Building the reputation of independent NHS care
About the author
Martin Flegg Chart.PR FCIPR is a PR professional specialising in internal communication. He is also a guest tutor and assessor for PR Academy on CIPR qualification courses.
This case study is based on a CIPR Professional PR Diploma assignment by Sara Dawson, edited by Martin Flegg.
Independent Medical (IM – a pseudonym) is an independent healthcare provider based in the UK offering urgent, community and primary care services across England.
IM’s biggest revenue stream is NHS services, that is winning new NHS contracts to grow the business and keep existing ones when the contract is up for renewal. One of IM’s main Key Performance Indicators (KPIs) is to grow turnover through acquiring new business and the growth of existing business.
A major challenge to its business model is the fact that it is a private provider bidding for NHS services, in an operating environment that is sometimes hostile to private provision.
In the past, the company has lost contracts as a result of local negative attention born out of the perceptions of local councillors, commissioners and GPs in certain areas, although this negativity did not stem from patients or employees, or the quality of the service offered.
To achieve their KPIs, IM’s reputation must be evaluated and communication strategies identified to influence key stakeholders and grow the business by winning contracts based on improved reputation and a better understanding of their products and services.
Tracking the issues and drivers of reputation as part of a coherent measurement programme could also provide IM with a strategic tool for countering the potential impact of a loss of reputation by engaging with stakeholders and influencers in a timely way.
Research and key findings
Secondary research was undertaken to analyse the importance of a positive reputation, segment key stakeholders, identify factors that could impact on the company’s reputation in the future and explore the role communications could play in enhancing IM’s reputation. The research included:
- A media analysis exploring where IM focuses its public relations activities and to whom.
- Qualitative case study research.
- A desk top analysis of the actions of competitors within the private healthcare sector and how they improved their reputation.
- Horizon scanning using a PEST (political, economic, social, technological) and a SWOT (strengths, weaknesses, opportunities, threats) analysis.
- Stakeholder mapping and segmentation using the stakeholder salience model.
At the time of the research IM’s PR function was managed by an external PR agency. An analysis of the agency’s annual activity plan was undertaken to identify issues and possible opportunities for improving the PR approach.
Measurement was identified to be an issue. The agency’s plan did not link PR strategy to IM’s objectives/KPIs, and their PR objectives were not SMART. The PR contribution to KPIs were being measured by an annual target for cuttings, brand sentiment and share of voice.
According to the media content analysis, the PR agency were heavily focussed on clippings from across the country with no strategic target.
B2C rather than B2B focus
The existing PR was found to be heavily patient-focussed, with the PR agency identifying their role as making IM “stand out from the crowd” by maximising innovative stories of patient care.
Given the animosity towards private companies taking over local NHS services, exposed by other parts of the research, standing out from the crowd could potentially lead to negative outcomes that affect business growth.
The focus in the existing PR activity was also on IM as a B2C company primarily concerned with delivering the best services to its patients, with a clear lack of awareness of IM as a B2B entity. This was significant because the stakeholder mapping undertaken in other parts of the research revealed that the definitive stakeholders, who had the power to grow the company, were found in B2B relationships – Commissioners, the Care Quality Commission (CQC), Integrated Care Networks (ICN) and Primary Care Networks (PCN).
In terms of making or breaking the business, patients had no power or legitimacy, yet they were the focus of most of IM’s PR.
Stakeholder identification, planning and engagement was limited. The annual plan focussed PR activity around awareness days (e.g. National Diabetes week, cycle to work day etc.) to “position IM on a national and regional level by gaining press coverage”. Plans included engaging with ‘stakeholders’, yet there was no explanation of how these could be identified and engaged.
Cuttings evidence and past PR activity revealed a lack of structure and planning. A study of four months of cuttings and PR activity showed that IM had a varied reputation locally, and they did not have a solid national reputation. Missed PR opportunities also included a new local flagship practice opening with no PR plans to promote it.
A lack of segmentation in communication planning for publics (patients, stakeholders locally and nationally), meant that IM was communicating the same message across multiple channels.
