Not your average practice: The oldest patient population in England

In a recent Pulse series, we’re chatting with GP practices that have unique patient demographics to understand their operations. Barn Surgery caters to the oldest patient age group in the nation, with an average age of 59. Maya Dhillon had a conversation with GP partner Dr. Ian Pidgeon to explore his insights on providing care to a largely elderly population.

"I really enjoy my work. I believe it's crucial to express that, especially when many individuals are expressing dissatisfaction with general practice," says Dr. Ian Pidgeon.

Who wouldn't be tempted to work at Ferring? This charming village in West Sussex, with fewer than 5,000 residents, is nestled between the South Downs and the English Channel, showcasing breathtaking natural beauty. It has that typical English village feel, complete with its coastal charm and picturesque surroundings.

Barn Surgery, where Dr. Pidgeon has worked for 11 years, serves a unique group of patients. Aside from care homes, it has the oldest patient base in the nation, with an average age of 59. The statistics become even more compelling when analyzed further. Out of approximately 4,100 patients receiving treatment at the surgery:

Where Are The Practices For Aging Populations?

"When I became a partner, I knew that the patient base was primarily made up of older individuals," says Dr. Pidgeon. "The previous partners even mentioned to me that it was among the oldest patient populations in Europe!"

He argues that even though Barn Surgery has a unique group of patients, it operates much like any other medical practice. They don’t offer longer appointment times or have special clinics for certain age groups or health conditions, as one might expect. The demand for appointments is effectively controlled—patients can book appointments when they prefer—and it’s straightforward to see a patient multiple times a week if necessary.

The straightforward access and effectiveness in catering to their specific patient group can be attributed, in part, to their manageable patient list. However, it’s also largely thanks to the practice team, who are highly knowledgeable about their patients and are attuned to their needs. Barn Surgery’s staff includes two partners, one salaried GP who works under a retainer agreement, and other professionals from the Primary Care Network (PCN) who come in once a week, such as physiotherapists and pharmacists.

Dr. Pidgeon candidly acknowledges that residing in Ferring, a pricey location along the South Coast, typically means you are financially secure. This, in turn, shapes the kind of health issues seen in the local community: "We don't deal with significant levels of poverty or hardship here. There aren’t many patients struggling with mental health challenges. Instead, we mostly care for older individuals who aren't necessarily sick. Those in the wealthiest socio-economic groups tend to experience better health results and enjoy longer lives."

Heart disease and skin problems related to sun exposure are among the most frequently encountered health issues that Dr. Pidgeon and his team address. Regarding heart disease, Dr. Pidgeon notes that Barn Surgery sees four times the anticipated number of patients diagnosed with heart failure for a practice of their size, primarily due to the older demographics of their patients. When it comes to skin concerns, both age and the socio-economic status of the patients play a role: many have had years of sun exposure, and their relative affluence means they are more likely to have lived or traveled abroad frequently.

Oldest Patient Populations In England: A Complete List

When inquired about any changes since he joined the practice, he notes that over the years, more young individuals and families have settled in Ferring. However, he emphasizes that the most significant shift was the pandemic.

"Bringing about change in a community can be difficult, unless there’s no other choice," explains Dr. Pidgeon. Before 2020, the clinic followed a very conventional approach and hadn’t embraced any remote practices. "Often, it’s not that we, as general practitioners, are afraid of change; it’s more about the hard work that comes with implementing it."

"While the Covid pandemic brought significant challenges, it also acted as a driver for us and the community to adapt to new norms." Most consultations at Barn Surgery are still conducted in person, but there has been a noticeable increase in online appointments. This shift benefits both patients and doctors; for instance, individuals with mobility challenges value the option of phone consultations, while GPs find it helpful to assess a patient's blood pressure online rather than requiring an in-person visit. However, relying on digital tools isn't without its issues. "Generally, people struggle with taking clear pictures. We receive numerous images that are hard to decipher. I often remind our patients that if the photo looks unclear to them, it will look just as unclear to me!"

Despite the hazy rashes, Dr. Pidgeon expresses great confidence in their approach to patient care. He portrays the practice as a classic example of general medicine—a small clinic located in a quaint village, conveniently situated near the local community. This setup allows for consistent care, as both the doctors and their patients are familiar with each other, which suits the practice's distinctly traditional client base: "They wouldn't appreciate having to consult with 27 different doctors!"

Dr. Pidgeon has been reflecting on how primary care is provided after witnessing the operations at Barn Surgery. He notes that the nearby practice, just two miles away, serves a completely different community than they do. "We tailor our services to match the needs of our local patients, which isn’t something larger practices can achieve," he said. While the government seems to believe that all health services need to be as expansive as hospitals, Dr. Pidgeon strongly believes that small, community-focused GP services are essential for effectively meeting the unique needs of different patient populations.

Considering the UK’s increasing number of elderly citizens, what insights can Dr. Pidgeon share about providing care for such a predominantly elderly population?

The initial step is to change how we view death, moving away from the idea that it's a failure, especially for certain age groups. “If either of us were to pass away right now, it would signify a breakdown in the system. However, when an elderly individual in their 80s or 90s with several health issues dies, it’s simply a part of life.” He emphasizes that using death as a measure of failure isn't very useful. “When nursing or care homes have a few fatalities in a short period, the Care Quality Commission seems to react. But keep in mind, people enter these facilities because they can no longer manage at home and might be approaching the end of their lives!”

It's no surprise that death is a topic many avoid discussing. People shy away from conversations about the end of life, particularly in the UK. However, Dr. Pidgeon highlights that by not engaging in discussions about death with older individuals or their families, we are doing them a great disservice.

I frequently ask my patients, regardless of their age, if they have a will in place. Most of them do; they are clear about how they want their belongings and finances handled after they’re gone. However, when it comes to their wishes for their own bodies in the dying process, they're often completely unaware or unprepared.

Dr. Pidgeon believes that care planning doesn't need to be as detailed as it used to be with lengthy, five-page documents. He emphasizes the importance of clearly informing individuals when they are nearing the end of their life, much like how one would straightforwardly let a pregnant woman know about her condition. He notes that it can be even more challenging to communicate openly with patients who aren't terminally ill but are simply aging. People are aware that they won't live forever, yet they often struggle to accept the idea of their own mortality.

I frequently tell patients and caregivers that at both the start and the end of life, we require assistance. It's not about being unwell; it's simply about needing support.