Practice Plus Group Surgical Centre Portsmouth

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Our rating of safe stayed the same. We rated it as good.

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.

Staff recognised incidents and near misses and reported them appropriately. Staff told us they were encouraged to report concerns and safety events. Leaders told us they investigated incidents and shared lessons learned with the whole team and the wider service. Staff told us learning from incidents was shared via daily multi-disciplinary team huddle and monthly bulletins. However, some staff commented that this was not always the case and staff were not always made aware of learning from incidents.

The service reviewed incidents at weekly incident meetings and monthly clinical governance meetings. We reviewed the clinical governance minutes which showed evidence of incidents being reviewed every month. We saw evidence of themes and trends being discussed and learning from incidents being shared. The service released monthly bulletin for each department which highlighted issues, changes and updates. In the case of a never event, the service issued 48 hour flash bulletin to all staff. We saw evidence of this following a recent wrong lens implantation . The flash included initial actions which were undertaken following the event with a note that further learnings would be shared once these had been identified. There were clear open and transparent processes for reporting and learning from incidents. When things went wrong, staff apologised and gave patients honest information and suitable support. Leaders ensured that actions from patient safety alerts were implemented and monitored. Staff received training on Patient Safety Incident Response Framework (PSIRF). The PSIRF sets out the NHS’s approach to developing and maintain effective systems and processes for responding to patient safety incidents for the purpose of learning and improving patient safety. The service had a patient safety incident response policy which set out the company’s approach to developing and maintaining effective systems and processes for responding to patient safety incidents and issues for the purpose of learning and improving patient safety. The service managed patient safety incidents well and monitored results to improve safety. The Duty of Candour requires healthcare providers to disclose safety incidents that result in moderate or severe harm, or death. Organisations have a duty to provide patients and their families with information and support when a reportable incident has or may have occurred. Staff received training on duty of candour.

Patients confirmed they attended a pre assessment appointment prior to their admission. We reviewed the comments received through the friends and family test. Patients commented on the smooth transition from theatre to recovery back to the ward.

Leaders described positive relationship with partners which included the Integrated Care Board (ICB) and the local acute trust. Staff told us patients were risk assessed to make sure only those that were suitable received treatment at the centre. Leaders told us the service did not have a dedicated resus team, and staff were trained in Advanced Life Support and Basic Life support in the case of an emergency. These individuals were named at the daily huddle and names written on the huddle board. Staff told us patients were transferred to the local trust in the case of emergencies. The service reported they had transferred 3 patients in the last 6 months.

We could not collect sufficient evidence to score this evidence category.

The service obtained feedback about people’s experience through their comment card. Patients received this after each admission, and the responses were reviewed at monthly Clinical Committee meetings. Leaders at the service acted on this to drive improvements for the service. Staff followed the organisation guidelines on how to identify and report incidents. Staff used the reporting system to report incidents. Policies and procedures were readily available, and staff knew how to access these. Staff demonstrated a comprehensive approach to identifying and supporting children and young people with learning disabilities, autism, and mental health conditions. Patient risks were reviewed, and patients were appropriately monitored during their stay. Staff in the operating theatres and treatment centre followed the World Health Organisation Surgical Safety Checklist and five steps to safer surgery and monitored this to make sure this was completed accurately. Post operatively the centre used a nationally recognised Early Warning Score to identify patients who were at risk of deteriorating. This included observations of vital signs and the patient’s wellbeing to identify whether they were at risk of deteriorating. The scoring system provided guidance for staff about what action to take if the patient was at risk of deteriorating . Review of patient records showed that staff was following this. The service kept a sepsis recognition and response policy which outlined the actions needed to be taken for patients with suspected or confirmed sepsis. This document was in date and due for a review in June 2026. The service had a service level agreement in place with the local trust and transferred patients out to the trust in the case of an emergency. Staff had access to the escalation protocol for deteriorating patient which clearly outlined the organisational response required in dealing with different levels of abnormal physiological measurements and observations.

Staff told us they received safeguarding training as part of their mandatory training. Staff demonstrated, through conversations, a good understanding about safeguarding processes and the action they needed to take if they suspected a patient was exposed to or at risk of being exposed to abuse. However, staff we spoke with did not have any examples of when they had had to follow safeguarding procedures.

The service had a safeguarding lead. All staff employed within Practice Plus Group Health Care Services undertook mandatory Safeguarding Children/young people and adult training in accordance with the latest guidance. We reviewed the training data which showed compliance with safeguarding adults and children level 1 and 2 mandatory training was 100% across the treatment centre. However, compliance with safeguarding adults level 3 was 66% for theatres and 80 % for endoscopy. Safeguarding level 3 training had been booked for the five outstanding staff members in November 2024. The service kept a safeguarding children and safeguarding adult policy which were both in date. The policy aimed to provide procedural guidance and direction for the implementation of high quality safeguarding services for children, young people and adults. The service had a chaperone policy which was in date and due for a review next year. The purpose of this policy was to ensure that patients’ safety, privacy and dignity was protected during intimate examinations or procedures, and during delivery of intimate clinical care interventions and minimise the risk of any action being misinterpreted. The service also kept a domestic violence and abuse supporting Practice Plus group staff policy which contained links and contact details for a 24 hour national domestic violence helpline. Data showed that from April to September 2024, the service had made 61 safeguarding referrals to the local authority. In the same time period, the service reported 8 safeguarding incidents. The service completed safeguarding compliance audit. We reviewed this for the month of April which had a score of 66.7%. As a result of this, the service had identified three actions plans with a completion date. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff received training on how to recognise and report abuse and they knew how to apply it.

