Can customer care training alone create lasting cultural change?

Many health services have placed an emphasis on providing customer care training for all staff in order to improve patient experience. I would argue that although customer care training is an important contributor in improving customer service generic customer care training cannot be relied upon as a method by which change is created. There are a number of reasons for this:

  1. Most training provided is not site specific, so it is a ‘day out’ for certain staff and is generic in nature. This fails to look at individual service needs and get to the root cause of poor customer care;
  2. Only certain staff attend. Usually this is receptionists and other administrative staff, rarely is it the key people who have the greatest contact time with the customers, the nurses, doctors and support staff. This continues the myth that the receptionists are the key to customer care rather than all team members. If customer care is going to be at its very best, a fully integrated approach needs to be taken;
  3. The decision makers rarely attend. Customer care training is seen as an add on. If the decision makers are not in attendance then even the very best in customer care training will not resolve long standing issues as it will not be able to address and create cultural change;
  4. Customer care training deals only with staff not with services. It is important to identify service issues which may be preventing good care.  It is usually a combination of caring staff and good service delivery that makes fantastic customer service.

The above are the reasons why I approach customer care training differently.  I carry out in depth initial consultations, following this meeting and observing staff to get a really good understanding of the issues and drivers.  For staff who need that extra support I offer coaching options.  This way long lasting cultural change can be created and add benefit to staff and patients alike.

What do you think? Have you had Customer Care Training alone which has delivered results?

The impact of ending practice boundaries?

What is happening?

April 2012 will see patients in parts of London, Manchester and Nottingham being able to choose to register or receive a consultation with a GP practice of their choice, without regard to practice boundaries.  The pilot is set to last one year, but it is difficult to see how this can be reversed or stopped once patients have developed a relationship with a different practice.

Why is this happening?

Competition in public service is central to changes in education, health and other public sector areas.  Removing practice boundaries is as Andrew Lansley said, “…just the beginning of a range of measures… to make the NHS truly patient focused”.

Clearly there are different views about whether abolishing boundaries will improve choice and quality.  A recent Patient Association poll found that 92% of people would like to register with a GP practice of their choice, rather than just a local practice.  The LMC, however, feel that these changes will ‘put a nail in the coffin for local and personalised care’.  Whatever your view, it is clear that increased choice will be rolled out countrywide and that practices need to act to meet these challenges.

Benefits Issues
  • Patient choice
  • Improved access
  • Competition will drive up standards?


  • Home visiting
  • Continuity of care
  • Funding
  • Public health
  • Emergency and community care services

Who will benefit?

Like all competitive markets, informed consumers who are able to change providers will benefit.  They will ‘shop about’ for the practice that best suits their needs.  Most patients are willing to travel to a good practice, just as they are willing to travel to see a dentist they like and trust, or one who has been recommended by a friend.  Mobile patients will register with practices who they believe offer good patient experience.  This will be decided by looking at existing patient feedback on websites like NHS Choices, talking to friends, family and neighbours and seeing how accessible the practice is.  Much has been made about statistics on clinical outcomes; however, research shows that personal recommendations and patient stories have a more powerful impact than statistics in helping us decide what health services we use.

Who will lose?

It is likely that elderly, vulnerable and less mobile patients could be negatively impacted if changes are made with regard to home visiting responsibilities.  Equally practices that have lost patients will have fewer resources to improve services and patients could find themselves trapped with a deteriorating practice.  ‘Difficult’ patients could find themselves passed from one practice to another across a much wider area, rather than have their care provided by a small number of practices.

What is the impact on practices?

Undoubtedly the government’s intention is to create a competitive market. Practices which cannot keep or attract patients will go out of business, others which attract new patients may well be incentivised to grow. An immediate impact of greater choice, is that practice-patient turnover will increase.  If we look at NHS Choices alone, this receives 350,000 visitors every month, that’s 4,200,000 visitors a year, which is equivalent to more than half of London’s population, for an average 6.5K practice that’s just under a 1,000 of all registered patients.  Most visitors look at patient comments and ratings.  If a practice has mixed or poor reviews this will inevitably mean patients will not choose this practice unless friends and family have found their experience to be different.  Again this highlights that it is patient satisfaction and reputation management which will be key to survival.

The Survivors The Strugglers
  • Practices with a good reputation
  • Practices with good patient experience
  • Practices delivering good customer care
  • Practices with a good reputation near large offices and schools
  • Practices offering and promoting a wide range of services for patients which are easy to access
  • Super Practices’ that can obtain economies of scale
  •  All practices with reputation issues and/or poor patient experience
  • Suburban practices with a poor reputation
  • Practices with unexplained poor clinical outcomes

What is the solution?

All practices will need to adapt to become more focused on patient experience, marketing and reputation management.  With improvements in these areas practices will be less vulnerable to population changes and will be able to maintain a healthy list size.