Social media was also underutilised in plans, with IM’s Facebook and Instagram accounts only having 12,000 followers, with minimal likes, shares and comments.
The experience of competitors
At the time of the research IM did not have any documentation which analysed their competitors on a local or a national scale and they did not monitor them regularly. Secondary research was therefore undertaken to acquire some insight, and this revealed that many competitors had historically had a bumpy ride attracting much negative publicity for being private providers of NHS services. It was concluded that marrying the two appeared to be a difficult proposition for publics to understand and this had the potential to propagate negative perceptions and tarnish reputations. The PR response in many cases was to simply ‘rebrand’.
A number of examples of this were found. For example, in 2018 the Practice Group based in Buckinghamshire, were acquired by the Centene Corporation, a US company. A backlash ensued and national negative stories of the acquisition flooded the media and were heightened when a local GP practice was closed. The Practice Group responded by rebranding themselves as Operose Health and sought to downplay their reputation as a large corporation.
Similarly, another competitor, Care UK, had become Practice Plus to appear smaller.
Lessons learned from IM case studies
IM had also experienced similar negative public perceptions of its activities which had impacted on contract acquisition and business growth.
In 2019, IM prepared a bid for a GP contract. After a successful presentation to local commissioners, they were awarded the contract over four years. In the weeks that followed, regional media, supported by local councillors, applied pressure on the commissioners to withdraw the contract offer because ‘IM was an American company looking to take over and destroy local services.’
This was based on rumour and was ill informed, as IM is a British company, yet the contract offer was withdrawn and offered to someone locally. Stakeholder segmentation by the company had been minimal in the region and IM was therefore an unknown entity.
A more positive outcome for IM, founded in a more proactive PR approach, was their Yorkshire Hub. At the time of the research, half of IM’s sites were based in Yorkshire, and this was attributed to the good reputation they had among local commissioners and local health leaders, including the leader of the regional city council.
One of their Walk-In Centres was described as a real champion for the company with the local team actively campaigning for IM to keep the local contract, positioning IM as a local company that ‘works when it is local’.
This part of the research concluded that PR around high-performing practices, such as those in the Yorkshire Hub, could be promoted as examples of good management and quality.
Issues and opportunities exposed by the PEST and SWOT analyses
The fundamental issues flagged by the PEST were in the political sphere around commissioning. A pressing political consideration was the move towards more strategic NHS commissioning of patient services. IM would need to build a stronger reputation in order to get a seat ‘round the table’, as bidding for contracts without a prior relationship would become more challenging.
Economically the impact of the pandemic on the business needed to be monitored. Many of IM’s contracts were activity-based (paid per patient). During the pandemic people had used urgent care far less and this had impacted on turnover. If the trend for video consultations and less use of urgent care continued after the pandemic, IM would need to win more contracts to replace the urgent care ones.
Both of these political and economic issues highlighted the need to focus future PR on influencing key stakeholders in key existing and growth areas in order to successfully bid for and retain contracts.
Socially the perception of companies managing NHS contracts as being ‘evil’ and ‘private’ would likely continue. A PR strategy that therefore promoted IM locally and played down their national profile among patients could build a more digestible reputation.
The SWOT analysis identified IM’s core strengths as being financially stable and having a successful history of partnering with the NHS. Threats were dominated by the limited brand awareness among local stakeholders (commissioners, councillors) in multiple areas.
Limited brand awareness among patients in some localities could also be seen as an opportunity for IM to downplay their national standing and promote local services using ‘identity distancing’ techniques.
IM had previously created stakeholder maps of their locations using a simple power/interest stakeholder matrix. However, this method did not help in identifying or prioritising which stakeholders should be influenced first. This was important for IM’s regional growth as this would be dependent on influencing people in different places at different times.
A more effective model for segmenting IMs stakeholders was Mitchell et al’s stakeholder salience model. This was an ideal tool to identify and prioritise the key stakeholders that could be reached through strategic PR to create a positive reputation for IM and grow the company through increased successful bids.
