Lesley Hill On putting business plans to work

Published: 30/09/2004, Volume II4, No. 5925 Page 31

North Bradford primary care trust uses rigorous mechanisms to check that work and investment are really making a difference.

The process starts with our business plan, which contains what we are going to do, and when. The difference is that we also work out how we are going to measure that this has made a quality improvement to our services. These are on the same principles as the measures being used in the new general medical services contract, except that we work out how they will be delivered.

The plan is clinician led. Each section is developed by a clinical lead, supported by other clinical peers (usually those interested in the area) and is pulled together by a supporting manager. Thus the staff within the PCT and the clinical leads have joint agreement about what work they are going to do during the next 12 months, the timescales involved, whether any funding is required and how the quality improvement will be measured.

All the different sections are then compiled in the PCT's business plan, which goes to the professional executive committee and board for discussion and approval.

The local delivery plan process is then simple: we just use the business plan, as this almost always covers all the areas required (and many more). If part of the mandatory local delivery plan is missing, it is simple to add a new section to the business plan.

Business plan implementation is then rigorously measured.

Different clinical areas report to both the PEC and board throughout the year. The PCT directors have to report the performance of the whole business plan to a sub-committee of the board, quarterly.

This is a useful process, as it requires an update of the business plan (for new areas) and a performance update to be done by each clinical lead with their manager. Each target is traffic-lighted and a summary report of the section is produced.

This takes only a couple of hours for each section and we have found this to be very motivating, as it reminds everyone what we have set out to deliver and also checks whether we have delivered. No-one wants their area to be red traffic-lighted.

As a PCT we are very ambitious and have a reputation for delivering. This process underpins our service improvements.What we do not have in North Bradford is a performance management function which is separate to the delivery parts of the PCT. Everyone is expected to deliver service improvements.We have an information function to supply packages of information to show how services are improving. This is used by the clinicians and managers delivering the quality improvements.We believe it is better to get on with a project and change it as we go along, rather than spending months planning, only to find the plan has to change.

Once the PCT's business plan is completed, it is then used as the basis for each of the practices' business plans. By doing this, we are confident that we will deliver what we promise in primary care.

Why is it, then, that the Department of Health has to make NHS organisations write business plans through processes like the LDP, when actually they are so useful to the organisation?

Lesley Hill is deputy chief executive of North Bradford PCT, winner of the prime minister's award in last year's HSJ Awards.