Dr Satpal Shekhawat explores the business development challenges faced by primary care clinicians, and the steps necessary to overcome them

shekhawat satpal

Dr Satpal Shekhawat

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Read this article to learn more about:

  • why bid writing is challenging for GPs
  • the importance of shared vision, workforce capacity, and preparing answers in advance
  • elements of successful bid writing.

When I qualified as a GP in 2009, Clinical Commissioning Groups (CCGs) were non-existent, and commissioning and the provision of clinical services were not part of the Royal College of General Practitioners (RCGP) training curriculum.1 In 2012, CCGs came into being and became responsible for the provision of healthcare to all residents within their clinical boundaries.1 Clinical services delivered by primary care, secondary care, and the private sector are commissioned by local CCGs, and the contractual agreements between these bodies contain the specifications for the commissioned services (see Figure 1).2 CCGs are accountable for the care delivered to the residents of their area, and must ensure that the services delivered are in accordance with the specifications and that the outcomes for patients are as agreed.

Nationally, CCGs regularly commission new services, renew existing contracts, and monitor the performance of providers against all commissioned contracts. The NHS portal is used by CCGs to advertise new procurement activity, and all providers can register on the portal to track newly advertised services.

NHS commissioning cycle

Figure 1: The NHS commissioning cycle2

NHS England. Commissioning cycle. www.england.nhs.uk/participation/resources/commissioning-engagement-cycle/ (accessed 7 September 2018).

Why is it challenging for primary care to win bids?

Primary care is currently facing a massive challenge in the form of workforce shortages, which are compounded by the fact that the workload has increased excessively.3 These challenges are keeping most healthcare professionals in primary care extremely busy: we don’t have the time or capacity to focus on the future growth of the practice as a business, get involved in bid writing, or take on more work. We are all working hard to keep our heads above water and deliver basic general medical services (GMSs) to registered patients. In addition, most of us don’t have the availability or resources needed to deliver these services once contracts are secured.

Currently, commissioning, bid writing, and procuring services constitute a small part of the RCGP curriculum;1 most newly qualified GPs have a poor understanding of these processes, and it is left up to them to develop the necessary skills in their own time. We are clinicians, and our work experience helps us to design effective services, ensuring that there is robust clinical governance in place, improving the patient journey, and achieving clinical outcomes in line with commissioning intentions. Despite this, the bid-writing process tests us in terms of putting this vision on paper and sharing it with non-clinicians, who award contracts based on whether the proposal covers key areas of clinical governance, its mobilisation plan, its use of existing resources, additional costs to the system, whether it addresses health inequalities, and, most importantly, how it impacts the delivery of other contractual services.

Conversely, most private providers have dedicated teams to track new commissioned services, write bids, and secure contracts, that are economically lucrative to their organisations. These organisations use existing contracts to demonstrate effective governance, mobilisation plans, financial security, established referral pathways, and approaches to delivering services within budget to help them in securing NHS contracts.

How can we turn the tide in our favour?

We are primary care clinicians with years of experience in the provision of good clinical care and keeping our patients healthy. We are the frontline, and the wisdom gained from providing care in the community is extremely useful when tendering for NHS contracts. To succeed in winning contracts, bids should include several key features, which are described below. 

1. Develop a shared vision

Providing good GMSs to registered patients is the main contract for general practice. Practices need to ensure that everyone is committed to the idea of bidding for a new contract and shares the same vision. Primary care is all about teamwork, and it is impossible to move forward unless the entire team works together.

2. Define the workforce strategy

Workforce shortages and increasing workload in primary care present an opportunity to those who have foresight and are willing to engage the entire team to work hard and achieve more. Practices need to ensure that the workforce within the team is sufficient to provide existing services and take on additional work. If this is not done properly, it can impact the work–life balance of the team and lead to problems in the future. One way to enhance the efficiency of the team is to diversify the workforce, i.e. by incorporating paramedics, nurse prescribers, physiotherapists, and pharmacists.

3. Invest in time

Most contracts are advertised with an extremely short deadline, usually 1–2 weeks, which puts tremendous pressure on the team to prepare the bid within the given timeframe. Identify team members who have strengths in bid writing and business development and provide them with protected time to fulfil this part of their role. Discuss the 5-year plan for the organisation during practice meetings. This also helps with achieving a shared vision among team members.

