Handbook of Practice Management > Volume 71, Number 0 > Pp. 8-01-8-44

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8. Patients

General practice exists to serve patients. But as primary care is more and more driven by regulations and targets handed down from above, it is all too easy to see the sick person sitting in the waiting room as an inconvenient interruption to the business of the organisation, rather than its reason for being.

This section is about patients and about how practices can ensure that their services really meet the needs of their patients. Patient's prime concern is to be able to see the doctor when they need to. So the section starts with advice on drawing up a suitable rota and managing demand.

Traditionally, patients went to see their GP. Face-to-face consultation is still the gold standard, but as demand has increased, telephone consulting has become routine. Online health care is growing. There is an increasing need to send patients reminders and information, and SMS messaging offers a way of doing so. We look at the benefits and risks for both clinical and administrative functions, and discuss how to manage all forms of access.

Different groups of patients have different needs. A 'one size fits all' philosophy is likely to fail those patients with the greatest need for help. We consider how practices can progress from defining patients as a problem to working with them.

We look at the special problems and needs of patients such as those from ethnic minorities, the socially excluded, students and young people, and the steps that the practice can take to meet them.

We work in a 'patient-led NHS', but what does patient and public involvement mean for general practice? What are the benefits? How can we involve patients as partners? Who is in control? We consider how practices can increase patient involvement in a way that benefits patients and staff.

Complaints are an uncomfortable form of patient feedback. But the easier it is for patients to express their feelings, the more constructive and less painful the experience is for both patients and the practice. We look at handling compliments, comments, informal grumbles and formal complaints.

Consent to treatment and consent to sharing of information about them is of great concern to patients. These issues are discussed, and so is confidentiality, which is closely linked to information sharing. Issues of confidentiality and consent also arise when use of a chaperone is considered. There are particular problems with confidentiality and consent in relation to children and to those who may not be able to make decisions on their own behalf. Child protection, legal competence, mental capacity, power of attorney and advanced decisions are discussed.

Practice managers find themselves asked many unexpected questions. There is guidance about organ and body donation and other matters which may trouble patients.

Patients should be the focus of everything the practice does. A practice which involves patients meaningfully will find its work more rewarding and often easier rather than more difficult. We hope that every Section of the Handbook will be read and put to use with patients in mind.

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