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Why you may soon be making a business case

1 June 2006

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Patricia Gray
Patricia is a management adviser, trainer and facilitator in general practice. She is a Fellow of the Chartered Institute of Personnel and Development and was a practice manager/
partner for 11 years

T  01279 777371
[email protected]

If you have been working in general practice for a while it may seem that changes are brought in, often with a flurry of feather ruffling orchestrated by a few vocal GPs predicting doom and disaster, but then everything settles down pretty quickly and everyone wonders what all the fuss was about. Take the Quality and Outcomes Framework (QOF) targets of the new GMS contract (are we still calling it new?). Initially it seemed like an incomprehensible muddle of constantly moving goalposts. But a couple of years down the line and most practices have things well under control, with managers viewing this year’s changes to the criteria as manageable with a bit of “system tweaking”.

However, this is no time to get too complacent, as the future of general practice still holds some surprises, and major life-changing developments are just around the corner.

A paper published earlier this year by the NHS Alliance entitled The Nuts and Bolts of Primary Care Provision makes very interesting reading for those who are keen to take stock of the situation and make plans for the future.(1) Practices that have previously got by quite comfortably with a reactive approach to managing change are likely to be left behind by the various proactive lobbies who are already well ahead of the game.
If you still don’t know what I am talking about, I’m referring to the brave new world of “commissioning” – something that, apart from a few years of fundholding in the 1990s, general practice hasn’t usually had any involvement with. However, perhaps it won’t be “commissioning” that will become the responsibility of GPs in the future, but “providing” that will have the biggest impact.
While there are already some well-established alternative routes for contracting traditional GMS primary care services,  such as personal medical services (PMS), APMS (alternative personal medical services) and SPMS (specialist personal medical services), there is much speculation that the groundwork will soon be laid for anyone to provide health services. There will still be the traditional players – NHS trusts, GP practices, dentists, and so on – but this list might also include private companies, pharmaceutical companies, the voluntary sector, not-for-profit social enterprises, clinicians banding together in companies or “chambers”, industrial and provident societies, foundation trusts, walk-in centres, NHS Direct and commuter centres.

There will be issues of regulation, robust commissioning and transparency , but the fact is that the marketplace is about to open up dramatically. With GPs at the driving wheel (notoriously enterprising and thrifty), keen to place value-for-money contracts and make efficiency gains, and with patients navigating from the passenger seats (remember, it’s a patient-led NHS now), with an eye on more choice and better access, the whole scene promises some interesting developments.
Still not sure what this means for managers in primary care? It is anticipated that more joint ventures will emerge and that NHS providers (such as general practices) will work alongside the voluntary and independent sectors. “Supersurgeries” are likely to emerge housing several practices, diagnostic facilities and outpatient services. They might be run by GP companies or commercial companies. Alternatively, a group of practices might create a provider network, offering a broad range of services and sharing the managerial and overhead costs.
Specialist general practice services may also evolve, such as care of the elderly or services to commuters. Future new providers might offer a range of services, including diagnostics, specialist outpatient services, walk-in services, care of nursing home patients, district nursing, midwifery, health visiting, physiotherapy, community psychiatric nursing, counselling, sexual health services, drug and substance abuse, care for ethnic minorities or asylum seekers, pharmacy, dentistry, optometry and complementary medicine.
With the likelihood of a good deal of cherry-picking and the funding implications of a possible redesign of services, the impact is likely to hit smaller practices and those least prepared the hardest. These practices might find themselves sending their patients to neighbouring surgeries or commercially run centres for a range of services that previously they either provided themselves or were provided by the local community and acute trust. Moreover, they might have to take hits in their own income.

In a more competitive future, GPs will have to consider how to market their expertise and services. They are likely to have to put together bids for services they want to provide, with astute business cases and effective presentations. Bids will usually be evaluated on the basis of financial information, quality systems, environmental policy references and site visits. GPs will undoubtedly need clever-thinking managers at their side, who will need to have good communication and negotiating skills. It could be you.

Making a business case
If you are not sure how to go about making a business case and presentation, here are some tips that should help.

