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Practice leaflets are crucial but are often very badly produced – Dr Rod Sheaff explains how to get things right

Practice leaflets contribute to the quality of general practice, yet they are not always well-produced, properly thought out or readable. Producing a good one involves getting two things right. On one hand, the leaflet is produced by the practice to help the practice. On the other, it must give patients something they find useful, otherwise it will join other junk mail in the dustbin. The essential task when producing the leaflet is to discover what content and presentation will interest patients enough to get them to read the messages the practice needs to convey.

To start with, decide what purpose the leaflet serves. Is it to recruit patients to the practice or to a specific service? Is it to

inform patients how to access care out-of-hours? Is it to explain particular illnesses and their management? You need to be clear on this to decide which patients the leaflet will chiefly be aimed at and what changes in patient knowledge or behaviour the leaflet is intended to produce.

Next, discover how patients use the leaflet and what they think of the practice and the local NHS. The only way to know is to ask. You can do this through the practice's patient survey or, if you have one, through a patient group. The NHS patient survey analyses data down to PCT level, and though this analysis does not reach down to practice level, it still gives a useful first approximation.

Other sources include complaints, PCT lay members, patient forums and talking to those staff who are in daily contact with patients. These sources suggest which aspects of general practice interest patients and whether they have any gaps in knowledge or misconceptions that the leaflet might address.

It appears patients use leaflets not so much for comparing different practices before choosing as for making best use of the practice they have already chosen.

Often their requirements are relatively straightforward. For example they want to know what services the practice offers and when and how to access them. They also want to know about the individual doctors and nurses who provide them. Performance data is better given by comparing the practice with local or national averages than with recognisable general practices nearby.

Now the practice can draft a leaflet. Example one lists, by headings, the contents of the leaflet of the Lowry practice in Salford near Manchester. It is a good example, but an example nevertheless. The crucial point is to tailor the contents to suit what local patients want and what the practice needs to tell them. The best presentation again depends on the patients. About 20 per cent of Britons are less literate than a 10-year-old is expected to be; indeed they are functionally illiterate.

So test your drafts with the Fogg index, it includes benchmarks against newspaper styles (, or consult the Plain English Campaign (

In general, use small blocks of text, graphics and bullet points. In areas with a high number of ethnic patients, if staff or patients cannot translate the leaflet into other languages, voluntary bodies, hospitals and universities often have lists of translators.

Before printing thousands of copies, try out a draft leaflet. What do patients think of it? What do they think its main messages are? Will they keep it? If so, are they ever likely to refer to it again? Expect the leaflet to go through several drafts. On the right is an example from Shirebrook Surgery, Mansfield.

The PRIDE project at the national primary care R&D centre at the University of Manchester is developing methods for involving patients in producing leaflets that state the practice ethos.

Rod Sheaff is senior research fellow, national primary care R&D centre, University of Manchester

Example 1

Lowry medical practice booklet


•Practice staff

•Our commitment to you

•With these rights come responsibilities, and for patients this means....

•Change of address, name or telephone number

•Disabled services

•Teaching in general practice

•Practice confidentiality

•Complaints and suggestions

•Making an appointment

•Requesting a visit

•Out-of-hours emergencies

•Requesting a repeat prescription

•Doctor clinics and practice nurse services

•Blood tests; well person checks; paediatric clinics; antenatal clinics; diabetic clinics; asthma clinics; arterial disease checks; contraceptive care; minor surgery;

smoking; travel vaccinations; influenza vaccination; cervical smear screening;

breast screening

•Discussion about performance data

•General advice for minor illness

•Diarrhoea and vomiting; burns; stings – allergic reactions on the skin; cuts; injuries; thrush; coughs, colds and sore throats

•Other services available at

•Useful telephone numbers

•Where to find us [map]

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