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 strategy in relation to acquisitions and seeking out new opportunities according to the company’s website . The company has a “‘buy and build’ expansion strategy” it notes, seeking to expand its range of services, with 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 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. Most recently 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.
Premier Physical Healthcare and Optimum Physiotherapy provide physiotherapy and podiatry to NHS patients, various police forces and prison sites and provide occupational health and ergonomic services to corporate and private clients.
About Health Limited is a provider of dermatology and referral management services to the NHS. About Health has been providing community based health services under contract to the NHS since 2009.
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 also has a subsidiary - Totally Health - which provides clinical health coaching via a business to business model to the NHS and the private sector as well as direct to consumer health coaching to individuals and families. The service supports the management of long term conditions in patients such as chronic obstructive pulmonary disease (COPD), diabetes, asthma, heart disease and smoking cessation and obesity management.
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 acquired Vocare in October 2017 for £11 million.
Totally plc's most recent accounts are for a 15 month period to the end of 31 March 2018. In this period, Totally plc reported revenues of £42.5 million, which resulted in a gross profit of £7 million and a loss after tax of just under £1.8 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.
Totally plc’s largest investors as of 20 June 2018 are the three asset management companies: Unicorn Asset Management (9.63%); Legal & General Investment Management (8.19%); and Lombard Odier Investment Managers (7.21%).
Other significant shareholders are Seneca Partners Ltd (5.64%); Killik & Co LLP (5.09%); Mr John Harrison (4.8%) and Mr Michael Harrison (4.8%).
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. The company also manages the North East NHS 111 service, in partnership with the North East Ambulance Service.
Under the name, Bath and North East Somerset Doctors Urgent Care (BDUC), Vocare provides an integrated urgent care service for Bath, Keynsham & District, Midsomer Norton, Radstock & Chew Valley. The company also provides GP out-of-hours cover for the whole of Bath and North East Somerset and medical cover to Paulton Memorial Hospital and St Martin’s Hospital. In August 2017, Vocare lost the contract to run the urgent-care centre at the Royal United Hospital Bath (RUH). From 1 May 2018, the centre will be run by the Royal United Hospitals Bath NHS Foundation Trust in partnership with B&NES Enhanced Medical Services (BEMS), also a private company.
In November 2017, a contract worth £14.7 million to run a regional urgent-care contract in Bath and North East Somerset was awarded to a consortium of three private health companies, including Vocare. Vocare and BEMS+ will support lead provider Medvivo to run the NHS 111 service across B&NES, Swindon and Wiltshire, the GP out-of-hours service in B&NES and Wiltshire, and telecare monitoring and urgent care and response at home for Wiltshire Council.
As Somerset Doctors Urgent Care (SDUC), Vocare delivers primary out-of-hours care and the 111 service in Somerset and the 111 service in Devon.
Through Staffordshire Doctors Urgent Care (SDUC), Vocare provides GP led out-of-hours care for Staffordshire and the NHS 111 service across the whole of Staffordshire serving a population of over one million people.
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. YDUC also runs a GP out-of-hours service for the Vale of York at York Hospital and the GP OOH Service based inside Selby War Memorial Hospital. Vocare also manages a new urgent care service covering the east of the county and Rutland. Vocare 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.
Working as South London Doctors Urgent Care (SLDUC), the company is working with SELDOC to provide urgent care centres around the South West London region and as London Doctors Urgent Care (LDUC), it provides an urgent care centre, based at St Mary's Hospital.
Premier Physical Healthcare
Premier provides physiotherapy and podiatry services via NHS contracts and to private patients. The company has a number of contracts to provide these services to prisons and to police forces.
About Health is involved in referral management services (RMS). Contracts include a number of contracts for NHS Clinical Commissioning Groups. Recent contracts for RMS include:
In November 2016 a £763,000 per annum three year contract renewal to provide dermatology services to NHS East Lancashire CCG, with an option to extend for a further two years.
In October 2016, a £120,000 contract extension and pilot scheme for North Tyneside CCG.
In October 2016, a £240,000 12-month pilot of a RMS service for North Durham CCG. This contract added cardiology and gastroenterology as two new specialities to the RMS.
In November 2016, a one-year contract extension with NHS Lancashire North CCG, worth £120,000 per annum.
In September 2017, a £331,750 per annum four year contract to provide dermatology services to Castle Point, Rochford and Southend CCGs.
The subsidiary, Totally Health has contracts with numerous CCGs to deliver the company’s long-term management programme for COPD patients and other patients with chronic conditions. Since 2012, the company’s programmes have been developed and rolled-out for use with patients with other long-term conditions, including diabetes, chronic heart failure and asthma.
The company is also involved with the development of Apps for patients, including Patient Decision Aids (PDAs), that cover 36 specific disease areas.
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'. Three are awaiting inspection and have no rating. There are also services listed under different names, including Staffordshire Doctors Urgent Care Ltd (seven services).
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 and its leadership and effectiveness. A year ago the centre had been rated 'good'. 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, run 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 well-led 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.