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How to write the perfect business plan

A good business plan is essential to communicate your ideas to the PCT – Dr Tony Brzezicki shows how to increase your chances of success

A good business plan is essential to communicate your ideas to the PCT – Dr Tony Brzezicki shows how to increase your chances of success

Why write a business plan?

To develop a new service or pathway, you need to explain and communicate your ideas and proposals to the PCT. The PCT is responsible for putting your ideas into practice and for paying for the service. The business plan is an outline of your new service, and need not contain every detail.

It need not be longer than two sides of A4 paper. If submitted as a PBC proposal, the PCT must give a formal response within two months, as specified by early PBC guidance. Most will respond much more quickly. The PCT will also, if asked, explain why it does not wish to proceed with a project.

What is a business plan?

A business plan is simply an outline of a proposed development or service redesign. It explains to the PCT what you intend to do, and why the PCT should be interested in taking things further. To interest the PCT, you will need to ensure you help the PCT meet one of its own objectives.

What are the PCT's objectives?

The PCT will lay out its plans for the next three years at least in its Commissioning Strategy Plan – or CSP. This is a public document and should be available on the PCT website or your local SHA website.

The CSP will explain in detail which clinical areas are important to the local population, and which ones the PCT has prioritised for action. The priority attached to each area is important. PCTs now only have a limited capacity for managing projects, and even if your cause is worthwhile it may not be able to devote time or people to develop every idea.

Are there any general PCT objectives?

Many PCT targets are set by the Government and are applicable to all.

Every business plan should say how it may make it easier to hit these targets. These include:

• 18-week waits
• four-hour A&E waits
• hospital cleanliness
• NICE and other national targets.

Other generic PCT targets will include:

• improving the patient experience
• care closer to home
• meeting local need
• improving health outcomes.

What about saving money?

All PCTs have a statutory duty to have a balanced budget – or break even. So projects that save money, in addition to meeting other targets, have an advantage. It is also much easier to identify resources for schemes that save money and much easier to set financial objectives and targets than for, say, improving the patient experience.

41222503What headings or sections must an outline business case cover?

The box to the left details the headings that should be included in a business plan.

What are the most common mistakes people make?

• Not understanding NHS costings – will the sums stand up to questioning?

• Not working with the PCT – there's no harm in having a chat with the PCT before you submit the plan to give it a ‘heads up' on what you're doing and gauge a reaction. Your plan may be more palatable if it doesn't land on the PCT desk out of the blue.

• Business plans also run the danger of being perceived as something the GPs simply fancy doing because they have a particular interest in that clinical area. That's all very well, but you must also show how this addresses your population's needs. Similarly you must make clear to the PCT the benefits of the project, and don't forget to remind the PCT what the patient experience is like if the current service involves a long journey or waiting times.

• Not having a reasonable idea of the scale of the project – how many referrals you're likely to get in year one, for example.

I've heard it's good to have a business plan that helps a PCT meet its KPIs. What are these?

PCTs are judged on how they perform – just as we are appraised and judged in general practice.

All PCTs are graded according to how they meet a number of key performance indicators (KPIs). It goes without saying that helping the PCT achieve these will mean your objectives coincide and that your business plan will be more likely to get approval.

Are there any KPIs that apply to all PCTs?

The vast majority of KPIs are nationally set, but local SHAs also set targets and the PCT is supposed to set some local targets too.

The PCT will also have outstanding commitments it has to keep – so there are four components.

Nationally the KPI has some 114 lines for PCTs to meet. The PCT self-assesses – as green, amber or red – its own progress, and has to provide evidence of its success.

KPIs are publicly available. How each PCT is performing is also publicly available as they will form part of PCT board papers, which are in the public domain.

Involving patients is a KPI for all PCTs and one that most struggle to achieve.

So if you can, try to include patients in designing the pathway. This is often done poorly or not at all. If you cannot find a patient or group to work with, at least try to build in some measure of patient acceptance or experience. A simple audit of how patients feel about the service may suffice.

How do we convince the PCT of the quality of our service?

The PCT has a statutory duty to ensure the services it purchases are ‘fit for purpose' – or the quality of the service is good.

Hospital trusts have their own clinical governance arrangements and are reviewed independently by the Healthcare Commission. Generally the PCT will assume the clinical governance of a hospital service is acceptable. There is no such acceptance for new providers of services within the NHS and this also applies to GPs carrying out non-core work.

As such, the PCT may be obliged to set out stringent guidelines for how the service should be run. This may seem like setting double standards. In reality, such tough measures actually protect primary care, as by meeting them we can be reassured we are providing the best possible care.

If we are to take on new work it is important it is of a high quality. One criticism levelled at primary care in general is that as a profession we cannot all be relied upon to deliver quality.

Commissioners will not generally know what the current medical practice in your area is, or what the best possible ‘gold standard' practice is. This will need to be explained. What constitutes ‘best care' will vary as to who you ask. GPs will feel they are best placed to manage follow-up of chronic conditions, but hospital trusts may beg to differ. Tariff prices apply to procedures and short care episodes, and not to pathways, so a pathway approach has definite benefits.

Is there an example of how this works in practice?

As a PBC group we felt the care of patients with Barrett's disease was not optimal. We felt there were a number of issues that needed to be resolved.

• Quality of care was variable and inequitable

– many patients were having their reflux symptoms fully suppressed
– many had defaulted from any follow-up
– others were being seen annually in OP and having three-year gastroscopies.

• Doubt had been cast on the clinical effectiveness of Barrett's surveillance

– meta-analyses had shown that overall more harm was likely to come to patients with Barrett's disease (through side-effects of gastroscopy) than good through the earlier diagnosis of oesophageal cancer
– the British Gastroenterology Society (BSG) had stated all patients should be counselled as to the unproven benefits of surveillance gastroscopy.

• There were long waits for OGD.

We proposed changing the pathway to virtually full GP follow-up, with a structured annual review, annual FBC and improved patient awareness. We felt that a formal review of everyone with Barrett's would:

• provide a service at least as effective as before
• be more convenient to patients
• improve equity
• improve clinical governance
• save money and help meet 18-week waits.

To see how we translated these points into a brief business plan, see the linked case study.

Dr Tony Brzezicki is a GP in south Croydon and vice chair of the Pan Croydon PBC group

How to write the perfect business plan

There's no harm in having a chat with your PCT to gauge their reaction before you submit a business plan.

Headings for a perfect business plan

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