Every practice will have to find solutions which fit their individual service as each practice’s population needs will be different.  For example, if patients like the practice because of the personal nature of the service offered, then it is important this is strengthened and reflected in any practice marketing. There is no one size fits all.

Your reputation really is the key to your success.

For tailored advice and support on how to improve your service so that it is more competitive, please get in touch with me. The services I offer will save you money, improve patient experience and reputation.

What do you think? What do you believe will be the outcome from changes to practice boundaries?


How do I attract new patients?

Less than 10 years ago few GP practices would have asked this question as there were patients aplenty. Now, with list purging and increased competition, the environment looks quite different. Many practices will, over the next few years, struggle for resources and ultimately struggle to survive in their current form. All practices will be looking for greater economies of scale and will need to be smart to meet the challenges ahead. Practices will need to attract new patients as well as hold onto their existing patients.

These are my generic five top tips for attracting new patients. There are countless other ways to attract patients, but each surgery’s needs are different.

Ensure that the practice has a good patient feedback system

If you don’t know what your patients like or don’t like then you will have a problem keeping your patients let alone attracting new patients. Hearing what your patients say at the reception or in a consultation is not the same as having dedicated systems to capture what people really think. Ideally, having someone independent of the practice to find this out is even more useful; then you hear it how it really is.

Make changes from the feedback you receive

So you have good feedback processes so now you need to act on the feedback. If 50 people have said they do not like your appointment system then you need to act on this. You may want to involve patients in any redesign but do not expect them to come up with the solutions. You need to find these out yourself, possibly using other experts.

Improve NHS Choices feedback

If you are recommended by only three out of ten patients, why would I as a prospective patient register with you? You need to improve your image and reputation. Firstly, you need to ensure that you provide suitable feedback to those ten people who have been kind enough to comment. Secondly, you need to look at what they have said and do something about it. Thirdly, you need to increase the positive feedback you are getting.

Improve the practice’s own website

If you have a practice website, it is important that you have this reviewed. Is it doing what it is meant to do? How easy is it to use? How easy is it to find? From a website review, changes can be made, most of which will not cost any extra but may make patients who use online services happier. If you don’t have a website, consider talking to a communications expert about how having one can help you communicate with your patients.

Ensure the practice has good signage

Often when people are new to an area they just pass by a practice and remember that they need to register with a GP. If your practice is the first practice they see you are more likely to become their practice. Just make sure the receptionist smiles when they meet the prospective new patient.

For advice on increasing patient numbers tailored to your practice, or, if you need support in making changes and increasing your practice’s population, please get in touch with me. The services I offer may cost less than you think, they will save you money, improve patient satisfaction, increase your patient numbers and your practice’s income.

How do people choose a GP Practice?

Unfortunately, there is little if any recent research within the UK about how people choose their GP practice. This is in contrast to research on patient satisfaction. The last major UK research was in 1989 by Christopher Salisbury who conducted a national survey with results from 447 people. The research found that 44% of people chose the GP practice because it was the closest to them (although for some there were closer practices). 23% of respondents registered with a practice because it was recommended to them. However, when asked how you first knew about the surgery that you chose to join, 47% said that a neighbour or friend had told them about the practice (which I would take as being a recommendation in itself).

Clearly since 1989 times have changed. Today 60% of the adult UK population (30 million) access the internet every day. In 1989 the internet had only been in existence for 6 years and by 1990 only 0.009% of the UK population had access to the internet.

In 2008 American research by the Center for Studying Health System Change found from the 5,805 people who responded most (50.3%) relied on family and friends when finding a primary care physician and only 10.8% on internet ratings. The figures are somewhat skewed by the American healthcare system as ‘Health Plans’ and ‘recommendations by other healthcare personnel’ make up the remainder. Furthermore, internet ratings in the States are provided by various services, not one comprehensive website like NHS Choices and the States does not operate a practice boundary system which prevents family members who live apart having the same doctor.

In the UK the power of the internet should not be underestimated. Anyone who worked for a PCT during the change of dental contracts will know that a huge number of people looked on the internet to find a dentist who would accept them. In the UK it may be found that there is a difference between rural areas (where choice may be restricted by geography) and urban areas where there may be a plethora of choice, but this is just supposition. I would always recommend that practices ask new patients how they found out about the practice and establish why they choose the service. This information can be reviewed to ascertain what attracts new patients to the surgery.

Within the UK we can take an educated guess that the decision as to which surgery a patient chooses is largely based upon word of mouth, internet feedback and the visibility of the practice. However to get a more exact understanding of why people choose the GP practice new and more comprehensive research is required.

How do you, as a patient, chose a GP practice? Do your patients tell you how they found you? Please reply and let me know. Your experience and thoughts could contribute to future research and to the success of your own practice.