The + sign is meant to tell you that other access codes might need to be dialed to call that number. I am in Brazil and to place a call to the USA, I need to dial 0014 then 1-714-555-1212 from a public or private PSTN phone to reach my GV phone in the USA, or any other PSTN phone in the USA.
So from any UK PSTN phone you would dial 00-1-714-555-1212 to reach my GV phone in the USA or any PSTN phone in the USA.
Hope that explains it.
PS. By having the + sign setup in my contacts phone number on my cell phone the cell phone recognizes that if I am in a foreign country it needs to dial an access number and it does that automatically. By example if I were traveling in Argentina and my cell phone had a USA sim card and I wanted to call someone in the USA and their number was in my contacts list with the +1 in front of it, the access code would automatically be dialed when I selected that individual.