We reviewed patient comment cards as part of the information request. Patients commented that the service had “a good smell of hygiene” when they arrived. Another patient commented on the environment being very hygienic. They also commented on the environment being clean and safe. The waiting environment was described as “quiet, private and clean” by service users and their families.

Staff carried out daily safety checks of specialist equipment and ensured servicing was up to date. Staff told us there were backups in place as the service used a lot of equipment. Staff told us they were able to put forward a business case if they required new equipment and we saw evidence of this.

The service was safe, clean, well equipped, well maintained and fit for purpose. The stock room appeared organised, and we saw evidence of a weekly checklist. Equipment was visibly clean. Items we checked were labelled with the last service date and review date. They also had an asset number for ease of tracking for servicing or maintenance. All signage was found to be compatible for visually impaired patients. The design of the environment followed national guidance. The service had enough suitable equipment to help them to safely care for patients. The service had suitable facilities to meet the needs of patients’ families. The waiting area was spacious and had comfortable seating areas and drinking water. Resuscitation trolleys were kept on the ward and in theatres. We saw staff checked these daily.

The service carried out fire testing once a week and Portable Appliance T esting (PAT) tested all equipment. The provision of medical equipment maintenance was carried out by an external company. The service carried out cleaning and environmental audits for different areas within the department. For areas which scored less than a 100 %, an action plan was set up as a result. For example, on September, four corrective actions were commenced because of the cleanliness audit in the urgent treatment centre . Review of the action plan showed that these had been completed. In addition to this, the service completed a Health and Safety and Environment Departmental Audit Tool. The service kept an audit action plan tracker and reviewed this monthly with actions and a completion date. The service had a service level agreement with an external company for the disposal of clinical waste. Results published in February 2024 from Patient-Led Assessments of the Care Environment (PLACE) resulted in scores of 100% for cleanliness of the environment. Housekeeping staff made sure areas were clean and updated cleaning records. We saw complete cleaning records which were dated and signed. Staff disposed of clinical waste safely. Used scrubs were collected daily at the end of the day. The on call manager provided access to the stock room if staff required clinical supplies out of hours. We saw that the stockrooms for the surgical service were well organised and clearly laid out. All equipment was stored off the floor to ensure cleaning could be carried out effectively. Staff told us the service was looking at installing a barcode system in the future.

Staff told us they were up to date with their mandatory training and managers reminded staff to complete these. Leaders told us the service had a close working relationship with the local Universityto ensure that students were provided with the necessary practical exposure within the department, to enable a deeper understanding and to build confidence. The service had received positive feedback from student radiographers who had completed their practical placements with the hospital. Leaders told us that the service was currently in the process transitioning to utilising one of their bank nurses who had extensive practice education and development experience as a senior educator across the NHS to support their managers and mentors with employee practice education.

The service had enough nursing staff and medical with the right qualifications, skills, training and experience to keep patient's safe from avoidable harm and to provide the right care and treatment. We viewed staffing rotas which showed staffing in theatres met the guidelines from the Association for Perioperative Practice (AfPP). Staff confirmed there were always sufficient numbers of staff on duty. The hospital used their own bank staff and agency staff to cover staff sickness and annual leave. Staffing levels were looked at in advance and discussed at the weekly booking meetings in order to ensure theatres had enough skilled staff to provide appropriate care and treatment.

Managers regularly reviewed staffing levels and skill mix. In addition to mandatory training, the service provided additional training to staff in Oliver McGowan Mandatory Training on Learning Disability and Autism and Prevent radicalisation. New starters received an employee induction checklist. The induction was planned over 12 weeks and provided staff with the opportunity to learn about the service and how they worked. The service also had an Induction Policy for temporary, agency and locum staff. We reviewed five staff records which included Disclosure and Barring Service DBS, revalidation, references, qualifications and NMC registration and found these to be completed and up to date. The service had a Human resources recruitment and selection of medical staff policy which covered the recruitment and selection of medical staff (that is all roles that necessitate General Medical Council (GMC) and General Dental Council (GDC) registration), including employed doctors, Locums, Bank and non-agency temps. This document was in date with a review date of 2025 at the time of our assessment. In addition to this, the service kept a Recruitment and Selection Policy for all applicants, bank workers, volunteers, contractors, self-employed individuals, and employees of the Company. The hospital employed practice supervisors and practice educators who supported students and staff with training and development. Data showed a number of staff in different departments within the hospital who were enrolled for Practice Educator and Assessor Preparation (PEAP) programme. The service provided practical placement opportunities for a number of students studying various health care qualifications including student nurses, student paramedics and student radiographers. Information provided by the service showed that endoscopy and medical wards were complaint with their mandatory training with the exception of theatre which had a compliance rate of 87.72%.

Staff told us they had received infection control training as part of their mandatory training and received refresher training on this.

Staff adhered to the 'bare below the elbows' policy when providing care and treatment. Disposable aprons and gloves were readily available. Staff used them when delivering care and treatment to patients to reduce the risk of cross infection. The service had wall mounted PPE in place, and we observed excellent hand hygiene by several different staff during inspection. Storage bins were correctly labelled and assembled with temporary closures in place. Decontamination was carried out offsite at the local acute trust. We observed cleaning schedules to be signed and dated. Linen was observed to be correctly stored in plastic lidded box to prevent contamination.

The service controlled infection risk well. Staff used equipment and control measures to protect patients, themselves and others from infection. They kept equipment and the premises visibly clean. There were reliable systems in place to prevent and protect people from a healthcare-associated infection that were in line with national guidance. There was an Infection Prevention and Control lead Nurse (IPCN) for the service that supported infection control link staff from each department. Infection prevention and control audits of the environment on the ward area and theatres were carried out on a rolling programme over the year. The service carried out hand hygiene audits as part of their audit program. We reviewed the audit for the ward for the month of April, May and October which scored 100%, 96% and 100%. The service developed an action plan to drive improvement when results didn’t show compliance. Staff received training on Advanced life support, immediate life support and Basic Life support. Data supplied by the service showed compliance for Basic life support to be 100% across the service. Compliance for advanced life support training was 100% for endoscopy. Staff also attended presentations on the aseptic non-touch technique and how this was relevant to clinical practice.

Staff told us they received a full medicine list for patients who were referred by their GP. Patients who were privately referred brought their own rep slip. In addition to this all patients had to complete a self-assessment questionnaire. We were not assured that there were processes in place for the management of critical medicines for patients receiving day surgery. For example, we were not assured patients who had been prescribed critical medicines (such as insulin and anti-Parkinson medicines), could access these whilst at PPG awaiting or after surgery as required. Staff told us there was no process for this. Medicine related incidents were reviewed by the pharmacy team and the department manager. Staff told us they had received training in SEIPS/PSRIF investigation and were part of small MDT huddles where they shared learning. The pharmacy team were not part of the MDT meeting at present but were able to access the notes on the MDT tracker. The pharmacist issued TTO packs and FP10s for NHS patients. In the absence of the pharmacist the nurses and surgeons issued these from prescription. Nursing staff told us they had access to ‘Unit 4’ which was the system for ordering from Sigma who provided all in over labelled TTO stock to the service.

There was a pharmacist who was employed 3 days a week and responsible predominantly for stock management and medicines governance within the service. There was a lot of scope to utilise their clinical expertise, to improve patient care and experience, with greater involvement inpatient admissions, pre-op MDTs and the discharge of patients. All prescribers could access the medicine cabinets for dispensing via a unique user PIN and QR code. There was a manual override for the locking/unlocking of the medicine cupboard doors and keys were held in the key safe. All drug cupboards were locked when not in use. We found the clinical room and storage room to be organised and tidy. The service kept four resus trollies within different areas of the hospital.

The service employed a chief pharmacist who lived locally and could provide emergency cover. There were systems in place to ensure the ongoing supply of medicines. However, the process was reliant on the very small pharmacy team, with no contingency planning in place, should one or both members of the team be off. We were not assured that there was a clear system for the management of critical medicines for patients receiving day surgery. We requested this as part of the additional data requests and did not receive any evidence of this. Antimicrobial stewardship was a driving factor in prescribing antibiotics, audits were undertaken and actions taken to make improvements when required. The provider had not updated the Controlled Drugs Accountable Officer details held on the CQC register, this was rectified following the inspection. Controlled Drugs (Supervision of Management and Use) Regulations 2013 sets out the requirement for occurrence reporting. Organisations are required to submit a quarterly report via the Occurrence Reporting module on the CD Portal. These reports were not up-to-date at the time of the assessment. However, were completed retrospectively having highlighted this to the provider. There was a suite of policies and procedure in place for the management of medicines. However, these were generic / corporate policies and not tailored to the service, for example as a day service, how time critical medicines administration would be manage in the absence of a routine ‘meds round’. There was a process for clinical mentorship and audit of Non-Medical Prescribers (NMP), however oversight wasn’t evidenced in terms of audit or supervision. This had been undertaken follow inspection. Controlled drugs were managed well. However, audits of theatre did highlight some ongoing issues with record keeping. For example, for the month of June, the entries in the CD register were not always fully completed for the sample CD orders.