Foxhayes Practice

Updated 19 March 2018

Foxhayes Practice provides primary medical services to people living in the city of Exeter and the surrounding villages. The practice has one location, which we inspected:

117 Exwick Road

Exeter

Devon

EX4 2BH

Tel: 01392 208789

Website: www.foxhayespractice.nhs.uk

At the time of our inspection there are approximately 3,400 patients registered at the Foxhayes Practice. The practice population area is in the fifth decile for deprivation. In a score of one to ten the lower the decile the more deprived an area is. There is a practice age distribution of male and female patients equivalent to national average figures. Average life expectancy for the area is similar to national figures with males living to an average age of 79 years and females to 83 years.

The practice is unusual in that it was established ten years ago by two full time partners; one GP (male) and the other an Advanced Nurse Practitioner (female). In addition there is a male locum GP who works every Friday. The GPs are supported by two other female registered nurses, one of whom is also an advanced nurse practitioner, a female health care assistant and additional administrative and reception staff.

The practice supports four residential and nursing homes in the area. Patients using the practice also have access to community staff including district nurses, health visitors, and midwives. The practice holds a primary medical services contract.

Foxhayes is an approved training practice providing vocational placements for GPs and medical students. The GP partner is approved to provide vocational training for GPs, second year post qualification doctors and medical students. A GP registrar was on placement at the time of the inspection.

Foxhayes Practice is open from 8am-6pm Monday and Friday. As per local arrangements, outside of these hours a service is provided by another health care provider by patients dialling the national 111 service. On Wednesday and Thursday the practice is open from 8.30am until 6pm. The practice is a founding member of Exeter Primary Care (EPC), a federation of all 16 Exeter GP practices. The EPC group organise increased GP access outside of core hours. All registered patients are therefore able to be seen by appointment by an Exeter GP, with read-only access to their medical record upon consent, at an Exeter GP practice between Monday and Thursday 6.30pm until 8pm and Saturday and Sunday 9am and 5pm. Information regarding this service is displayed in the practice on a weekly basis and explained when patients book their appointment.

Updated 19 March 2018

Letter from the Chief Inspector of General Practice

This practice is rated as Outstanding overall. (Previous inspection November 2014 – outstanding)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Outstanding

Are services responsive? – Outstanding

Are services well-led? - Outstanding

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Outstanding

People with long-term conditions – Outstanding

Families, children and young people – Outstanding

Working age people (including those retired and students – Outstanding

People whose circumstances may make them vulnerable – Outstanding

People experiencing poor mental health (including people with dementia) - Outstanding

We carried out an announced comprehensive inspection at Foxhayes Practice on 14 and 19 December 2017. This was a routine inspection.

At this inspection we found:

• Leaders had an inspiring shared purpose, strive to deliver and motivate staff to succeed. The practice is unusual in that it was established ten years ago by two full time partners; a GP (male) and an Advanced Nurse Practitioner (female). Staff development continued to be a high priority with all staff supported to achieve advanced qualifications in their individual fields of work.

• The practice had a clear vision which had quality and safety as its top priority. A business plan was in place, was monitored and regularly reviewed and discussed with all staff and patient representatives. High standards were promoted and owned by all staff with evidence of team working across all roles. Patients said they felt safe.

• Networking continued to be a priority of leaders and staff to deliver safe, effective, caring and well led service.The nurse partner was elected by Exeter GPs as their representative to the Eastern Locality Board, and she was co-chair of Exeter sub-locality. She was a driving force in promoting a common focus on improving quality of care and people’s experiences in Exeter in this role and sat on the local Health and Wellbeing Board. Since the last inspection she gained agreement from 16 practices to provide a shared service of extended access to GP appointments during the evenings and weekends for patients.

• The practice worked collaboratively with a larger GP practice situated close by to provide access to comprehensive midwifery services for young pregnant mothers.

• Audit was embedded, with the practice routinely reviewing the effectiveness and appropriateness of the care it provided. Care and treatment was always delivered according to evidence-based guidelines.

• There was sustained high patient involvement at Foxhayes practice. Patients were consulted through several routes: virtual PPG (100 patients) and face to face meetings with representatives from the ‘Friends of Foxhayes practice’. Their suggestions had developed into work streams to implement changes at the practice.

• All 28 patients gave strongly positive feedback at the inspection about staff treating them with compassion, kindness, dignity and respect.

We saw one area of outstanding practice:

Leaders were innovative in gathering feedback from people who use services, other stakeholders, professionals and the public to support high-quality sustainable services. This included: Early involvement in pilot projects to improve health and social care in the community, for example the development of the Exeter Well Being service. Representation on the health and wellbeing board to promote the needs of the community, Leadership ensured active patient involvement in decision making, development and planning of services. Proactive succession planning based on staff development and training of future GPs, doctors and practice nurses.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 19 March 2018

Updated 19 March 2018

Updated 19 March 2018

Updated 19 March 2018

Updated 19 March 2018

Updated 19 March 2018