The Practice of Medicine has advanced so much in the last one hundred years that it is worth recording some of the changes that have occurred in the Lenham Practice during those years.
In 1900 Dr. Gray came to live in Stanfield (the large house on the east side of Lenham square) which, it has been assumed, had always been the Doctor's house. As was the custom then, and lasting for the next 50 or so years, the Doctor had the Consulting Room in his own house and worked on his own without any ancillary staff, apart from his own family and his domestic staff. His formulary would have been limited, but he had the reputation of being a kind and wise Doctor. His concern was shown during the First World War when he made his house over to the Red Cross where 50 convalescent wounded soldiers were nursed.
When he retired in 1934 he was succeeded by Dr. Laird practising from Stanfield until he joined the RAMC at the beginning of 1940. To maintain the Practice during the war Dr. Richard Posner, a refugee from Germany, was employed as a Locum. During that difficult time he extended the catchment area and increased the number of patients. Consequently, when Dr. Laird returned in 1945, Dr. Posner insisted on a Partnership and he practiced from the house he had bought in Harrietsham. Although nominally a Partnership the two doctors operated independently.
In 1948 the National Health Service was inaugurated by Aneurin Bevan, M.P. the Secretary for Health. He stated at the time the service would cost ?250 million per annum, but, as the facilities would be available to all, he argued that the people would become healthier and the demands less. Consequently the cost would be less in the future! General Practice was to be funded with a Capitation Fee for each patient registered with the practice, a system dating from Lloyd George's initial limited Health Service in 1911. The initial annual Capitation Fee was 14 shillings and 6 pence (72.5 pence). this system lasted until 1965 when the GP's charter was introduced and the method of payment totally revised. General Practitioners were then encouraged to improve their premises and employ Surgery Staff. At that time the morale in General Practice improved.
When Dr. Laird retired in 1953, Dr. Posner offered a Partnership to Dr. Anna Gardiner. Dr. Gardiner, a Doctor's widow, was working in Kent County Public Health Department and was pleased to accept the offer. She then took up residence in Stanfield. Dr Gardiner had graduated at the University of Glasgow along with Dugald Baird and his wife May, and they were lifelong friends. Sir Dugald Baird became Regius Professor of Midwifery at the University of Aberdeen, which was relevant to the subsequent development of medical practice in Lenham.
Unfortunately in 1955 Dr. Posner became ill and he decided to employ an assistant until he was eligible to retire with an NHS pension in July 1958. So it was in 1956 Dr. Robin Donald, an Aberdeen Graduate, on the recommendation of Dr. Baird, came to Harrietsham with a view to a Partnership. Sadly Dr. Posner died in April 1958.
The only ancillary help at that time were 2 District Nurses, Nurse Garrett and Nurse Shepherd and a Health Visitor, Miss Featherstone. Mrs. Donald and members of Dr. Gardiner's family were expected to be available at all times outside Consulting Hours to accept messages at the door or by telephone. In Lenham Mrs. Jessup worked on a ad hoc basis as a secretary.
In 1959 when the new surgery was opened in Harrietsham, Mrs. Blandford acted as a receptionist there during consulting hours. Mrs. Jessup then had a similar role in Lenham.
By 1964 when the sizable basement in Stanfield was converted to Surgery premises, several part-time receptionists were employed so that the surgery was open all day. The staff was able to take messages thus freeing the doctors' families during the working day, but not out of hours or at weekends.
By 1960 because of new housing developments in the area the Practice was growing and it had help from Dr Freda Reed and Dr Mary Buchanan. However by 1961 Dr Alistair Turner, a contemporary colleague and friend of Dr. Donald in Aberdeen, had joined the Practice. When Dr. Gardiner retired in 1965, Dr. Barbara Macpherson from Faversham arrived as an Assistant for 3 days a week. By 1967 a full appointment system was in operation with the surgery open from 0845 until 1800, so there were no longer unlimited consultations lasting long into the evenings. As well as a full complement of receptionists and secretaries, Sister Bradley was employed as Practice Nurse and Dispenser, having previously been a Casualty Sister at Buckland Hospital, Dover.
Unfortunately Dr. Turner died suddenly in March 1969 at the age of 40 and there followed a great period of upheaval in the Practice with several Locums being employed. During that time an Answering Telephone Machine was installed which did not accept messages but told callers whom to telephone for advice. However Dr. Macpherson was able to introduce Dr. Martin Porter in July 1969, and he in turn brought in Dr. Ian McMullen so that by 1970 there were 3 full partners in the Practice.
Increasing demands meant new premises were required and in 1974 the Practice was able to move into the purpose built Tithe Yard Centre, which was thought to be more than adequate at the time. This coincided with reorganisation of the Health Services so that no longer were Local Authority Child Welfare Clinics held in local Village Halls.
From 1959 the Partners had Clinical Assistantships in the local Hospitals, which helped to broaden the outlook of doctors and maintain interests in other specialties.
In 1976 Dr. Donald accepted the opportunity of returning to his native Scotland, although he had enjoyed the opportunity of working in Lenham. Frustrated by the lengthening Waiting Lists and the inadequate local Hospital facilities, he realised there had been no improvement during his 20 years in Kent.
So when Dr. Donald Left Dr. Porter took over the senior partnership at the age of 34. Dr. McMullen was a couple of years younger, and with Dr. Hipkins younger still, the practice was distinctly youthful, and rather green!
Dr. Hipkins had joined the practice as Dr. Donald's trainee and it was a great pleasure when he agreed to join as a partner when Dr. Donald returned to Scotland.
