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by Anne Crandles
29 March 2011

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Little big voice?


Practice Management Adviser
Boroughloch Medical Practice, Edinburgh

You may recall my earlier blog that reviewed Scottish and English health reforms, but I promise this isn’t another ‘compare and contrast’ ditty.

It is, in fact, the opposite – looking instead at the common challenges we face in finding ways to ‘put patients centre stage’ and ‘at the heart of the NHS’.

No doubt practice managers up and down the land are already grappling with the introduction of patient participation groups, joining relevant associations and avidly reading articles on harnessing patients’ views and opinions.

But what about the rest of the primary healthcare team?

How do you engage reception staff in this? The patient focus part is straightforward: review front-desk skills and revisit communication, including body language, telephone technique and so on.

But what about actually involving the patient? Reception staff don’t normally chair patient groups (though that is not to say they couldn’t or shouldn’t). But generally speaking, it isn’t often the case. 

Staff already engage with patients every day – asking how they are, signposting them towards the most appropriate member of the team, etc – so the next step might be to encourage staff to enquire about practice services.

For example, “Is our baby clinic at a suitable time for you?” Or perhaps you could involve the reception staff in designing questionnaires. Not the big, contentious ones, but the smaller, everyday audits covering subjects such as opening times and the popularity of telephone consultations.

Patients like and trust nurses, and will confide all sort of information to them. Nursing staff are ideally placed to involve patients, again asking about practice services and what patients would like to see provided, as well as discovering what could be reduced or even withdrawn.

As ever, practice managers will have to find ways to make sure that the GPs play their part in this, possibly identifying a doctor who thinks patient involvement is a good idea and persuading him/her to become the practice champion.

A further suggestion might be to invite patient groups and/or voluntary organisations along to talk to the practice team, perhaps as part of a Protected Learning Time session. This would provide an excellent win-win opportunity to demonstrate to patients that the practice genuinely values their views and comments, and is making real efforts to engage (rather than doing the minimum possible or merely employing a bit of lip service in order to tick a box).

Returning to the big surveys, how proactively do you share your GP Patients’ Survey/Better Together results with the reception staff? If not, why not? Staff performance and attitudes are key issues in these assessments. Surely they should know how they have ‘scored’?

If a problem has been highlighted but staff are unaware of this, nothing will change. If you have discussed results as a team, have you subsequently drawn up group action plans? Are these being followed through? How will this be measured? Do you have another review meeting planned to evaluate the improvements?

It would be interesting to know just how many practices plan to introduce, or have already engaged in, public involvement. Despite the positive advice above, there is a long way to go before the concept can claim to be embedded in general practice culture.

A recent King’s Fund report found that 60% of participants, representing various members of the primary healthcare team, believe that patient experience survey results are the least effective approach to making quality improvements. If this is true, selling public involvement to the practice team might just be the practice manager’s greatest challenge yet!

1. Goodwin N, Ross S, Smith A. The Quality of Care in General Practice: capturing opinions from the front line. London: The King’s Fund; 2010.

“We have an active patient participation group who actively seek patients’ views and happily report back the good and unfortunately the bad! I chair the group and am also the assistant manager at the practice. Our biggest problem? – recruiting more members from the practice population! We hold regular FULL team meetings in the practice to look at what services are provided, and how we can improve. The patient questionnaire is shared with all staff, most are keen to see how we’ve done, and how we compare to other practices. We believe it’s about involvement at all levels. No one gets it right all of the time nor does any practice please all their
patients all of the time. The important thing is to try and don’t be afraid to make changes if you fail” – C Parker, Winshill Medical Centre

“Patient survey is a very effective tool to assess the quality of care and continuous improvement of customer care at all levels. In fact the customer satisfaction survey allows objectively to plan further improvement and take future actions” – P Ballah, Cardiac Centre, Mauritius