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How to Start a Business Proposal document sample
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Do not start here
Do start by reading the beginners guides and guides to designing services
Do not reinvent the wheel
Do look at what other areas and services have done already
Do not attempt this on your own
Do involve other members of your LOC and other people who can help you
Do not assume you can do this in isolation
Do research on the needs and priorities of your PCT
Before you start using these spreadsheets
Design your proposed service, using the guides in the toolkit and the support of local organisations and optometrists
Use your local knowledge and strengths wisely. Local information will always be as if not more powerful than national data
Use your collective and individual experience (both clinical and business experience) to test the feasibility of a proposal in the local "market"
Identify your "commissioner" - are you aiming at a PCT manager or a group of GPs (for example)
In preparation for using these spreadsheets
Visit and explore the key websites that the toolkit will ask you to use. Some are very user friendly and others less so.
Talk to other LOCs about how they are approaching this
Whilst using these spreadsheets
Avoid the temptation to micro-analyse every data item. Data + Common Sense = Meaningful Information
Focus on the objectives rather than the minutae - if something doesn't fit, don't put it in!
If something doesn't seem to work, leave it and come back to it later, ideally with someone else.
Remember that you don't have to do this all in one go. You can fill it in bit by bit as you collect the information.
So you've had your idea, you've planned your proposed service and you've made
an appointment to present to your commissioners.
What next… read on!
The following pages of this spreadsheet contain…
Leading Questions
We are going to fill in the GREEN boxes on the spreadsheet labelled "Leading Questions". These collect data which will be used to underpin your business case.
Name of PCT(s) This is one of the few boxes in here that isn't required for any clever
calculations - it is simply a sanity check. Do you know what you are doing?!
Population (numbers) This is usually the population that the PCT(s) serves and therefore those
eligible to access PCT commissioned services. This number can be found
either through the PCTs website, annual reports, public health reports etc. OR
on the local government websites that relate to the same geographic area.
School Intake This figure is relevant for school-screening proposals. The default figure used
is generated from some national work, however if a local figure is know, please
use it as a percentage figure from 1-100. If your model does NOT relate to
children, replace the figure in the box with 0.
Minority Ethnic Group representation This may be relevent in specific situations and services where ethnicity has an
impact on either disease prevalence or access to services. This information
can be found in PCT Annual Public Health Reports or by contacting the PCTs
Public Health department.
Particular Ethnic Group(s) identified Enter text
% of local population within this ethnic Group(s) The default position is 0. Otherwise you must enter a percentage as a figure
from 1-100
Number of NHS sight tests carried out in year This figure, which should be pertinent to the population given above, is available
from the payments agency (the ones who pay your monthly GOS fees!)
Current NHS Sight Test Fee (£) Set at a default of the 2005 figure of £18.39. If and when this increases in
future, you will need to enter the new value.
Tariff values for HES outpatients
Current Tariff value for outpatient referral to Ophthalmology - first attendance This information is available within the Department of Health (DH) website.
The link given should take you to the Tariff values for 2005/06 and subsequent
updates. Locate the page relating to outpatients, and the row relevant to
Opthalmology. You need to use the figure for the First Visit for Adults, unless
your service relates specifically to children.
Current Tariff value for outpatient referral to Ophthalmology - follow-up Follow the instructions above but use the figure for follow-up appointments.
Local Market Forces Factor The website listed in the guidance box takes you to a spreadsheet listing, by
provider, the Market Forces Factor to be applied. Scroll down to the relavant
trust and use the figure given.
Case-mix
In a standardised UK population sample, the likely case-mix for referrals is as These figures were generated through an audit of real-time referrals from a
follows. high street optometrist. They can be used as a default or replaced with local
data where it is available.
Local data may be available to refine this.
Urgent/Acute conditions Enter relevant, known, figures where you have them, as percentage values
Glaucoma (%) from 1-100
Cataract (%)
Paediatric referrals (%)
Dry-Eye / Red-Eye (%)
Other (%)
Service Proposal proportion of existing referral case-mix (%) Select the patient groups from the above list to which your service is relevant
and add them up, placing the total in this box.
Hospital Eye Service Activity
Number of referrals received in year This data is usually locally held and although it used to be nationally reported it
is now no longer collated at a national level, becoming less significnat as
waiting times have decreased. If you know this figure and want to use it, you
can record it here.
Number of first appointments in year The data link takes you to a Department of Health website which contains
"clean" data from quarterly returns. This data is high quality and timely,
however it is only recorded at provider (not commissioner) level. Once on the
web-page, follow the link to the period that you want to use for input (remember
that they are QUARTERLY statistics, not annual ones). To get a figure for a
whole year you will need to add up the figures from four sequential quarters.
Number of follow-up appointments in year this comes from the same source as the first appointments data above.
