Jim Pink (top) is a GP, father and songwriter with an interest in people, rather than patients. Jenny Coventry (right) is a fourth year medical student at Cardiff. In her free time she loves country walks and playing in the Cornish waves. Leo Duffy (left) is a fourth year medical student in Cardiff. He enjoys writing and rugby and is a full time Welshman.
The Apprentice: an assorted collection of wannabe entrepreneurs selling their souls in front of the TV cameras for the privilege of working with the self made billionaire Lord Sugar. As we sit in front of the goggle-box, unwinding from the day before, we learn about profit margins, innovation and “up-selling”. Back in the surgery, we reflect on what The Apprentice can teach us about running a GP surgery.
The economic reality that most surgeries are profit-making enterprises is lost to most patients, and indeed, some of our secondary care colleagues. There is a certain irony that whilst most GPs would resist the privatization of the NHS (to profit making organisations), those same GPs work tirelessly to maximize the profits of their own small businesses.
Up-sellling in general practice can mean two things. Even since before Stott and Davies1 described “the exceptional potential of each primary care consultation”, GPs were offering tidbits of health promotion to anyone who might listen, particularly amongst those with potential to improve their lifestyle. This practice of offering “a little extra” is now entrenched in modern UK general practice, so one can’t attend a GP with a sore throat without having a blood pressure check, and few people leave consulting rooms between October and Christmas without a flu jab, whatever they came for. Up-selling in this sense means offering a little bit more healthcare to patients for the price of one consultation, which in most cases, can be mutually beneficial to both patient and practice (not least, in terms of income).
Most will stop there, with the acceptance that if QOF points are maximized and as many people as possible are vaccinated we’ll have done the best for our patients and paid this month’s mortgage. However, what would Lord Sugar say? Perhaps he’d expect a little entrepreneurship in each surgery, particularly in a time where GPs are experiencing the double whammy of falling income and increased demand. He’d expect GPs to come up with a plan to fight back.
Over a mid morning beverage and snack, we had a brainstorm; it hit us. Why not turn the waiting room of our surgery into a coffee-shop? (Selling life insurance or funerals, although no doubt profitable, were rejected on account of insensitivity.) Imagine the scene at the front desk, “I’ll have a skinny, decaff latte with soya milk, a flapjack and a cervical smear please?”
Sadly, not all of us can always run to time, so there are often waiting rooms full of ill, tired and sometimes understandably grumpy patients. Surely a cup of something warming would help? Also, we all know of a patient or two who consider a trip to the surgery as a social outing, so why not make the environment more conducive to this, with newspapers, comfortable furniture and a selection of hot drinks and snacks. Whilst waiting for their coffee to brew, they could either have a natter with other patients, comparing the severity of their ailments, or simply just relax in a quiet corner browsing on their iPhones using the complimentary WiFi. Profits from sale of beverages could be re-invested in to the practice, to improve the service provided and employ additional staff.
Clearly, there are a few potential pitfalls with this plan (not least that not all receptionists are keen to retrain as baristas) but the change of perception of what a GP surgery should look like is worth considering. The future will tell us what role private providers will play in primary care provision, but they will surely not share most GP’s moral reservations about making money from patients.
The strength of NHS general practice is delivering personalized healthcare in the heart of a patient’s community. As such, why should the building not be a community hub? The walls could be decorated with art from the local school and sell local produce in the cafe. Charities offering support to patients such as Age Concern, Citizen’s Advice Bureau and Macmillan could be offered a platform. The building could be used in the evening for exercise classes, book clubs, stress management classes etc.
The inspirational Bromley by Bow Healthy Living Centre have adopted this holistic approach to great effect, with healthcare provision being provided alongside projects to improve skills, lifestyle and support people back into work. Not all surgeries can hope to emulate their approach, but if we strengthen the links to our communities, we may just be able to resist the private healthcare companies that are circling overhead waiting to pounce on our patient lists.
Our vision of the future of General Practice is caffeinated. Whilst patient-centred, individualized healthcare would be the base, we could also add a steamy layer of partnership and engagement with local charities and sprinkle on top the utilization of the practice premises for health improving activities out of surgery hours. And we could sell coffee. We think Lord Sugar would approve. We could call it StarDocs…..
1. Stott NCH, Davis RH (1979).The exceptional potential of each primary care consultation. JRCGP,(29), 201-5