The model brings together three stakeholder attributes – power, urgency and legitimacy; that is the power to influence IM, the legitimacy of the stakeholders’ relationships with them and the urgency of the stakeholders claim on them.
This more sophisticated analysis identified IM’s definitive stakeholders as Commissioners, the Care Quality Commission, Integrated Care Systems and Primary Care Networks, for they have the power, urgency and legitimacy. Although local councillors, NHS Trusts and the media were classified as dangerous, yielding urgency and power, they did not have legitimacy. As IM is accountable to the CQC and their Commissioners, the decisions of these groups would directly impact on business growth through IM winning more contracts. These latter stakeholders therefore needed to be prioritised and targeted in a strategic way.
Business and PR objectives
A number of business objectives were identified from the research to enable IM to develop a more effective public relations strategy and enhance reputation so that the business could win more bids and retain existing contracts.
- Create a PR strategy linked to KPIs and objectives focussing on B2B key stakeholders.
- Engage key stakeholders to understand the driving perceptions both negatively and positively about IM to allow a good understanding of what their agendas and concerns are.
- Encourage the introduction of formal risk registers as standard for every strategic decision.
- Promote a positive reputation on a local level at existing sites, rather than focusing PR on a national level.
- Undertake stakeholder salience models of the most profitable sites or those in areas where IM wants to grow.
- Perform effective horizon scanning and create a strategic timeline for bid deadlines and the renewal of existing ones focusing PR activity around them.
- Complete a thorough competitor analysis on a national level.
- Review social media strategy and assess its effectiveness on a local level
The PR objectives to support this were defined as being
- The creation of a two-year timeline of contract bid deadlines and contract renewals.
- Make risk registers mandatory for every key strategic decision immediately.
- Conduct scenario planning and horizon scanning.
- Perform salience stakeholder mapping of key growth areas.
- Survey key stakeholders on their perceptions of IM.
- Tailor a programme of key stakeholder engagement events.
Following the research, IM took action to implement the business recommendations, which catalysed a change of approach to PR and communications at the company.
To strengthen the link between PR activity and the company KPIs, which had been exposed as an issue by the situational analysis, PR planning and implementation was brought back in-house.
A Head of Marketing and Communications was appointed to help the business grow using strategic communications and PR.
The research highlighted the importance of understanding stakeholders better and managing specific groups of stakeholders through targeted communication to achieve business growth. Investments have subsequently been made in B2B stakeholder management and IM now work with a lobbying company to engage with GPs, politicians and other local decisions makers in healthcare commissioning. This is helping to change stakeholder perceptions of independent providers and how they work, in the localities where the business wants to grow.
Stakeholder mapping using the stakeholder salience model is now more routinely used as a business tool and IM have used the model to identify key stakeholders, for example in the CQC and PCNs, in the areas of service provision where they want to achieve business growth. As a result, the company recently won a large contract through using this improved approach to stakeholder mapping, management and targeting of communications.
Sara Dawson – What I learnt from completing my assignment
“I loved completing this assignment and the first part of the PR Diploma course. It has completely transformed the way I look at and approach communications. I’m much more aware of PR strategy and I’m looking at my work in a very different way.
Understanding PR models, frameworks, ideas and theory is so important, and I now have a much better understanding of why PR should be done in a particular way to achieve success.
I’ve really enjoyed applying what I’ve learnt and putting this into practice. I now have the confidence to blend theory and practice together to create much more strategic and effective PR and communication plans.
I also feel that the course has broadened my PR and communication skillset. In previous roles my focus has very much been on internal and corporate communications, but I was also always interested in expanding into external communications and building on my experience of this. The course has definitely prepared me to take on higher profile external facing PR roles in the future.
What I’ve learned so far by doing the PR Diploma has also helped me with my volunteer work for a charity and my local residents association. I help with their communications and PR, including social media and community engagement. I must be doing something right, as I’m now Vice Chair for the charity and we are achieving some great results with our digital and social communication!”