Dr. Porter continued Dr. Donald's role as trainer, and was joined after a couple of years, by Dr. McMullen. Over the next fifteen years they trained about 10 fledgling GP's. Being a trainer is a great responsibility and extremely rewarding. Almost without exception the trainees or registrars as they are now called, brought a breath of fresh air to the practice together with new ideas and challenges.
In 1983 Dr. Isobel Burch and her husband, moved to Egerton. Following a letter from Dr. Burch advising us of the move, we met with her and offered her a partnership. She accepted and joined the Practice. She bought with her the much-needed balance of a female partner and was an excellent addition to the practice. In 1987 Dr. Burch's husband was appointed Bishop of Lincoln so Dr. Burch left the practice. Dr Gerri McKeever joined and filled the role of sole female Doctor.
Dr. Graham Hagan was Dr. McMullen's registrar at the time. He had fitted in so well in the practice that the three existing partners all wanted him to take Dr Mckeever's place when she left to join her husband in practice in Hoo, north Kent. Dr Hagan brought so much to the practice - total dedication, loads of ideas and a similar sense of humour!
In 1990 the Tithe Yard surgery was running out of room and a large extension was added to the roof. The extension was for administrative staff and included a large common room for meetings with community staff and medical colleagues.
The old Harrietsham surgery in Harlaw, closed its doors in 1991 and the branch surgery moved to a new purpose built surgery in Church Lane. The building was part of a Harrietsham Parish Council project combining a community hall and ample parking for both buildings.
The practice itself was changing. Of all the changes which happened since the early seventies, one in particular stands out, and was to change entirely the way medical practice was run. This innovation was, of course, the computer. In 1969, when Dr. Porter started there was not a practice in the country that had one. By 2001, when he retired, there was not a practice without, and now it would be impossible to run a practice without. But they brought with them many changes, the greatest of which was the staffing level. In 1969 we had 5 office staff but by 2001 there were nearer to 15. And when the new surgery at Tithe Yard was built and opened in1973 there was no provision for this dramatic increase in staff, so now the building is to small and the practice will move.
In 1996 Dr. Hipkins decided to leave the Partnership for a new practice in Sittingbourne. He was a loyal servant of the practice, a good friend, and much missed.
Dr Anu Rao joined the practice in Dr Hipkin's place, She restored a welcome female presence to the partnership. She was initially able to pursue her interest in Dermatology as a clinical assistant at Maidstone Hospital but with the increasing pressures of work at the practice, all of the partners agreed to withdraw from their various assistantships, At the time, these were in Ophthalmology, ENT and Rheumatology, in addition to Dermatology. This withdrawal from Hospital work was part of a national trend, lamentable for the loss of contact between primary and secondary care. It is hoped that the new GP contract, due in 2004, will allow the situation to be corrected.
Into the 21st Century
On 17th April 2000, Lenham Parish Council was proud to announce a new project on the eastern outskirts of the village. This project included housing association homes, a new village hall and a plot of land for the new surgery. The Parish Council's assistance in securing this site and their patience with the subsequent negotiations to build the new surgery has been greatly appreciated by the practice. We hope that the new surgery will be completed in 2004.
With the start of Dr Rao's family and Dr McMullen's wish to reduce his commitment prior to retirement, Drs McMullen and Rao decided to job share in 2000. This created a vacancy which was ably filled by Dr Andrew Taylor. He had trained in South Africa and bought a wealth of experience, especially in Orthopaedics.
In 2001, Dr Porter decided that it was time to retire. His career at Lenham had spanned two generations and he had acquired a large and loyal following. Dr Porter's concern for his patients, his medical colleagues and his staff had always made being a patient at Lenham surgery or working there, a very special experience. His retirement was thoroughly deserved but a considerable loss to the practice.
Dr Codlin joined the practice to replace Dr Porter and sustained an energetic and compassionate approach to medicine, in similar measure.
In November 2001 another large change occurred with the purchase of a new computer system aimed at going 'Paper free' in line with current development of primary care. The buff coloured (Lloyd George) patient medical record envelopes were summarised electronically and consultations recorded on the computer directly. Unfortunately the new system didn't come with typing skills for the partners! The increasing demands from the NHS for reports on practice activity were more easily met using the computer system but the workload seemed to continue to rise despite the new technology. Letters, reports, records, results continued to arrive on paper and all needed to be transferred to the electronic format. Staff now had to deal with information on paper and on computers. Staffing levels rose again.
Dr McMullen retired in May 2002. Like Dr Porter he had spent 32 years at the practice. He and his family had first lived over the small branch surgery at Harlaw, Harrietsham. With his keen eye for organisation, he had widely overseen the administrative growth of the practice in to the large organisation that it is today.
Dr McMullen was replaced by Dr Gruboeck in 2002. She had trained in Austria and her arrival, for the first time gave the partnership a female majority. She retained a day a week of ultrasound work outside the practice.
Following the four additions to Dr Gruboeck's family, she decided to leave the practice to spend time at home. Dr Andrew Reed was currently a long term locum at the practice and was appointed her replacement. He became full time to join Dr Hagan and Dr Taylor, reversing the previous female dominance. He trained at the Royal London Hospital in Whitechapel London, and completed his GP training at Maidstone Hospital and Marden Medical Centre. He has an interest in Prison Medicine and currently works one day a week at a local prison providing GP services to the inmates.
In 2016 Dr Rao decided to leave her part-time position as Salaried GP, to continue her locum work.
In July 2016 Dr Nik Kendrew joined the practice as a Partner.
At the end of November 2016 Dr Codlin left us. In July 2017 Dr Lee Welsh joined the practice as a Partner.
Acknowledgments to Dr Donald, Dr Porter and Dr Hagan