Practice Plus Group Surgical Centre Portsmouth

On this page

• 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

Our rating of well led 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 knew of the vision and strategy of the service, which was to provide high quality service in a timely and effective way. Staff spoke passionately about the service they provided and were proud of the facilities they worked in and the care they could offer to patients. The service engaged, listened and involved staff and service users. The majority of staff we spoke with felt respected, supported and valued. There was a transparent and open culture where staff could escalate concerns and report incidents. Staff reported that the team was supportive and helped one another despite recent changes within the team. Staff expressed communication throughout the surgical centre as an area which could be improved on .

The executive board attended monthly governance meetings to engage in the hospital strategy and operational running of the hospital. Minutes of these meetings were shared with staff and other locations. The service promoted equality and diversity in daily work and provided opportunities for career development. Staff told us there was good working relationships within departments and the team was supportive. The service had a Human resource learning and development policy to ensure employees have consistent and fair access to relevant all training, learning and development opportunities during their employment.

Staff we spoke with told us leaders were approachable and visible and supported staff to develop their skills and take on more senior roles. The service had appointed a new Hospital director, and staff reported the change as good and positive. Staff told us managers were supportive and addressed any concerns raised. Managers completed staff competencies and signed these off.

The service had a clear management structure with clear lines of responsibility and accountability. The service was led by a hospital director who had overall responsibility for the service and was supported by divisional heads of governance, heads of nursing and professional leads and clinicians. The service had a recruitment process for senior leaders which included proactive candidate sourcing, application screening, presentation and competency based interview. The service had checks, and could effectively demonstrate, staff who worked for the service had the necessary skills and competencies to carry out their role. The service followed processes to ensure all surgeons working under practising privileges had the appropriate skills and competencies and received supervision and appraisals. The HR department made checks against the relevant professional registers and the Disclosure and Barring Services. All new staff were required to attend complete an induction programme. Nursing staff confirmed they completed an induction programme.

Prior to the inspection we were contacted by several staff across the service who had raised concerns about the culture within the department. Within the information shared with the CQC, staff described the culture as toxic and felt there was inequality within the roles. Staff told us they felt intimidated which led to to them not being able to perform their duties. Staff told us they felt bullied and demoralised and treated differently and unfairly. They felt their concerns weren’t addressed and they felt unheard by the senior management team. They stated that they felt unable to disagree or challenge for fear of reprisal and or punishment. During the inspection, the majority of staff we spoke with told us that following the change in management which happened pre-inspection, the culture had improved, and morale had gone up. However, some staff told us that communication from management was sometimes poor and there was still work needed to be carried out to improve communication within all departments. Staff also told us that they would appreciate the opportunities to develop their understanding of how other areas of the department worked so that patient pathway could be better understood. We fed this back to the service following inspection. We were told staff could report anonymously into the FTSU incident reporting log.

Leaders had the integrity, skills and abilities to run the service. They understood and managed the priorities and issues the service faced. There were a number of ways staff could raise concerns within Practice Plus Group. The service had a regional freedom to speak up guardian and 57 local champions who had completed their training and were available should staff wanted to raise any concerns. The service reported to the National Guardians Office and provided themes and trend reports quarterly relating to freedom to speak up. All staff knew who the hospitals freedom to speak up guardian was and how to make contact. Staff were given the opportunity to complete training modules if they wished to become champions. The service held training sessions for staff on freedom to speak up, incident reporting and kept an SOP which explained the process of raising concerns. However, at the time of inspection the service was in the process of developing their Freedom to Speak up policy which was within the final stages of completion.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

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

Staff at all levels were clear about their roles and understood what they were accountable for, and to whom . The service had a governance framework through which the service was accountable for continuously improving their clinical, corporate, staff and financial performance. The Healthcare wide governance committee reported directly to the executive board team. There were 8 departmental meetings which fed into the healthcare-wide governance committee. Some of these included, infection prevention and control, clinical education learning and development and decision making group. The patient safety and quality committee were made up of various sub-committees which included medicines optimisation and safety group, decontamination committee and patient safety group. Subcommittee meetings fed into the clinical quality and governance assurance meetings to ensure information was shared across all services and that staff were fully informed of any risks and safety concerns. The board of directors held monthly meetings to discuss companywide issues. We reviewed the clinical governance minutes and could see they were planned, structured and followed a set agenda and were thorough in their content. Topics including operational updates, incidents and practising privileges were discussed. The service held a several healthcare-wide governance meetings which took place quarterly with the leaders and the heads of departments. Information from these were shared to the staff via monthly meetings, daily huddles, and newsletters The service collected, analysed, managed, and used information well to support all its activities, using secure electronic systems with security safeguards. Computers were password protected.

Staff reported good multidisciplinary working with the medical, nursing, pharmacy and administrative staff working effectively together to achieve the best outcomes for patients. Staff worked with the local GP surgeries and would contact them should they pick anything up during a pre-assessment appointment. Staff told us that the GPs would always confirm telephone numbers and addresses with them. Staff told us that once a patient had been booked the GP practice had 5 working days to make sure this was confirmed and uploaded on the system. The service also received referrals from external high street brand opticians and other opticians for Ophthalmology.

The service worked with external partners which included the ICB, HealthWatch, local authorities and local trust and universities. The service engaged with the local clinical commission groups (CCGs) and the local acute NHS trust to plan services. The CCGs monitored the hospital’s performance for NHS patients at quarterly contract meetings. Leaders met with external partners to share information and learning. We reviewed meeting minutes for the contract review meeting and saw that the meeting covered quality and risk, operational update, diagnostic update and contract management. The hospital had good working relationships with the local NHS trust and service level agreements in place for emergency transfers, decontamination and pathology services.

Leaders had a genuine interest in developing staff abilities and skills to benefit the service. Staff we spoke with told us they could access development through leadership programmes.

The service had policies and procedures which were in date and reviewed annually to make sure they were current. Performance was measured against these policies in form of audits. The service undertook several Quality Improvement (QI) projects, some of which included Patient Boards, Dementia friendly site and staff recognition purple hearts. A Post Operative Helpline document was set up as part of QI project as the service had noticed an increased number of Datix’s surrounding patients being unable to get through to their current post operative helpline. This document provided patients with the contact numbers on discharge for post procedure concerns.

As part of the dementia friendly site project, all staff had now become dementia friends and taken part in the dementia bus training. Toilet seats, signage, clocks etc had all been changed to be in line with the Dementia friendly criteria. Another QI project, computer of wheels forward which was set up as the size of the workstation was delaying the discharge process. As a result, the ward was re-figured and computers on wheels were purchased which aided discharge times which led to the ward running more smoothly and timely. At the time of the inspection, the service had an ongoing project with Healthwatch Portsmouth to understand what could be improved as the urgent treatment centre, which we did not inspect on this occasion, was seeing a rise in aggressive patients.