In our ‘Not your average practice’ series we speak to the GP practices with distinct patient demographics to find out how they run. Stamford Hill Group Practice serves one of the youngest populations in the country due to the significant Hasidic Jewish community in the area. Maya Dhillon sat down with the practice team to discuss their experiences working with such a unique population.
When thinking of GP practices with young populations, it is easy to go straight to those on university campuses, or with solely university students as patients. While those practices are, of course, varied and interesting in their own right, it is also fascinating to look at those outside that category and see why their population might be of a certain age.
Serving just over 18,000 patients in north east London, Stamford Hill Group Practice has one of the country’s youngest populations with an average age of 26.06. This is not due to having a number of students around to bring down the average. It is in fact because the practice is situated in a large Hasidic Jewish community, with a large population of children. The team estimates that more than 80% of their patients follow a form of Orthodox Judaism.
‘We have lots of families in our practice population who have more than the UK average of 1-2 children per family’ says GP partner Dr Harriet Mitchell. ‘Some families have up to 16 children.’
Where are the practices with the youngest populations?
The staff aren’t certain about the average number of children per family for their patients, though GP partner Dr Laurence Blumberg comments that – in his 38 years at the practice – the most pregnancies he treated in one person was 24 (though they did not all result in live births.) Regardless, the birth rate at Stamford Hill Group Practice is very high with over 600 a year. And, 13.82% of their patients are between 0-4 years old; the third highest percentage of that age bracket in the country.
This means that the staff have to run a lot of baby checks to keep up with demand. ‘One GP does a whole session on a baby clinic, and it takes about two sessions a week of GP time to maintain mother and baby checks’ says Dr Mitchell. The practice is made up of: five partners, four salaried GPs, one long-term locum GP, three paramedics, one ANP, three pharmacists, physios and nurses.
Beyond maternal and natal health, the practice spends a lot of its time seeing unwell children in winter. Some days the majority of appointments can be taken up managing minor illness, which puts a lot of pressure on the team to free up other clinical time to focus on long-term conditions or other issues. ‘We can be totally sideswiped by a flu or chickenpox outbreak. A few years ago we had a huge measles outbreak and it completely took over’ says Dr Barker. Dr Blumberg comments: ‘We used to have cyclical outbreaks of measles and Hep A – the latter which we don’t get anymore. But it used to be 100s and 1000s of people getting it all at once.’
Obviously, having high numbers of unwell children is par for the course if there are lots of children living under one roof. But there is also another reason as to why outbreaks are so prevalent in Stamford Hill Group Practice’s population: immunisation uptake in the Orthodox Jewish community is generally low.
This isn’t a new challenge for the practice; for years immunisation uptake rates have been low. The surgery currently has the 5th lowest DPT vaccination rate for babies (17.04) and the 6th lowest for MMR vaccinations in babies (33.06). ‘There’s a lot of work that happens in the practice, and in the PCN around that, around education, around immunisations, but we are lucky enough to work in a very innovative and supportive PCN to help support the community to have good access to immunisation appointments and education’ says Dr Mitchell.
The team is constantly in contact with rabbis and local community services to help reach their patients. A lot of the outreach work has to be done in person – Stamford Hill Group Practice’s patients do not have the same access to mobile phones and internet use as the general population, which may be surprising when thinking about young people as a demographic. But, many Orthodox Jewish communities limit their access to the internet and digital devices, meaning that they cannot receive or send text messages or emails. ‘Getting our patients to engage with us can be more challenging and time consuming as we have to call. We can’t batch-send text messages – we just can’t guarantee getting through to everyone’ says Dr Barker.
Full list of practices with the youngest patient populations in England
The practice is not completely analogue though. The team is able to do telephone consultations, as those do not depend on people having a smartphone. And, the pandemic also brought surprising revelations about the population’s use of technology. Dr Mitchell says that the team’s perceptions were challenged and that there was actually more digital use within their population than they thought.
‘We were all kind of forced to try and work out how we can communicate effectively. There were more smartphones around than we realised; people started giving us their email addresses and sending in pictures – some were taken by digital cameras and then uploaded and sent to us. We even managed to do some video consultations, which we previously would not have thought possible.’
One challenge that Stamford Hill Group Practice faces is funding. ‘We are penalised by the funding formula because of our young population’ says Dr Barker. ‘Having thousands of five-year-olds means that a lot of the consultations we do are not recognised because it is skewed away from that formula. Of course, funding formulas have to be based on something universal, and unfortunately we are just outside the mean. Even though we have over 18,000 patients, we are currently only paid for 15,777.’
The practice did receive an extra payment for a couple of years a few years ago which they used to employ an extra doctor to keep up with baby clinics and post-natal work. Unfortunately though that was a short-term investment due to an individual in the CCG who appreciated the nature of the practice’s situation and what it does, and campaigned for this additional funding.
‘I think they lost sight of us a bit when the CCG boards merged to become the ICB,’ Dr Barker says. ‘We became a smaller fish in a bigger pond and I think the understanding of how unique our area of North East London is was lost.’
Despite the challenges faced by the practice, the team could not imagine themselves anywhere else. They praise the sense of community – which is unusual for young urban populations in general, given that younger populations will be more mobile with people shifting around. ‘It is different here,’ comments Dr Barker. ‘Here you get to know the families and their extended families.’ Dr Blumberg adds that he even remembers patients’ great grandparents.
‘It is a real honour to work with our patient community,’ says Dr Humphreys. ‘While the majority of our patients are from the Orthodox Jewish Community, we also have a very diverse inner-London population and this makes the job very enriching. Working with our Orthodox Jewish community is very rewarding – honouring life and keeping themselves alive for as long as they can forms a significant part of their religious beliefs. This means that our patients often engage with their health and healthcare services very well, and we are an important part of their lives. To be trusted by our patients in the way that we are is such a privilege.’
See more from our ‘Not your average practice‘ series