Published waiting time for first outpatient appointment (weeks) Dr Foster offers a huge amount of comparative information at consultant and
hospital level. When you enter the site, use the search options to find the trust
that you want to look u. You will need to specific that you want to know about
"eyes" and outpatients. As with many of these data items, you will need to
apply local knowledge to turn them into information. If a consutlnat waiting time
is agiven as 3 days but they've only been in post 1 month then perhaps you
need to exclude them from your field of reference.
Proposed Service Model Refer to your existing (if recent) work to design and define a service proposal.
Anticipated number of referrals per year This box defaults to an assuption that the % of the referral case-mix you have
identified above can be applied to the number of referrals received by the HES.
If your local knoweldge suggests that this is not a valid assumption, use your
local data to enter a more valid figure
Anticipated proportion of patients that will be discharged at first visit These boxes default to an assumption (based on national data) that 60% of
Anticipated proportion of patients that will be referred onto HES (from first visit) referrals do not require further intervention, 20% need a second appointment
and 20% require specialist acute care. Once again if local knowledge or data
Anticipated proportion of patients that will require a follow-up appointment suggest otherwise, this can be overwritten.
Average number of appointments per 4-hour clinic session This deafults to a figure of 20 appointments per 4 hour session, but this
depends upon the type of clinic and patient involved. Again, use your
experience and that of others to guide this.
In the Costings Schedule
This spreadsheet is designed to help you calculate an approximate cost of delivery of your service model. Dependent upon the resulting bottom-line you may wish
to test alternative cost breakdowns. If reducing costs is a key local driver then, as a general guide, commissioners are likely to want to see a saving of at least
15% but this may be higher (50% or more) depending upon local circumstances. This is where talking to your commissioner is essential.
Salary Costs These will obviously vary across locations, staff groups and methods of
employment. Guidance may be available in relation to NHS pay scales. HR
departments in NHS Trusts may be able to offer up to date information.
Alternatively, look at current adverts for the level of staff you wish to engage.
Premises Costs Many people make the mistake of thinking that a room is "free". This is of
course not true and the costs associated with the lcoations in which a service is
provided should be built into the cost of the service as a whole. Calculating this
is no different than calculating the overhead costs for your own practice.
Service Management and Administration Use this section to include specific and generic management costs in relation to
implementing and running the service, including referrals, records, governance,
IT etc.
Equipment The type and amount of equipment needed to support the service delivery will
be determined by your service model, the number of locations, etc. remember
that any such equipment must be compatible with and calibrated against that
used in the HES.
The final spreadhsheet gives the figures that will need to be lifted into the Business Case Document and Powerpoint presentation. They are
generated by a series of embedded calculations but can can be edited to reflect local circumstances,
COMMON SENSE CHECK - if the Drop-out figures do not look right, go back though the Leading Questions and check that you have entered the
figures correctly as a first step. However it may be that your local information is more valid than calculations based on raw data. Trust your
instincts - particularly if you can back them up with a local audit.
User Guide
The following spreadsheets will ask you a series of questions. In each case, enter the relevant figure into the green box(es).
What catchment population will the service cover ? Comments
PCT 1 PCT 2 PCT 3 sum
Population (numbers) 0 0 PCT populations will be given in their annual reports which will be accessible via PCT websites or offices.
(percentage proportion) #DIV/0! #DIV/0! #DIV/0!
School Intake - approximate percentage of local population 1.4 based on ODPM figures relating to the anticiapted population growth - can be overwritten with local data, if available
estimated number of school-starters per PCT - - - - if your model does NOT relate to children, overwrite this with a 0
Minority Ethnic Group representation
Particular Ethnic Group(s) identified PCT populations will be given in their annual reports which will be accessible via PCT websites or offices.
% of local population within this ethnic Group(s) 0 0 This information will identify particular ethnic groups in relation to specific health concerns, where relevant
estimated number of people involved 0 0 0
Number of NHS sight tests carried out in year 0 0 0 0 Available from payment agency (PSU/PCT/etc.) http://www.dh.gov.uk/assetRoot/04/09/56/83/04095683.pdf
Current NHS Sight Test Fee (£) 18.93 18.93 18.93 18.93 Figure as at 2004/05 - will need to be updated in future financial years
Tariff values for HES outpatients
Current Tariff value for outpatient referral to Ophthalmology - first attendance 96 96 96 96 Figures represent a standard value in 2005/06 which will need to be updated annually http://www.dh.gov.uk/assetRoot/04/09/15/32/04091532.xls
Current Tariff value for outpatient referral to Ophthalmology - follow-up 47 47 47 47 Figures represents a standard value in 2005/06 which will need to be updated annually http://www.dh.gov.uk/assetRoot/04/09/15/32/04091532.xls
Local Market Forces Factor #DIV/0! These figures are abailable at PCT level via the weblink… http://www.dh.gov.uk/assetRoot/04/09/78/89/04097889.xls
Case-mix
In a standardised UK population sample, the likely case-mix for referrals is as follows.
Local data may be available to refine this.
Urgent/Acute conditions 0.9 0.9 0.9 #DIV/0! These figures refelct the results of a recent audit in a high street optometrist of referrals made into secondary care. They can easily be replacead by local audit data, if these are available.
