In a new Pulse series, we speak to the GP practices with distinct patient demographics to find out how they run. Barn Surgery serves the oldest patient population in the country – with an average age of 59. Maya Dhillon sat down with GP partner Dr Ian Pidgeon to discuss his experience of treating an overwhelmingly older population.
‘I love my job. I think that’s important to say at a time when so many people complain about general practice’ says Dr Ian Pidgeon.
And working in a place like Ferring, who could blame him? With a population of less than 5,000, the West Sussex village lies between the South Downs and the English Channel, and it is home to stunning natural scenery. Coastal and quaint, it is every bit the ordinary English village.
But Barn Surgery, where Dr Pidgeon has been for 11 years, has a distinct patient population. Barring care homes, it has the oldest patient demographic in the country, with an average age of 59. Those numbers get even more interesting when you break them down. Of the roughly 4,100 patients the surgery treats:
- More than half their patients are over 65;
- 18% are over 80 years old (the surgery with the second oldest patient demographic only has 10% over 80);
- 3% of patients are over 90;
- Five patients are over 100.
Where are the practices with the oldest populations?
‘When I took over as partner, I was aware that it was a distinctly older population’ comments Dr Pidgeon. ‘In fact, the previous partners used to tell me it was one of the oldest patient populations in Europe!’
He maintains that despite the distinct nature of the practice’s patient list, Barn Surgery is not run so differently than any other practice. They don’t have longer appointment slots, nor run any specific age or frailty clinics as one might initially presume. Demand is well managed - people can get an appointment for when they want - and it is easy to review a patient a few times a week if needed.
The ease of access and success in dealing with their particular population is in part due to the small patient list. But it is also down to the practice team, who are ‘well-versed’ in managing their population and understand their needs. The staff at Barn Surgery is made up of two partners, one salaried GP on a retainer scheme, and additional staff obtained through the PCN that will come in one day a week - such as physios and pharmacists.
Dr Pidgeon is frank about the fact that in order to live in Ferring, an expensive area on the South Coast, you are generally quite well off. That then obviously influences the types of cases prevalent in the population: ‘We don’t have large areas of poverty or deprivation. There is not a massive number of patients with mental health issues for instance. What we do have is a lot of patients who are just very old, rather than ill. Being in the highest socio-economic groups means that you probably have better health outcomes and live longer.’
Heart disease and sun-related skin issues are two of the most common conditions that Dr Pidgeon and his team see amongst patients. With the former, he says that Barn Surgery has four times the expected patient numbers diagnosed with heart failure for a practice their size - purely because of the age of the patient. The latter comes as a result of both the age and socio-economic profile of the patients: cumulative exposure to the sun over the years; and the fact that they are fairly wealthy, so have lived or holidayed abroad frequently.
Full list of practices with the oldest patient populations in England
When asked if anything had changed in the time since he has been at the practice, he mentions that there have been younger people and families move into Ferring over the years. But of course, the big change was the pandemic.
‘Instigating change in a population is a challenge, unless you’re forced to’ says Dr Pidgeon. Prior to 2020, the surgery was very traditional in how it operated and didn’t do anything remotely. ‘Sometimes we as GPs are not scared of change itself, but are more fearful of the effort involved in making change.
‘Even though Covid was terrible with everything that happened, it was a catalyst that forced both us and the population to accept certain changes.’ Most of Barn Surgery’s consultations carried out now are still face to face, but there has been a shift towards more online consultations. It can be useful on both sides: patients with mobility issues appreciate phone appointments when necessary; and GPs find it useful to review a patient’s blood pressure online without having to see them in person. Though there can be drawbacks with using digital platforms: ‘People in general are not very good at taking photos. We receive so many photos that we just can’t make out. I often tell our patients that if it looks blurry to you, then it is still blurry for me!’
Blurry rashes aside, Dr Pidgeon is very confident in the practice and how they deliver care. He describes them as the traditional model of general practice - a small practice, in the middle of a small village, geographically close to the population. Continuity of care is easy; the doctors - including the two regular locums - know the patients, and vice versa which works for the surgery’s decidedly ‘traditional’ population: ‘They wouldn’t like it if they had to see 27 different doctors!’
The way Barn Surgery operates has left Dr Pidgeon with resounding thoughts on how primary care should be delivered: ‘The practice only two miles down the road from us has a vastly different population to us. We are adapted to our patient population - which is something a super practice cannot do. Despite the Government thinking that everything should be hospital-size, I do think that delivering GP in little silos particular to a patient population is so important.’
With the UK’s ageing population, are there any lessons in caring for an overwhelmingly elderly demographic that Dr Pidgeon can impart?
His first step is to normalise death and stop seeing it as a failure, especially in certain populations. ‘If you or I died right now, that would be a failure of the system. But if someone in their late 80s or 90s, with multiple health comorbidities is dying - well that’s just what happens.’ He points out that death is used as a metric of non-performance which isn’t necessarily helpful: ‘If nursing homes or care homes have a few deaths within a few months, the CQC are calling to them. But, people go into nursing homes because they are unable to cope at home and may be nearing the end of their lives!’
It’s no big revelation to say that death is a universal taboo. Nobody wants to talk about the end of life, especially in the UK. But Dr Pidgeon points out that by not talking about death with an elderly person or their family, we are doing them a massive injustice.
‘I often say to my patients, whatever age they are: ‘Have you got a will?’ And they all do - they know exactly what is going to happen to their possessions and money when they pass away. But they have no clue about what they want to do with their body when they are dying.’
Dr Pidgeon doesn’t think that care planning needs to be as intensive as it was a few years ago, with five-page documents. But he is adamant that people need to be told, in a matter-of-fact sort of manner, that they are dying and approaching the end of their life - in the same respect you would tell a pregnant woman she is pregnant. In a sense, it is almost harder to be frank with patients who don’t have a terminal disease but are simply just getting older. ‘Nobody believes that they will live forever, but nobody thinks that they will die.
‘I often use the analogy with patients and carers that at the very beginning of life and at the very end, we need help. We're not ill. We just need help.’
