Practice Plus Group Hospital, Plymouth

We carried out a short announced comprehensive inspection of the services on 9 and 10 November with a further telephone interview on 22 November 2022. We completed a further follow up inspection on 19 January 2023.

Practice Plus Group Hospital, Plymouth is an independent hospital that employs around 160 staff 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, 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 did not have a registered manager, the interim hospital director had made an application to be the registered manager and it was being considered. 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 13 and 14 July 2016 when the hospital was a different legal entity and managed by a different organisation. It was rated as outstanding overall with ratings of outstanding in caring and well led, alongside good in safe, effective and responsive. The previous rating included a joint rating for outpatients and diagnostic imaging service, we have rated them independently as part of this inspection.

Following this inspection our overall rating of this service was good. 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, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. 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. People had instant access to translation services and interpreters were available by phone or video using a portable tablet device.
• 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 medicines were stored securely. Intravenous medicines on the surgical ward were not stored securely in accordance with national guidance.
• Not all staff were in date with their mandatory training. There was not an effective governance process and oversight of training performance.
• There was a reduced ophthalmology service due to staffing levels.
• We were told learning from incidents was discussed but this was not always documented within meeting minutes.
• In outpatients, staff did not routinely receive a daily brief with key information to keep patients safe.
• Some people had to wait a long time for treatment. The hospital was not meeting referral to treat times in line with national guidance but were working hard to reduce the waiting times for patients.
• The provider did not have a robust system to respond to concerns about a person's fitness to practice. Where a person’s fitness to carry out their role was being investigated, appropriate interim measures were not taken to minimise any risk to people using the services. A risk assessment was not completed to evidence rationale, decisions and actions. Information was not shared with the location.