatory training.
• There was not suitable secure storage for staff clothing in the ophthalmology department.
• There was not oversight of the quality of data and systems used to monitor mandatory training compliance.
• Not all risks were recorded effectively and monitored.

Outpatients is a large proportion of hospital activity. The main service was Surgery. Where arrangements were the same, we have reported findings in the Surgery section.

We rated this service as good because it was safe, caring and responsive. We rated well led as requires improvement. We do not rate effective.

Diagnostic imaging:

Diagnostic imaging is a small proportion of hospital activity. Surgery was the main proportion of hospital activity. Where our findings on surgery, for example, management arrangements, also apply to other services, we do not repeat the information but cross-refer to the surgery service.

We rated this service as good because it was safe, caring, responsive and well led.

We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Most staff had updated their training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. The service managed safety incidents well and learned lessons from them.
• Staff provided good care and treatment. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients and had access to good information. Key services were available seven days a week when required.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

• Not all staff were up to date with their safeguarding adults training.