Totally Plc

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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 is investing heavily in the insourcing sector, whereby it conducts surgery within NHS premises. The company’s contracts are with both the NHS and private sector organisations.

Strategy

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. The other major target market for the company is insourcing. This is where in an effort to bring down waiting lists, hospital trusts contract private companies to carry out procedures, such as diagnostics or elective surgery, using the trust's facilities while they are not being used by the NHS, such as at weekends.

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. 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.

In June 2019, the board announced that its enlarged share capital has recently been admitted to trading on AIM (Alternative Investments Market) and the company had completely acquired Greenbrook Healthcare, which runs primary care centres, urgent care and walk-in centres in London and the south east.

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 subsidiary, My Clinical Coach, launched in 2016, is a direct-to-consumer UK health-coaching service for people with long-term health conditions or general ‘wellness’ concerns. Individuals or their families can choose to subscribe to the monthly subscription based service. 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.

In October 2019, Totally plc created a new business focused on insourcing, Totally Healthcare, which delivers insourcing services across the UK and Ireland. Insourcing is where a hospital trust employs a private company to carry out procedures on NHS patients within the hospital trust using the hospital's facilities. For example, insourcing companies would provide a team to carry out elective surgery in a hospital's theatres on weekends when the NHS is not carrying out surgery. In the first few months of operations the business secured contracts across the UK and Ireland delivering bespoke services to reduce hospital waiting lists. These services were put on hold during the first months of the Covid-19 pandemic as all elective healthcare was suspended. By the end of 2020, Totally Healthcare was back working. The company views insourcing as a major growth area and in March 2022 acquired Pioneer Healthcare, a leading insourcing company, for £13 million. Both Totally Healthcare and Pioneer Healthcare are listed on the government's insourcing framework, which runs until September 2022. However, with the push to reduce waiting lists a major priority for the government, hospital trusts will use insourcing companies potentially for much longer.

Totally Plc has three divisions: Urgent Care (Greenbrook Healthcare and Vocare); Planned Care (About Health, Optimum Physiotherapy, Premier Physical Healthcare, and My Clinical Coach); and Insourcing (Totally Healthcare).

Financials

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 annual accounts are for the year to the end of 31 March 2021. In this period, Totally plc reported revenues of £113.7 million, up 7.4% on 2020 (£105.9 million), which resulted in a profit after tax of £0.06 million (2020: loss of £3.41 million).

For this 12 month period the Urgent Care division reported revenue of £105.4 million (2020: £96.5 million), Planned Care had revenue of £5.2 million (2020: £8.4 million), and Insourcing had revenue of £3.1 million. The vast majority of revenue is from NHS contracts.

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.

Investors

Totally plc’s largest investors as of March 2021 are the three asset management companies: Milton Asset Management (14.12%); Cavendish Asset Management (8.23%); and Columbia Threadneedle Investments (6.33%).

Contracts

Totally Healthcare

This is Totally's insourcing subsidiary and it is listed on the NHS Share Business Service national framework agreement for insourcing. The companies listed have already gone through a competitive tendering procedure to be put on the list and can be used by trusts without additional contract tendering. The framework began back in 2018 and runs until September 2022.  Pioneer Healthcare, which Totally acquired in March 2022, is also listed on the framework.

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. 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 (StDUC), 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. In February 2021 it was announced that Vocare will continue to provide integrated urgent care services for the Staffordshire and Stoke clinical commissioning groups for a further 12 months and in February 2022 a further 12month extension was awarded.

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. In February 2021, Vocare's contract for GP OOH service was extended by 2 months until March 2022; this was valued at £900,000.

Working as South London Doctors Urgent Care (SLDUC), the company is working with SLDOC 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.

In February 2022, Vocare won a two-year contract extension for the provision of GP services to NHS North West London CCG, worth around £1.3m a year. Under the terms of the Contract, will provide GP-led primary care services for Initial Accommodation Centre service users located within 34 hotels in the London borough of Hillingdon and neighbouring boroughs. The contract was initially awarded in February 2020 to meet the primary care needs of individuals seeking asylum in England who were located mainly within Hillingdon in London.

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

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 late 2019, About Health was awarded a three-year contract by the NHS Blackpool and NHS Fylde & Wyre Clinical Commissioning Groups to deliver Tier 2 Community Dermatology Services to the CCGs.
  • 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.

Totally Health

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.

Greenbrook Healthcare

Acquired in June 2019, Greenbrook Healthcare runs nine urgent care centres and four walk-in centres in London/home counties, an Ealing GP practice, Greenwich GP Out of Hours Service and Hounslow Intermediate Community Response Service.

Concerns

Care Quality

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. 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. By early 2019, the rating had risen to 'good'. The St Mary’s Urgent Care Centre inspected in June 2018 was rated ‘requires improvement’ for leadership and effectiveness and in June 2019, overall it was rated 'good' but 'requires improvement' for safety.

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.

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