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Special Report - Tendering to provide primary care

We launch our new series on winning contracts with an overview of the bid process by Jonn Elledge.

The process of tendering for NHS contracts involves tight deadlines and voluminous paperwork. But today any practice wanting to take on new work is likely to have to bid for it against other doctors and private providers.

GPs who wish to thrive in this environment must get to grips with the process. Commercial health companies have a big advantage over practices in that they are comfortable with competitive tendering.

'Contrary to what the DoH claims, it appears that the dice are heavily loaded towards large private-sector companies,' warns Dr Haroon Siddique, a GP in Southend whose practice is bidding for a local Darzi centre contract jointly with another local GP.

Dr Haroon Siddique believes commercial companies have an advantage but that practices can prevail

On your marks
The process begins when a PCT publishes an advert inviting bids to run a new service or take over a vacant practice. At the same time it sends out Memoranda of Information to likely bidders.

More details will be available at the PCT's procurement events where it presents its specifications. These events are the best chance for bidders to question PCT officials face to face. Any questions you ask during the formal bid process and the answers will be copied to all bidders.

If you want to bid, you must submit a formal Expression of Interest. In exchange, you will receive a prospectus, briefing you on the PCT's needs and the tendering timetable.

Get set
You will also receive a Pre-Qualification Questionnaire (PQQ), designed to filter out inappropriate bids, and whittle down the field down to a shortlist of four or five. In the PQQ you provide a brief description of your plans, and your assumptions about costs, premises and so on.

The PQQ also asks for background on your practice or consortium, corroborating references and accounts. This is a good opportunity to detail your role in the local community and to highlight your strongest selling points compared to faceless multinationals.

The chosen few will receive an Invitation to Tender: to submit a detailed business plan. This formal stage is the most daunting as it involves several dozen different documents.

The PCT will not only want to know what you plan to offer, but how you will deliver it and manage the transition period. You should specify how and when you will meet your goals and provide a detailed income and expenses breakdown.

This stage includes a presentation of your bid. This is the only time when you can talk to the PCT procurement team during formal tendering. Be clear on all the details, including financial assumptions.

The scores
The PCT will use a formal scoring system to judge each bid. Your invitation to tender plan is likely to be a large part of the score, the PQQ a smaller part. The largest score, however, is likely to be for value-for-money. As some GPs whose bids have been turned down discovered, it is no use putting together the best tender in terms of services quality if it costs twice as much as the competition's bids.

Pricing your tender is difficult as the Memorandum of Information may not provide any clues about the price the PCT is willing to pay.

'You won't be able to ring up and have a chat about it,' warns London medical accountant Laurence Slavin. He adds that pricing wrongly may mean you have promised something you cannot afford to deliver. Getting help from a healthcare consultancy on pricing your bid could be money well spent.

A marathon, not a sprint
Tendering is neither cheap nor easy. Consultancy and lawyers' costs may well run into five figures. As Dr Siddique says, commercial bidders are likely to have a depth of bidding experience, and a network of advisers that GPs can only dream of.

They are also more geared up for the cost-cutting that competitive bids require. Dr Siddique says: 'Anybody with a bit of business sense could probably muddle through a PQQ without any help. But it would be nearly impossible to do the same with the full bid.'

Most GPs are confident that they can provide a better, more efficient service than any private provider. Now they must get used to proving it.

Golden tip
Emphasise your links with the your community and your understanding of its health needs. Private sector bidders are likely to adapt an existing tendering template and will not be able to demonstrate local expertise.


  • Accountants and management consultants offer advice on pricing a bid and putting together a business plan.
  • Solicitors can talk you through details of an APMS contract and other legal issues.
  • Your LMC may have details of past successful bids, and advice on putting together a bid.
  • The GPC has produced guidance on the bidding process
  • The DoH website has bidding document templates and other resources

The Bidding Process

  • PCT advertises tender and releases a Memorandum of Information.
  • Bidders submit Expressions of Interest.
  • Bidders complete Pre-Qualification Questionnaire.
  • PCT issues Invitations to Tender to shortlist.
  • Formal tender process.
  • Contract is awarded and signed.


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