Selling off York’s Minor Injuries Unit to Vocare
What is happening?
York Teaching Hospitals NHS Foundation Trust have decided to proceed with outsourcing part of the Emergency Department to Vocare. Under plans, the GPled service at the hospital will combine with the Minor Injuries Unit to form an Urgent Treatment Centre, but will not be based in the NHS, but run by a profitmaking company called Vocare.
There are obligations as to how the governance of the Urgent Treatment Centres can be established, and the concept of triaging patients into alternative assessment and treatment units does take the pressure off Emergency Departments, however there is no obligation that this should be in the private sector. The Royal College of Emergency Medicine definitively states that there should not be such false demarcations across emergency care in hospitals.
The Trust’s proposals could result in all patients who arrive at the Emergency Department being first assessed by this private company, before deciding where patients should be treated. This means that before a patient can be treated on the NHS, a profit-making company could be assessed as to whether they can go to A&E or to one of their services.
Urgent Treatment Centres require a booking system which is different to how Emergency Departments work, and therefore the IT systems are currently incompatible. Other Trusts have overcome these IT challenges without privatising services, so it is important that York’s commissioners seek alternative solutions. York’s GPs and the NHS111 service can book people into the Urgent Treatment Centre proposed, so systems simply need to coordinate, or there needs to be a way of transferring data and using the booking system which works across this interface.
Vocare is describes itself as “a leading provider of outsourced quality clinical healthcare services in the UK”. They are based in the North East, having formed in 1996 under the guise of the Northern Doctors Urgent Care (NDUC). Since it has expanded to other areas of the country, including to Yorkshire in 2015, trading as the Yorkshire Doctors Urgent Care (YDUC). Today they claim to be delivering GP out-of-hours and urgent care services to more than 4.5 million patients nationally. On further investigation, it appears that Vocare is a wholly owned company by a company called Totally plc.
Currently Vocare are involved in the Primary Care provision in York, so the commissioners are seeing this as a minor extension of its role, however it is not involved in the delivery of services currently provided by the NHS.
Totally plc has a clear objective to expand its footprint at the interface between primary and secondary care.
So who are Totally plc?
Totally plc works in the area of health and well-being services and provides a range of healthcare services in community settings, GP surgeries, and prisons. Its out-of-hospital services include physiotherapy, podiatry, dermatology, referral management services, clinical health coaching, and since October 2017, urgent care centres, out-of-hours GP services and 111 services. The company’s contracts are with both the NHS and private sector organisations.
Totally Plc has grown over recent years using a fairly aggressive acquisitions strategy on the basis of their “‘buy and build’ expansion strategy”. It states that it has the ultimate aim to “become one of the leading out of hospital healthcare providers in the UK.”
According to Totally, the out of hospital healthcare market is worth in excess of £20 billion per year and is a growth market due to NHS plans to move non-acute care services out of hospitals and closer to home. This is the target market for the company.
According to its website the company has an “ambitious management who have identified public-market outsourced health services as an attractive prospect and have developed a plan to fully develop this opportunity.”
In the first half of 2016, Totally plc acquired two companies – Premier Physical Healthcare Limited and About Health Limited, then in November 2016, it acquired Optimum Physiotherapy. In October 2017, Totally plc acquired Vocare (previously Northern Doctors Urgent Care); this is the acquisition that gave the company the most contracts in the NHS. Since it has acquired Greenbrook Healthcare which runs primary care centres, urgent care and walk-in centres in London and the South East.
Vocare is a provider of urgent care services to approximately 9.2 million patients across the UK through urgent care centres, GP out-of-hours services, integrated urgent care centres and the NHS 111 service.
Totally plc has a number of subsidiary companies including Totally Health providing advice on chronic conditions.
In October 2019, Totally plc created a new business focused on insourcing Totally Healthcare, delivering insourcing services across the UK and Ireland. In the first few months of operations the business secured contracts across the UK and Ireland delivering bespoke services to reduce hospital waiting lists.
This is around the time that Vocare first engaged over their proposals to run the front door to York Hospital’s Emergency Department, through assessing all patients and then referring them to the relevant care pathways, either the NHS Emergency Department or primary care services.
Totally plc now has three divisions: Urgent Care (Greenbrook Healthcare and Vocare); Planned Care (About Health, Optimum Physiotherapy, and Premier Physical Healthcare); and Insourcing (Totally Healthcare).
So it is worth understanding more about the finances of Totally
Totally plc is listed on the AIM (alternative investment market) of the London Stock Exchange.
In March 2017, the company raised £17.6 million for its strategy of company acquisitions within the UK out-of-hospital healthcare market; this was partially used to acquire Vocare in October 2017 for £11 million.
Totally plc’s most recent annual accounts for the year to the end 31 March 2020 reported revenues of £105.9 million, up 35.8% on 2019 (£78 million), which resulted in a gross profit of £19.2 million and a loss before tax of £3.4 million.
For this 12 month period the Urgent Care division reported revenue of £96.5 million (2019: £69.7 million), Planned Care had revenue of £8.4 million (2019: £8.4 million), and Insourcing had revenue of £1.0 million.
The company’s most recent accounts are for a 6 month period to the end of 30 September 2020. Within this period, Totally plc reported revenues of £54.1 million with a gross profit of £10.2 million and a profit before tax of £0.1 million.