Make time to plan effectively
Don’t forget that even the best innovative ideas can fail because of lack of planning. The investment of time and effort will always pay off. On a practical note, many GPs and practice managers find it difficult to find the time to plan effectively in their hectic surgery environments. Consider taking time out at an away day or a planning afternoon, preferably at a neutral venue. This would be particularly important if a group of GP practices are involved. Use the time to consider the implications, the expectations, the cost-versus-benefits and the resources (manpower and otherwise), and aim at producing an action plan detailing who will be responsible for doing what and by when.

Know your audience
When making a business case presentation it is essential that you know your audience. What sort of information do they need? Don’t be afraid to arrange some meetings before making your case so that you can find out what the real agenda is, what issues will lead to a successful bid, and what the concerns might be. Find out about any competing bids so that you can assess what advantages you have over them.
Make sure you do your research and understand the stakeholders. This might include liaising with current service providers and service users. A few blinding pieces of science, some meaningful and pertinent statistics, real-life stories or well-placed interesting examples of similar proposals will go a long way to engendering confidence. A good tactic is to subtly confirm what you believe is your audience’s own knowledge or experience so that they engage with the sentiments. Then build on this “where we are now” picture by providing an inspirational vision of how the future could look if your proposals were successful. Plan the key messages without going into too much operational detail, and keep focused on the outcomes.

Keep focused
Of course, you need to deal with some practicalities, but many business cases fail by providing too much irrelevant detail that swamps and dilutes the real message. If you have done your research, you will be able to anticipate any concerns and ensure that you recognise them and address them.
A good business case has a well-defined structure with an effective opening, followed by step-by-step material presented in an easy-to-read format, with links and summaries, and finally a succinct and compelling conclusion. Decision-makers like choice, so presenting a number of alternatives will facilitate a positive decision and avoid a single proposal being discarded on a small technicality.

Making a successful presentation
Making a presentation may be particularly challenging if you have not had much experience. Make sure that you are really well prepared and know your subject. Plan to arrive in plenty of time so that you can set up any visual aids and assess the size and shape of the room. Rearrange tables and chairs so that the audience have a good view and can sit comfortably and make notes.
No one would expect you to be a perfect presenter, but make sure you use a clear voice, speak up and pace your presentation so that it is not too fast or too slow. Remember the importance of body language. Aim to stand in an upright but relaxed position facing your audience. If you need to refer to visual aids or record on a flipchart, ensure you don’t turn your back to the audience. Eye contact is a very powerful tool that establishes a rapport between people. Sweep your gaze across the audience, remembering to engage with everyone. Members of the audience who feel excluded by the speaker are more likely to respond negatively than those who feel more involved. Use gestures to illustrate points but avoid nervous hand fidgeting. Don’t forget to smile. Illustrate your points with real-life experiences to maintain interest and empathy. The appropriate use of humour is a wonderful way of engaging with an audience. If you are going to sell your idea, you must be enthusiastic and confident without sounding unrealistic or cocky!
Start your presentation by introducing yourself and if necessary introducing others. Then proceed into your opening, followed by your core material and proposal, ending with a summary. Using a PowerPoint presentation can be helpful but runs the risk of being boring and thwarting discussion, so consider presenting a few slides at a time highlighting salient points and then breaking off for discussion. Some people find it useful to use prompts on index cards. Avoid just reading from a prepared wordy script.
Ensure that your presentation is as interactive as possible by inviting questions. If you are not sure of the answer, it is best to be honest, although the politician’s trick of turning one question into another one that you can answer is also useful!
Rehearsal is a vital part of preparing for a successful presentation. Mentally rehearse what you are going to say and how you are going to say it. Many successful presenters use a technique of visualising success. See yourself at your imagined venue with the audience in front of you. Then imagine yourself making an excellent presentation and visualise the positive response from the audience. Imagine their enthusiastic and interested faces as they listen.

As primary care continues to change, new opportunities arise to use managerial and business skills in different ways. Being able to successfully present a business case is a great skill for a primary care manager. And you never know – you may find you have some hidden stage talents!


  1. 1. NHS Alliance. The nuts and bolts of primary care provision. London: NHSAlliance; 2006.