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Competition means practices are having to look at how they market themselves – but not all GPs welcome it

Is GP advertising the final straw?

Before the NHS was created in 1948, it was standard practice for GPs to advertise for patients – some surgeries even had neon lights to entice sick and healthy alike.

Questioning the ability of the doctor down the road so you could steal their trade was also common practice.The return of competition in primary care almost 60 years on is not about to force GPs to stand on street corners in sandwich boards directing people to their surgeries, but practices are being forced to question whether or how to market themselves.The Department of Health this week issued guidance for hospital trusts on how they might hawk their wares to GPs, health care organisations and patients.Foundation trusts and independent sector treatment centres, driven on by payment by results, are already trying to get custom from GPs in the form of more referrals.The department says it may produce similar guidance for GPs, dentists and pharmacists early in the new year and is encouraging practices to make patients more aware of what they do.Incentives for practices to take on more patients are also in the pipeline.Dr Rory McCrea, a GP in Waltham Abbey, Essex, and director of ChilversMcCrea Healthcare, says some practices could lose patients if they ignore the new competition.'The world is changing,' he says. 'Once other GPs in the area start offering a certain range of services you may have to do the same thing. Most people want to go to their local practice, but there are some who want to shop around for GPs with a specialist interest in, say, diabetes or dermatology.'

Gentle promotion

ChilversMcCrea, which runs 23 practices, advertises its services through posters and leaflets, mainly in walk-in centres.

Dr McCrea's own practice also distributes 'professionally produced' leaflets telling patients of changes in NHS structures, smoking cessation clinics and flu vaccination programmes.Telling patients what services are available in their local area, Dr McCrea says, is an important element of what practices do and is only 'gentle promotion'.Any form of promotion or advertising whatsoever, though, is viewed with deep scepticism by much of the medical profession.The view that adverts by doctors could mislead vulnerable patients is the starting point for the GMC's Good Medical Practice statements on advertising and promotion (see box below).What concerns the BMA and other health unions most now, though, are the ethics of pitting one GP against another and diverting money away from patient care into advertising.Dr Laurence Buckman, GPC deputy chair, dismisses the argument that GPs must promote themselves more to help patients choose their primary care 'provider'.He says: 'It is rubbish to say this will encourage choice. GPs have been offering choice for years.'The BMA says it has not heard of any GPs advertising their services directly, and that there is no financial benefit in doing it. Unison head of health Karen Jennings is wary GPs might follow the lead of hospitals. She says: 'It is the Government's obsession with competition and choice that is forcing hospitals to set aside common-sense and waste money in this way.'Dr Elizabeth Barrett, a GP in Shirebrook, Derbyshire, says she finds the prospect of advertising 'deeply depressing'.She says: 'Blowing your own trumpet as a GP feels uncomfortable. We are more inclined to play ourselves down than up. It does not feel like the beginning of the end of the NHS – it feels like the absolute end.'


A Leicestershire GP, who does not wish to be named, believes the changes would mean larger practices becoming independent companies, growing increasingly powerful and employing NHS GPs or running the services themselves.

Cherry-picking fit and heal-thy patients who bring in the same amount of money, but far less hassle, is another problem with having more cut-throat competition in primary care, according to some GPs.GPs know it already happens to a small extent.Dr Mark Hunt, a GP in Frome, Somerset, argues that GPs who become good at advertising may build up large lists containing disproportionately large numbers of young patients. Many GPs will ignore Government calls to be more forceful in promoting what they do. They are busy enough as it is, have no room for extra patients and no spare money to start an advertising campaign.Crucially, and despite what the Government would have us believe, most patients are still happy to register at the practice nearest their home.And no amount of adverts on the backs of buses is going to change their mind.

GPs should do more to promote their work

Dr James Kingsland has a website publicising his practice and puts leaflets in libraries telling patients about the clinics he provides and opening hours.

He believes GPs should do more to promote their work.'I think it is vital that we celebrate what we do and publicise it. I do not think we should hide our light under a bushel. If I had a multi-disciplinary mental health team at my practice I would want everybody to know about it,' he says.Dr Kingsland, chair of the National Association of Primary Care and a GP in Wallasey, Merseyside, is strongly opposed to direct competition, however.'There is a big difference between advertising and publicising. I think if we got into a competitive market that would be a bad thing. If one GP started advertising saying they were the best thing since sliced bread that could be very damaging.'He does not envisage GPs will take to conventional advertising techniques.'There is nothing to stop you putting an ad in the paper, but it just does not seem good practice.'

How hospitals are targeting GPs to win referrals

Advertising by hospitals is increasingly targeting GPs, with the aim of getting as many of their referrals as possible.University College London ran a campaign based on its low MRSA rates and state-of-the-art buildings. Its adverts appeared as banners on internet websites.The independent sector treatment centre provider Capio also recently began advertising in medical journals for GP business.King's College Hospital NHS Trust's favoured method is to invite GPs to 'training' seminars, which also allow managers and consultants opportunities to promote hospital services. The trust uses Dr Foster software to highlight where GPs are referring their patients, enabling it to target those who are not sending people its way.King's College head of corporate communications, Sally Lingard, says about 35-40 GPs came to a recent meeting where consultants advised them on developments in fields such as child health, general medicine and diabetes care. 'It only costs a couple of hundred pounds, because pharmacy companies sponsor us,' says Ms Lingard. 'We see this as continuing professional development for doctors.'One GP who went to a recent seminar, but does not wish to be named, says it helped her to know what local services were available and also helped her learn more about conditions such as bowel disease.She adds: 'We were all wondering if it was a marketing tool. It did seem the case for one of the speakers. He just seemed to be saying how fantastic the hospital was.'But the GP says it was good to 'put names to faces' for consultants she made referrals to.

What Good Medical Practice says on promoting yourself

• If you publish information about your medical services, you must make sure the information is factual and verifiable.• You must not make unjustifiable claims about the quality or outcomes of your services in any information you provide to patients. • It must not offer guarantees of cures, nor exploit patients' vulnerability or lack of medical knowledge.• You must not put pressure on people to use a service – for example by arousing ill-founded fears for their future health.

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