This site is intended for health professionals only

Expanding your practice list

Dr Michael Taylor looks at how practices can combat falling profits by boosting their practice list

As the Government looks at increasing competition in general practice and practice profits take another dip this year, it has become even more important to look at boosting your practice list.

Patient numbers are the single most important determinant of practice income, and by developing a strategy to retain and attract new patients now, you will have time to rehearse and to learn to protect yourself against the worst of these challenges. Most of your colleagues and their practices will wait until they are forced to make changes, but by then with steadfastness and a little effort you will be well ahead of the game.

Developing a plan

To start your journey of preparation, perform a simple analysis of your strengths and weaknesses, and the potential opportunities and threats to your business.

Perform this ‘SWOT’ analysis with as many of your practice colleagues as you can muster. Consider the following questions to stimulate ideas:

• How many patients do you have? Is your list increasing or decreasing, and by how much?

• Is there a sufficient buffer to allow the practice to weather the loss of patients without undue panic and partner acrimony?

• Do you routinely ask patients who leave why they are moving? What does this tell you?

• Are your patient demographics approximately the same as your town and region, and if not, are the differences significant?

• Do your annual accounts tell you how you fare financially and organisationally compared with your peers? For example, what is the percentage of income that is spent on staff? Is this too high, setting you at a financial disadvantage for investment, or is it too low, so that your practice doesn’t present itself as well as it should?

• Do partners have a shared vision of where the practice is going, how it will respond to new challenges, and how it will become responsive to patient pressure?

• Where is your practice situated? Of course it is a destination for your current patients, but how visible is it to those who are registered elsewhere?

The questions you can consider are many, but it is likely that by simple reflection and conversation you will settle on those that are truly important to your circumstances.

Then start developing a plan. List what needs doing, who is in charge of it and when it must be done by. If you limit yourself to five to 10 items over, say, 12 months, the construction and implementation of the plan should be simple.

Our first plan had 12 items, cost £13,700 and gained an extra 120 patients over 12 months. So at, say, £100 per patient per annum, of which £50 is profit, the plan more than paid for itself in the first year.

Here are some ideas that you may wish to consider. You can find more help at the Family Doctor Association website (

Retaining existing patients

Most of us will remember the first patient satisfaction survey that showed 82% of patients were satisfied or very satisfied with general practice. This was helpful politically at the time, but masked a truly important marketing point.

Those who are merely ‘satisfied’ can be persuaded to change practice almost as easily as the ‘dissatisfied’. Only those who are ‘very satisfied’ can be counted upon to remain loyal. Therefore, the majority of your patients could be induced to defect elsewhere given the right circumstances.

So what can be done to make those who are merely ‘satisfied’ become ‘very satisfied’? Or to put it more memorably, what can you do to delight your patients? Here are some ideas.

Audit reasons why patients consult

So the patient has managed to see you or a colleague, but what do they want? Of course, as a good GP you have attempted to discover their ideas, concerns and expectations, but this may not be enough.

Ask your practice manager to conduct a small audit of the following:

• Perceived severity of the presenting complaint.

• Cues to consult – for instance symptoms, discussion with others, whether a condition has been highlighted in the media.

• Perceived efficacy of GP treatment, both general to medicine and specific to that GP.

• Perceived efficacy of self-care.

• The need for further information.

This will give you a unique insight into the patient’s perception of their treatment, and will give you clear areas where your practice can improve. Each patient will have a slightly different perception of a consultation, and this can be very different from yours.

Assess the ‘face’ of your practice

Grab a coffee, get a pen and paper, and take five minutes to do this exercise. Draw three columns and as many rows as you have receptionists plus one. Now in the column marked ‘competence’ and ‘pleasant’ place one of the symbols +, – or ?. Now, you can be excused one question mark, but if there are two or more it is you who are suspect.

Question marks betray a lack of knowledge about an important part of what your practice does. Looking at the other symbols, you must endeavour to turn each minus into a plus. Do any staff need additional training or development?

Also, bear in mind at every interview for a new staff member that it is much easier to make a pleasant person competent than a competent person pleasant.

Keep an open surgery

GPs stress and strain to maintain clinical excellence, and rightly so, for patients want clinical excellence as a given. But what is the point of clinical excellence if the patient can never get to see you when they want to?

Booked appointments are a way of organising a day, but often become a garrotte on the windpipe of demand. You can instead control supply with patient education, phone access and nurse clinics.

As a rule of thumb, if you have fewer than 75 patient-to-doctor face-to-face consultations per 1,000 patients per week, supply is inadequate and needs increasing. At the very least, you should add the occasional open surgery – to act both as a safety valve and also as a gauge to monitor the levels of supply and demand.

Recruiting new patients

This is where things get exciting. You need to consider the world outside your practice and the world inside your practice and you have to make them match.

Improve your ‘kerb appeal’

If these tips were ranked by ‘quick yield’, this would be top. You know where your surgery or health centre is, but how sure are you that your future patients do? Half a mile away from my practice, a Darzi centre opened, threatening my list. We needed to get our retaliation in first, so we put up large banners outside our building and in came the new patients. It was the best £150 my practice has ever spent.

I was astonished when interviewing new receptionists to discover that one of them had walked to and from work past the front door of my practice for two years and was unaware what our building was used for. Such simple steps as banners have big gains, even in the short term.

Employ a ‘mystery shopper’

You need to assess how a patient feels when they crack open the door, look inside and take their first breath. What will it tell them?

Enlist a friend or relative, give them a clipboard, a pen and a list of all the ‘touch points’ patients will see as they approach the building. Then get them to enter the building (what story does your front door tell?), sit in the waiting room, visit the loo, talk to the receptionist, get called into the consulting room and so on.

Ask for candid, detailed feedback. You can get three pages of touch points from the Family Doctor Association website.

Scrutinise the phone bill

The success of general practice is based on its cost efficiency. But for any service industry, cutting back on communication costs is equivalent to cutting back on oxygen.

Scrutinise your last practice phone bill. What does it tell you? How many phone lines do you have? Is the cost too much or too little? What do patients think about how easy it is to call to speak to staff, order a prescription or get their results?

Start with the premise that the unit costs are too high, especially letters, but that the number of units of transaction is too low. Do you have a practice newsletter? Do you text? Do you use email? Keep abreast of modern media and you can reduce costs and improve communication with patients at the same time.

Make sure staff know your mission statement

To be responsive, we partners and clinicians ideally need shared values. From your vision flows your practice’s mission statement, or it should do.

I have now asked representatives of more than 800 practices whether they have a mission statement, and about 40% do. However, when asked, not one of them could tell me what it was.

Ours is to ‘help the patient by knowing the person’. If you have one, find it right now and have it printed out in a 32-point font on landscape sheets of A4 and fix one to the wall next to the phone in reception and the other on the back of the door of the staff loo. If you don’t have a mission statement, now is the time to develop one.

Dr Michael Taylor is a GP in Heywood, Lancashire and head of external relations at the Family Doctor Association

Expanding your practice list