Foxhayes Practice

Letter from the Chief Inspector of General Practice

Foxhayes Practice was inspected on Friday 14 November 2014. This was a comprehensive inspection.

Foxhayes Practice provides primary medical services to people living in the city of Exeter and surrounding villages in Devon covering approximately 50 square miles. The practice provides primary medical services to a diverse population and supports patients living in four adult social care homes in the area. At the time of our inspection there were 3633 patients registered at the service. The practice has a higher percentage of younger patients under 55 years compared with the majority of practices in the city of Exeter.

The practice is unusual in that it was established ten years ago by two full time partners; one a GP (male) and the other an Advanced Nurse Practitioner (female) . The practice also has a female salaried GP, two female nurses, one of whom is a nurse practitioner and a female health care assistant. Foxhayes is a training practice, with a GP partner approved to provide vocational training for GPs, second year post qualification doctors and medical students.

Patients who use the practice have access to community staff including district nurses, community psychiatric nurses, health visitors, physiotherapists, mental health staff, counsellors, chiropodist and midwives.

The practice is rated as outstanding.

Our key findings were as follows:

• 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. High standards were promoted and owned by all practice staff with evidence of team working across all roles. Patients said they felt safe.

• Patients’ needs were assessed and care was planned and delivered following best practice guidance. The practice had a very good skill mix which included two advanced nurse practitioners (ANPs) and was able to see a broader range of patients than the practice nurses.

• The practice was well equipped to treat patients and meet their needs.
• There was a strong leadership structure and staff felt supported by management.
• Patients were involved from the outset in the development of the practice values and on-going projects to improve the service. Patients had an equal say in the mission statement of the practice which highlighted that they should be treated with dignity & respect, for example have a voice in all decisions about their own and their family care.
• There was high patient involvement at Foxhayes practice. Patients were consulted through the 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. There were many examples of these between 2006 and 2014 and included involving patients in the recruitment process and patient ownership of the practice newsletter.

We saw areas of outstanding practice:

• The practice was caring and extremely patient centred. Eight patients we spoke with and 24 in comment cards confirmed they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. The mission statement was developed and reviewed with patients. New patients were welcomed personally with a letter and one to one introduction. During the year, 32 patients in vulnerable circumstances had been give support through the practice taxi fund.
• The practice understood the needs of the entire patient list and had developed a responsive service accordingly. For example, early morning appointments were available twice a week and extended opening available one evening per week. The text messaging service had been extended to improve outcomes for patients with long term conditions. The patient list was managed in a way to avoid any barriers.,
• The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice. For example the practice worked collaboratively with a larger GP practice situated close by to provide access to comprehensive midwifery services for young pregnant mothers. The practice had a successful, active carers support group which provided a social, network and support for isolated and vulnerable patients. The co-ordinator had a team of volunteers who offered services including telephone support, a sitting and befriending service, social events and excursions and health promotion events. Patients at the practice also had an allotment club, which provided opportunities for vulnerable people to build networks within the community. There was a high incidence of patients registered at the practice with substance misuse problems who wished to change their lifestyle. The GP partner had completed additional training and was a qualified pharmacist so had the skills and experience to safely manage the detoxification process for suitable patients living in the community. He did this in conjunction with specialist agencies who provided further support for the patients. This facilitated continuity of care for patients in such situations.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice