Practice Business Manager,
The Waterfield Practice, Bracknell
Gary has more than 25 years' experience as a director and manager of businesses in the primary care, optical and veterinary sectors. As well as being a practice business manager he is also a practice management consultant, providing business and management support to general practices
Economic uncertainty, NHS reforms and increasing competition mean today practice managers need to possess skills that may not have been needed before. General practice, like any business, is facing new and increased pressures: changes in primary care are squeezing income, competition is increasing and added to this are the greater expectations of patients, who, fuelled by what they can easily learn from the internet, want more from services, access, facilities and medicines.
In this climate it is vital that the practice is run as a business and has a clear purpose and direction, understood by all, and driven by the overall strategy. Whatever the strategy, of which income growth is one possible option, it is still vital to protect the current profit from eroding. If income isn't increasing and your costs are rising then profits will be falling; so a business should always be looking to increase income to maintain its level of profitability.
For a general practice, much of the income is provided via the global sum, which is difficult to influence. Outside this, however, are revenue streams that the practice can have some bearing on, such as maximising Quality and Outcomes Framework (QOF) achievement, increasing list size and providing private services.
So if you are looking to increase income you should ask yourself:
It is a certainty that some opportunities aren't being realised; taking advantage of these is vitally important, so you should always be alert to any possibilities.
Having an objective to increase income or identifying new revenue streams are not enough on their own and the objective is unlikely to be achieved without a driving force. This is the role of marketing, which is the most important means of promoting the practice and its services and conveying the message you want to be heard.
So what is marketing?
To the uninitiated it will probably mean little more than the advertising or displays in the practice, but it is much more than this: "Marketing is essentially about marshalling the resources of an organisation so that they meet the changing needs of the customer on whom the organisation depends."(1)
This is one of many such definitions and while these may vary in what they say most share a focus on the customer (or patient). Being able to define marketing in a sentence is less important than being an accomplished marketeer or an organisation with great marketing, and two essentials are necessary to achieve this:
The four 'Ps' of marketing
To make this subject more easily understood and to help develop the marketing plan it is useful to use a tool known as 'the four Ps' or 'the marketing mix', which refers to product, place, price and promotion. It is vital to make sure each of these areas is organised in the best possible way to help achieve the strategic objectives.
These are the products the organisation sells or, as is the case in general practice, services that are delivered. Compared to a product, a service is an intangible item that can't be returned if unsatisfactory and is more of an experience, or something you do for someone, that occurs at a specific place. While harder to define than a product it can be considered in terms of the quality and features and should be designed to meet the needs of the patient.
This is where the service is provided to the customer, which of course will usually be the GP surgery and more specifically a consulting room or treatment room. However when considering 'place', all areas where the service, or part of it, is delivered need to be considered so this includes reception and waiting area as well as clinical areas. Important aspects here are accessibility, convenience, comfort and the suitability for delivery of the service.
This is less straightforward in general practice as primary care delivers most of its services without charge. Instead of the price a customer might pay for the service, think of the cost they incur in terms of time, effort and convenience. The 'cost' to the patient is probably rarely something we think about but to ensure patient satisfaction it is important that the perceived value is greater than the perceived cost incurred.
This one area – the way you let people know about your services – is often thought to be 'marketing', and while it is often the easiest to relate to it is only one aspect. Promotions should be designed to ensure your audience knows what services you offer and what benefit they provide. This can be done in a variety of ways such as websites, leaflets, brochures, personal calls, media events and in-practice displays.
Creating your marketing plan
Whatever the strategic objectives of the business, the successful achievement of these will rely on the creation of individual plans and objectives for marketing and all of the key business areas such as HR, purchasing and finance. For marketing, if the strategic objective is to increase list size then the marketing objectives should be ones to enhance and extol the benefits of the practice and encourage patient registration.
If the aim is to introduce new, or make better use of existing, services by driving patients in at the most cost-effective time – for example, vaccinations in flu season – then the marketing goals must be designed to achieve this.
If we take the strategic objective of increasing list size, supported by the marketing goals mentioned above, we need to create a marketing plan that will ensure these are achieved. The best way to approach this is to use 'the four Ps' described above and consider how each of these can be organised and improved to ensure success.
Remember your products are the services you offer and it is worth thinking of this as more than consultations with the GP or nurse. Consider the different type of consultations, or reasons for them, as each of these can be seen as a separate service – for example, medicine reviews, immunisations and
By thinking of these as unique services it is easier to design them to meet and exceed the patient expectations as they are likely to be different depending on the reason for using the particular service. It may be that the practice offers a range of services that meets the needs of its population and can concentrate on improving these. At the same time new services could be needed if they do not match the patient requirements – for example weekend clinics for working patients.
The next step is to consider the place where the services are delivered, which is probably the surgery premises in most or all cases. While it has to be fit for purpose it is worth thinking beyond this. Is it easy to access? Do patients feel relaxed and comfortable while waiting and in the consulting rooms? Are all areas clean, tidy and clearly signposted? Is the comfort and clinical balance right? It may even be that the surgery is not always the most convenient place if some services could be taken nearer to the patient?
The price or cost to the patient, while not easily judged in monetary terms, must offer value in their eyes. A visit to the surgery is something that is seldom enjoyed and can be likened to a 'grudge purchase'. Late-running appointments, inconvenient surgery times, difficult parking, complicated appointment systems, being called in unnecessarily and having to chase results, reports and prescriptions are all things that can add to the cost for a patient.
The last and most important area is the promotion of the surgery and the services, or more precisely the message that is communicated and how and when it is done. First, your message should be communicated in such a way to reach and appeal to your target audience. Think beyond posters in the waiting room. For example, if you have a young patient base then your practice website, social networks, YouTube and text messaging may be more appropriate.
Make sure what you are saying is what you are trying to achieve. So if you're trying to promote your new website, make the message about the benefits of using it, how to start using it and the website address. Put a 'call to action' in your message so it is more than a passive piece of information and make sure there is a clearly identified benefit – for example, "make ordering your repeat prescription easier by getting your website starter pack from reception now".
Finally, keep your promotions fresh, and avoid boring the audience, by changing them regularly: two months for each is usually long enough. Plan your campaigns 12 months in advance. Once this is decided upon, create a marketing calendar to show the campaign, activities and method of communication to be used each month.
Marketing may seem a complicated aspect of managing the business or perhaps even far removed from patient care. However, you can push all the mystery aside if you adopt this simple, structured approach: first identify your strategic goals, then consider how each of your 'four Ps' can be designed to achieve them. Finally, put the decided actions into a 12-month calendar for everyone to follow. It's never too late to start or relaunch your marketing campaign, and there has never been a more important time than now!