4. Be prepared

Prepare answers in advance. The clinical governance structure of your organisation should be documented (using illustrations to demonstrate the seven pillars of clinical governance3) and kept up to date so that it is ready to aid bid writing and overcome the challenges posed by short deadlines. Similarly, it is worth preparing answers to questions on areas such as the current contracts, service delivery relative to key performance indicators, policies on data sharing and use of information and technology, and the leadership model of the organisation. This information will already exist in your organisation and keeping it ready can help in formulating a bid in a short time.

5. Use the experts

There are many experts in NHS bid writing, and establishing relationships with them is worth every penny. Minimise expenses by doing the initial work and then employing the expert on a contractual basis to amend it to make your bid more successful. This process will also help you learn: in future, you may not need expert help and may be in position to provide consultancy yourself.

6. Keep patients at the centre

General practice is patient centred, and this is its unique selling point. When writing any bid, keep patient-centred care at the core and design the service around it. This approach will ensure that the right motives are in place to help deliver better clinical outcomes for the relevant population.

7. Innovate

When writing the bid, always include other areas for improvement and innovation, even if they have not been considered by the commissioners. This demonstrates a depth of understanding of primary care and passion for providing good quality healthcare. Grass-roots GPs are best placed to propose ideas for improving community-based healthcare.

8. Create a mobilisation plan

In any bid written for a service, a mobilisation plan is essential. A successful bid must have a detailed mobilisation plan, and it should include the timescales of all activities needed from award of contract to delivery of service. Clinicians will naturally focus on service design, governance, and delivery of service, and usually rely on practice managers for the mobilisation of resources, so this can sometimes get overlooked. Involving the practice management team can strengthen this aspect of your bid.

9. Use illustrations

All general practices are contract holders and possess the necessary infrastructure, policies, and skills to deliver healthcare services. Using this knowledge and providing examples in various areas of the bid are essential to demonstrate capability and will help secure the bid.

10. Demonstrate clinical governance

The bid should include an explanation of the clinical governance structures in place in the organisation and use examples to demonstrate all seven pillars of clinical governance.4 Newer providers with fewer contracts will need to demonstrate a robust governance process to reassure commissioners—this is the key to securing any contract.

What next?

I strongly believe that primary care can deliver safe, effective, outcome-based community services that will improve the patient journey and help secondary care to focus on acute, unplanned care. For this, we must get actively involved in bidding for upcoming services, propose business plans to our CCGs, and work towards winning bids. We need to share our experiences to help each other and promote good clinical practice in the community. I also feel that the GP trainee curriculum needs to include commissioning and provision of health services so that there is a capable workforce ready to face these challenges in future.

Further reading

Information is available on the commissioning cycle and how providers, patients, and clinicians can get involved in the process; one particularly useful resource is a document published by The King’s Fund on What is commissioning and how is it changing?5

Dr Satpal Shekhawat

GP partner and trainer, Kirton Lindsey

Honorary tutor, Hull York Medical School

Associate Medical Director, North Lincolnshire CCG

Key points

  • Commissioning, bid writing, and procuring services make up a small part of the current RCGP curriculum, and most newly qualified GPs have a limited understanding of these processes
  • Workforce shortages and increasing workloads mean that most healthcare professionals in primary care lack the time and capacity to focus on business development
  • The work experiences of primary care clinicians qualify them to design effective services, ensuring that there is robust clinical governance in place, improving the patient journey, and achieving clinical outcomes in line with commissioning intentions
  • Successful bids for contracts should include key features such as:
    • a shared vision among the team
    • a workforce strategy to deliver existing and new services
    • a patient-centred approach
    • a mobilisation plan
    • an explanation of the clinical governance structures in place
    • an innovative approach towards delivering service
  • More information on commissioning and the provision of health services should be included in the GP trainee curriculum so that there is a capable workforce ready to face these challenges in future.

References

  1. Clinical Commissioners. About CCGs. www.nhscc.org/ccgs/ (accessed 26 September 2018).
  2. NHS England. Commissioning cycle. www.england.nhs.uk/participation/resources/commissioning-engagement-cycle/ (accessed 26 September 2018).
  3. Buchan J, Charlesworth A, Gershlick B, Seccombe I. Rising pressure: the NHS workforce challenge—workforce profile and trends of the NHS in England. The Health Foundation, 2017. Available at: www.health.org.uk/sites/health/files/RisingPressureNHSWorkforceChallenge.pdf 
  4. Gray C. What is clinical governance? BMJ 2005; 330: s254.
  5. Wenzel L. What is commissioning and how is it changing? The King’s Fund, 2017. Available at: www.kingsfund.org.uk/publications/what-commissioning-and-how-it-changing (accessed 26 September 2018).