Archived: Dr Robert Stewart Also known as The Hawkinge & Elham Valley Practice

Updated 20 August 2015

Dr Robert Stewart (Also known as The Hawkinge and Elham Valley Practice) is situated in a converted house and located in the residential area of Hawkinge. The building has benefitted from subsequent extensions and refurbishments which have improved space and access. Wheelchair access to the building is through the front door. The inspection was undertaken at the Hawkinge practice. We did not visit the practice branch at Elham Valley.

A team of two GP partners, two salaried GPs, two locum GPs (all male), a nurse specialist/clinical services manager, two prescribing nurse practitioners, two assistant practitioners, two practice nurses, a nurse specialist, a practice manager, a performance manager, receptionists, medical secretaries and administrative staff provide care and treatment for approximately 9,220 patients.

The nursing team provide a wide range of care in the treatment room. The nurse specialist/clinical services manager specialises in the management and treatment of patients who have heart disease or have had a heart attack, stroke/mini-stroke, atrial fibrillation (a heart condition that causes an irregular and often abnormally fast heart rate), peripheral vascular disease, management and treatment of hypertensive disease and heart disease prevention, family planning, contraceptive advice and women’s health. The prescribing nurse practitioners are available daily and can be seen for a wide range of acute illnesses such as colds and flu, sore throats, infections, diarrhoea and vomiting. One of the prescribing nurse practitioners also specialises in respiratory problems such as chronic obstructive pulmonary disease (COPD) and asthma. The practice nurses undertake blood pressure monitoring, child and adult vaccinations, cervical smears, dressings, ECGs (a test which records the rhythm and electrical activity of a patients heart), ear syringing and other general nursing duties. The assistant practitioners support the practice nurses with their daily work and carry out tasks such as phlebotomy (drawing blood), blood pressure monitoring, weight management and new patient checks. They may act as a chaperone when a patient or doctor requests one. The phlebotomy clinics are held Wednesday morning at Elham Valley and Thursday and Friday mornings at Hawkinge.

Appointments are available from 8.30am to 6.30 pm Monday to Friday and 8.30am to 8pm on a Thursday. Saturday mornings were from 8.30am to 12.30pm. The practice provides an out-of-hours service to their own patients and appointments are booked via the practice’s reception or NHS 111 when the practice is closed.

Updated 20 August 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Robert Stewart (also known as The Hawkinge and Elham Valley Practice) on 11 March 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing well-led, effective, safe, caring and responsive services. It was also good for providing services for the care of older people, people with long term conditions, families, children and young people, working age people (including those recently retired and students), people whose circumstances may make them vulnerable, people experiencing poor mental health (including people with dementia).

Our key findings across all the areas we inspected were as follows:

• Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed and addressed.
• Risks to patients were assessed and well managed, with the exception of those relating to recruitment checks.
• Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
• Information about services and how to complain was available and easy to understand.
• Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 August 2015

The provider was rated as good for caring for people with long-term conditions. Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. All these patients had a named GP and a structured annual review to check that their health and medication needs were being met. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 20 August 2015

The provider was rated as good for caring for families, children and young people. There were systems to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were relatively high for all standard childhood immunisations. Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this. Appointments were available outside of school hours and the premises were suitable for children and babies. We saw good examples of joint working with midwives and health visitors. A walk-in and wait contraception/HRT clinic was held on a Tuesday afternoon and chlamydia testing “grab boxes” at both surgeries were available for young people to collect testing packs without the need to speak to a clinician. The practice also offered pre-booked appointments with their practice nurse for contraception advice for young people.

Updated 20 August 2015

The provider was rated as good for caring for older people. The provider was rated as requires improvement for safety. The concerns which led to these ratings apply to everyone using the practice, including this population group.

Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and had a range of enhanced services, for example, in dementia and end of life care. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

Updated 20 August 2015

The provider was rated as good for caring for working age people (including those recently retired and students) overall and this includes for this population group. The practice is rated as good for the care of working-age people (including those recently retired and students). The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

Updated 20 August 2015

The provider was rated as good for caring for people experiencing poor mental health (including people with dementia). The practice had a dementia register of 98 people experiencing poor mental health and 90 had received an annual physical health check. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. It carried out advanced care planning for patients with dementia. There was a dedicated trained GP who saw patients who had mental health issues and those on the mental health register were reviewed regularly. The practice undertook dementia screening, for patients over the age of 50 with a cardiovascular condition identified by a GP as being at risk of developing dementia. Screening was also offered to patients outside this group who were expressing a concern.

The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations including MIND and a mental health helpline. It had a system to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health. Staff had received training on how to care for people with mental health needs and dementia.

Updated 20 August 2015

The provider was rated as good for caring for people whose circumstances may make them vulnerable. The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability. It had carried out annual health checks for people with a learning disability and 95% of these patients had received a follow-up. It offered longer appointments for people with a learning disability.