The trouble with NHS Choices… And a better way to do feedback?

“This is the most mismanaged gp surgery I have ever had the displeasure to use. Difficult to get appointments, impossible to plan around work, rude receptionist…”


It is difficult to see how any surgery could use this sort of general criticism to achieve anything positive. More often I find that this sort of comment leaves staff demoralised and defensive.

The premise of NHS Choices sounds superficially sensible. Provide potential patients with honest, good quality testimonials about GP practices. These rational and informed consumers will then choose to take their business to the best practices. The good surgeries are rewarded with new business. The underperformers will respond to patient feedback and improve, or eventually lose patients and go broke.

In most industries and under normal circumstances this would make sense. But, General Practice is not a normal industry and these are strange times. In an environment of clinical staff shortages, many practices simply do not need or want to attract more patients. They simply cannot find or afford the staff they would need to look after them. In addition, due to practices boundary rules, patient choice may be limited to only a collection of equally poorly rated practices facing shared recruitment and demographic problems. 

Feedback is powerful. Thoughtful feedback given with good intentions by a skilled tutor or friend can encourage a student to improve and excel. But, careless feedback can hurt, demoralise and block progress.

Feedback is a useful tool when applied in the right way to a suitable problem…

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The 4 NHS Ways to Work Framework

The fields of management and leadership are full of simple schemes and classifications for understanding how people and processes tick. These can be a useful tool to turn to when planning change or when there is problem that is difficult to put a finger on. They provide concepts and vocabulary to help us explain problems to one another and find solutions together.

I encountered a new leadership concept this week…



Kurt Gebhard Adolf Philipp Freiherr von Hammerstein-Equord, the Commander-in-Chief of the WW2 German Army, had a fascinating system for classifying his officers.

“I divide my officers into four groups. There are clever, diligent, stupid, and lazy officers. Usually two characteristics are combined. Some are clever and diligent — their place is the General Staff. The next lot are stupid and lazy — they make up 90 percent of every army and are suited to routine duties. Anyone who is both clever and lazy is qualified for the highest leadership duties, because he possesses the intellectual clarity and the composure necessary for difficult decisions. One must beware of anyone who is stupid and diligent — he must not be entrusted with any responsibility because he will always cause only mischief.”

This system is amusing for its frank, perhaps outdated, description of most workers as stupid and the image it conjures of that much mocked workplace character – the “little Hitler”. We all recognise that person who enthusiastically applies rules and regulation without proper judgement or understanding of the systemic harm they are doing.

However, I think it is too reductionist, rigid (and rude) for the modern workplace.

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