Vocare was originally a not-for-profit organisation but on 31 December 2015,
Northern Doctors Urgent Care Ltd (the original company) converted from a
Community Interest Company (CIC) to a private company limited by shares. The two brothers, John and Michael Harrison, who set up the original company made £4.7 million each from the sale.
According to Company House records, in 2020, Vocare had a turnover of
£60,227,874, a gross profit of £9,847,260 and an operating profit of £3,463,449. It had £3,057,807 cash at the bank and in hand and £4,557,625 net assets.
Altogether, the company pays out £562,540 in directors’ emoluments and pension contributions and its highest paid director received £154,225 in remuneration.
In 2020, Vocare employed 49 Doctors, 99 Nurses, 321 Admin Staff and 491 Hourly Paid Staff, so has very little experience of employing frontline clinical staff, and yet is bidding to do so in York.
So who are Totally plc’s investors?
Totally plc’s largest investors as of 20 June 2020 are the three asset management companies: Milton Asset Management (14.12%); Cavendish Asset Management (8.23%); and Columbia Threadneedle Investments (6.33%).
- Milton Asset Management are a US based investment company
- Cavendish Asset Management, who’s business has transferred to
Stonehage Fleming is based in Jersey, but had origins in the US
- Columbia Threadneedle Investments is based in 17 countries, but is USbased
This clearly demonstrates how US private investment is infiltrating our NHS and profit from the contracts will be returning to the US and to tax havens like Jersey. Through extending its reach into the NHS, such private companies are creaming off public funds for private profit on the back of the sick. This money should be going into improving healthcare, but instead private companies are lucratively benefitting from NHS contracts.
It is also clear that these companies are determining the investment choices and aggressively pursuing opportunity for financial gain through the building of their empire out of our NHS.
As for Vocare
Under the name, Northern Doctors Urgent Care (NDUC), Vocare delivers urgent care and out-of-hours GP services to 1.5 million patients in Northumberland, North and South Tyneside and Newcastle.
Today it runs a range of services across the country including GP services, urgent care services, telehealth, and NHS111 in many locations.
As Yorkshire Doctors Urgent Care (YDUC) Vocare runs an Integrated Urgent Care service in Scarborough and Ryedale. This includes urgent care centres at Scarborough Hospital and Malton Hospital where there are reported recruitment and retention issues. YDUC also runs a GP out-of-hours service for the Vale of York at York Hospital and the GP Out of Hours Service based inside Selby War Memorial Hospital. Vocare manages a new urgent care service covering the east of the county and Rutland. The company further delivers urgent care for minor injuries and illnesses from 34 GP practices across the region and urgent care centres in Oadby, Oakham, Market Harborough and Melton Mowbray. In February 2021, Vocare’s contract for GP Out of Hours service was extended by 2 months until March 2022; this was valued at £900,000.
In October 2018, the CQC website listed 20 services for Vocare Ltd, mainly urgent care centres. Of these, four have been rated ‘require improvement’ and 13 rated good; this is an improvement on the previous year when six were rated ‘require improvement’ and three rated ‘inadequate’.
In December 2017, Vocare’s urgent care centre at the Royal University Hospital, Bath, was rated ‘requires improvement’ by the CQC, which found equipment inadequate, including children’s oxygen masks that had expired at least nine months before. The centre was told to improve its equipment, leadership and effectiveness. Vocare no longer has this contract. The Paulton urgent care centre in the same area was also rated as ‘requires improvement’.
According to the CQC, Wolverhampton Urgent Care Centre inspected in February 2018 was rated as ‘requires improvement’ overall, with criticisms of safety, responsiveness, effectiveness and its leadership. The St Mary’s Urgent Care Centre inspected in June 2018 was rated ‘requires improvement’ for leadership and effectiveness.
In September 2017, Vocare’s service in Staffordshire, under name Staffordshire Doctors Urgent Care, was given a ‘requires improvement’ rating by the CQC. Inspectors reported that the safety, effectiveness and leadership of the urgent care service was not up to standard, with lower standards at the weekends with under-pressure staff struggling to meet performance and response time targets. The urgent care centre North Staffordshire run by SDUC was rated
‘inadequate’ in June 2018; it was rated inadequate on safe, effective and wellled measures and was only good on the caring measure.
In August 2017, Vocare’s out-of-hours GP services in Somerset was rated inadequate by the Care Quality Commission following an inspection and it was put in special measures. Soon after the BBC received an anonymous letter, seemingly from a Vocare employee, which claimed that “night-time doctor shifts had not been filled, and doctors were brought in from as far away as Newcastle to plug gaps in out-of-hours cover.”
It also claimed “Vocare hired doctors without carrying out adequate background checks.” The BBC was told by a former Vocare HR manager that “he agreed with most of the claims, and agreed there was inadequate vetting of agency doctors.”
When asked by the BBC about Vocare’s service, the commissioning CCG said that the service was still “unacceptable” but that although it had considered cancelling the contract, as winter pressures were just beginning, it was considered too much of a risk.
Thanks to the NHS Support Federation for supporting this research
So where does this leave us?
York Teaching Hospitals NHS Foundation Trust is about to outsource part of the Emergency Department to Vocare, part of Totally plc. Vocare comes with a catalogue of poor inspections and an ambition to drive services out of the NHS into private hands. This flawed plan must be seen for what it is.
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