Glaucoma (%) 30.6 30.6 30.6 #DIV/0! The boxes that read "#DIV/0!" will change as soon as population figures are entered.
Cataract (%) 20.4 20.4 20.4 #DIV/0!
Paediatric referrals (%) 13.4 13.4 13.4 #DIV/0!
Dry-Eye / Red-Eye (%) 10.2 10.2 10.2 #DIV/0!
Other (%) 24.5 24.5 24.5 #DIV/0!
Service Proposal proportion of existing referral case-mix (%) #DIV/0! This could be derived from national or local data / audit
Hospital Eye Service Activity - Provider level figures Prov1 Prov2 Prov3
Number of outpatient referrals per year (if known) 0 0 0 0
Number of first appointments in a whole year 0 0 0 0 These figures are availble from the Department of Health website http://www.performance.doh.gov.uk/hospitalactivity/data_requests/outpatient_attendances.htm
Number of follow-up appointments in a whole year 0 0 0 0 or through PCT commissioning departments. www.drfoster.co.uk/GHG/
Published waiting time for first outpatient appointment (in weeks) 0 0 0 #DIV/0! The overall waiting time has been weighted in relation to the proportion of people within each PCT.
Approximate percentage of provider-based activity relating to target commissioners 100
Proposed Service Model PCT1 PCT2 PCT3
Anticipated number of referrals per year 0 0 0 0 This figure defaults to assuming that the referrals coming into the service will reflect the predicted % of referrals identified from the case-mix list above being taken from the actual activity numbers recorded in box F35. If local knowledge suggests otherwise, simply over-typw it.
Anticipated % of patients that will be discharged at first visit 0 0 For these proportions, refer to your service model (and see the Step by Step Guide page for more information)
Anticipated % of patients that will be referred onto HES (from first visit) 0 0
Anticipated % of patients that will require follow-up appointments 0 0
Average number of appointments per 4-hour clinic session 8 Reference service model
Additional time commitment (in sessions) required to deliver service 1 This should be a minimum of 1 session to cover developmnet, supervision, admin etc. but may include more depending upon your service model. Reference service model
Costings Schedule for new service models
Practice-based models can be generically costed using a model such as that designed by Lyndon Taylor (sourceref ) with allowance for additional costs
relating to equipment, disposables and communication/IT.
Clinic-based or locality-based models will need to be costed based on the workforce and overheads for the set-up and provision of the service as a
whole, then broken down to a per-appointment value.
Full Year Effect Salary Cost
Optometrist £ - At an assumed sessional rate of £ - per session
OMP £ - £ -
Orthoptist £ - £ -
Nursing £ - £ -
Technician £ - £ -
Management £ -
Administration £ -
Other £ -
Total salary costs £ - On Costs estimated at 25% £ -
Total Pay Costs £ -
Training (per annum) £ -
Supervision (where applicable) £ -
Premises Costs
Rent / Lease £ -
Utilities (if applicable)
Security
Cleaning/Services
Other
Total Premises Cost (pa) £ -
Service Management / Admin
Supplies £ -
Printing / Publications £ -
Reporting £ -
IT equipment £ -
IT maintenance etc. £ -
Total Management Costs £ -
Other Costs
Clinical Equipment (if purchased) £ - TOTAL SERVICE COSTS YEAR1 £ -
START-UP COST ELEMENT £ -
RECURRENT SERVICE COSTS £ -
Use the reference points to transfer data into the business case document / presentation
Reference Point
Population for which this service applies 0 N1
School intake assumed level 0 N2
Number of NHS sight tests 0 N3
Estimated number of non-NHS sight tests 0 N4
Notional value of undertaken sight tests £ - F5
Estimated total number of referrals from Optometry 0 N6
Outpatient tariff value of these referrals £ - F7
Estimated number of referrals for service area #DIV/0! N8
Estimated number of referrals for this service area that did NOT require consultant intervention #DIV/0! N9
Estimated number of associated follow-up appointments #DIV/0! N10
Outpatient slots to be released #DIV/0! N11
Cost of consultant-led HES activity in the current model
first outpatients (for this service area) #DIV/0! F12
inclusive cost (first and associated follow-up appointments) #DIV/0! F13
Average outpatient episode cost: #DIV/0! F14
Demand Profile for proposed service
Number of referrals #DIV/0! N15
Number of appointment slots required #DIV/0! N16
Number of clinic sessions required per week #DIV/0! N17
Additional time-commitment for service delivery 1 N18
Total number of clinical sessions required per week #DIV/0! N19
Total cost per year for proposed model £ - F20
Additional Start-up costs (estimated) £ - F21
Retained cost in the acute sector #DIV/0! F22
Opportunity Costs / savings
Released consultant capacity Number #DIV/0! N23
value #DIV/0! F24
Released GP capacity number #DIV/0! N25
value #DIV/0! F26
Overall potential saving / cost #DIV/0! F27
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