Patients are not customers of GP practices, and it is dumb to use consumer models to describe them

Patients don’t increase practice income by using more appointments and they have no power over how much is spent on their care. In fact, GP practices are more like “buying groups” to purchase care for patients and the only choice patients get is to switch buying group. Encouraging them to behave as demanding consumers can actually make services worse because practices have to divert resources away from more effective care to deal with complaints.

The true customers of GP practices are the doctors and nurses who provide the care. They are trading their time and skills for money and work life. And, unlike patients, they can sell to the highest bidder and dramatically affect the fortunes of a practice. Behind every failing practice is a failure to retain skilled clinicians who to provide care for its patients.

To paraphrase Richard Branson: [Patients] do not come first. Employees come first. If you take care of your employees, they will take care of your [patients].

So, if they are not customers, how should patients relate to practices? They are partners in stewarding a scarce resource for their community. The maximum benefit for everyone comes when patients use care thoughtfully and sustainably. Pro social rather than selfish behaviour can be enforced by the group.

This is not some pipe dream. Before the individualist consumer boom of the 20th century we survived by getting together for the common good and we are still wired up for this. Practices need to trust their patients and not be afraid to allow them to see inside the organisation or make suggestions.

Oh and in case anyone thinks this will lead to pressure on GPs to take a pay cut or endure awful workload, the pay and conditions for doctors and nurses are set by what is needed to attract people to work for you. You can’t pay less or have a rubbish job because they will go elsewhere.