Out-of-hospital services across England are shareholders’ gambling chip

  • Sustainability and Transformation Partnerships’ Care Closer to Home schemes have fuelled a £10m corporate purchase of a doctorpreneurs’ out-of- hours/urgent care company that provides services to over nine million patients across the UK.
  • Totally Ltd intends to use this purchase to expand and corner “a massive market opportunity” in out-of-hospital services.

Vocare Ltd, which has numerous contracts across England for NHS 111 and outof-hours and urgent care, has recently been bought by Totally plc, a private healthcare company whose current plan is:

“to build and develop a high quality diversified out-of-hospital UK healthcare services group… from diagnosis through to discharge.”

The NHS is “a massive market opportunity”

Commenting on the purchase, Totally’s Chairman Bob Holt OBE said that the NHS represents a massive market opportunity and that the purchase of Vocare Ltd had boosted their NHS contracts income from £10m/year to £100m/year.

Before buying Vocare Ltd, the Chair wrote to shareholders that:

“[T]he Acquisition allows the Group to obtain a foothold in the urgent care sector in the UK with Vocare being one of the leading privately owned providers of integrated urgent care services in the UK.”

He explained:

“[T]here has been an overall trend for the NHS and local authorities to seek to move the less acute or critical components of patient care from larger hospitals into smaller NHS premises… This process often takes place via outsourcing to private sector service providers such as Vocare. The Directors believe therefore that there is a significant opportunity for Totally to build and develop a high quality diversified out-of-hospital UK healthcare services group.”

Totally plc describe themselves as:

“an important player in the UK healthcare system, with a growing range of healthcare services to offer improved care for those whose conditions can be better treated at home, locally, or in the community.”

Update: Totally plc’s accounts up to 31 March 2021 show that Vocare substantially increased its turnover in 2016 after an expansion of urgent care services.

Totally’s “business” currently consists of:

  • Premier Physical Healthcare – occupational physiotherapy for NHS, prisons and the police force
  • About Health – community based dermatology services & GP referral management services
  • Optimum Sports Performance Centre – physiotherapy to private markets
  • Vocare – GP out-of-hours, integrated urgent care centres and  NHS 111
  • Totally Health – clinical health coaching via B2B model to the NHS and the private sector
  • My Clinical Coach – subscription based direct-to-consumer clinical coaching service for people with long-term health conditions or general ‘wellness’ concerns
  • Totally Healthcare An “insourcing” company set up in 2019/20. “Insourcing” means NHS hospitals pay Totally Healthcare to carry out medical services/procedures eg diagnostics, day-case surgery and outpatients, IN THE NHS HOSPITALS using their NHS premises and equipment during downtime. They say this “insourcing” is so the NHS hospitals can reduce waiting lists.
  • Greenbrook Healthcare – Totally Ltd bought this company in 2019/20. It’s a primary care “business” that provides urgent care services, walk in centres, Greenwich GP Out of Hours Service and Hounslow Intermediate Community Response Service (hospital admissions avoidance) for NHS patients. The NHS Support Federation has reported that in October 2016, Greenbrook Healthcare announced its intention to hand back an APMS contract for five GP surgeries in west London nine months before the end of the contract. This put around 27,000 patients at risk of losing their GP. Greenbrook Healthcare said that their withdrawal was due to rising demand and problems with GP retention. NHS England and Hounslow CCG used this as an opportunity to procure a new provider as part of NHS England’s APMS Tranche 5 programme.

As well as being listed on the AIM market of the London Stock Exchange, Totally plc says:

“Totally promotes health and wellbeing services by driving innovation and providing a range of responsive and preventative healthcare services in community settings, GP surgeries, prisons, workplaces and patients’ homes, from pre-diagnosis to discharge.”

Update 13.10.21 Vocare’s 111 contract for SW London terminated for poor performance

SW London Clinical Commissioning Group has ended Vocare’s contract to provide 111 services because its performance was unacceptably low. Totally/Vocare’s 111 contract started in 2016, as part of a bigger integrated urgent care services contract that was basically a pilot for the integrated urgent care services that the government rolled out nationally in 2019.

South West London Clinical Commissioning Group’s October 2021 board papers said less than one in three calls were answered by the Vocare service, against a target of 95 per cent. The number of abandoned calls was 15 per cent in August, a small improvement on the previous month, but still well above the 5 per cent target. The board papers also noted the volume of calls received by the service was around 31 per cent above contracted activity.

Totally’s Board  – a revolving door between the NHS, charities, and health, social care and housing companies.

Totally’s Directors include ex-NHS managers as well as people formerly or currently employed by Care UK, BUPA, EY, Mercury Health Ltd and large NHS and disability charities.

Wendy Lawrence, CEO of Totally plc, worked for the NHS as Chief Executive of three large Primary Care Trusts.  On behalf of the Strategic Health Authority she established new commissioning models for ambulance services and NHS Direct, and worked on Reforms of Urgent Care Provision and Taking Healthcare to the Patient. How convenient for Totally plc to have NHS insider knowledge of the sectors it plans to buy into. She also previously worked for BUPA and ran  her own company,

“working closely with numerous NHS and social care organisations across England, Wales and Scotland supporting delivery of many complex change agendas.”

The Chairman of the Board, Robert Holt, OBE, is also Chairman of Mears Group PLC, “a support services group focused on social housing and domiciliary care services”. “Bob” is described as:

“instrumental in Mears’ growth and oversaw the Company’s flotation on AIM and subsequent listing on the Main Market of the London Stock Exchange.”

Interviewed on IGTV – “the only broadcast channel providing up-to-the-minute trading ideas” – Mr Holt said,

“The acquisition of Vocare was very transformational for us. It provides a significant platform for future growth…It’s taken us from £10m [NHS] revenues to £100m revenues…
This is a large market. The NHS currently outsources £20bn of services. Clearly we’d like to take quite a bit more of that.”

Totally plc’s non-executive directors include one Tony Bourne, who is  a non-executive director of Barchester, “one of the UK’s largest operators of residential care homes” and Spire Healthcare Group plc, “one of the largest private healthcare groups in the UK, a London Stock Exchange-listed company and a constituent of the FTSE 250 Index” as well as Chairman of CW+ (formerly Chelsea and Westminster Health Charity), “one of the largest NHS charities”. Clearly a bloke for whom size matters. He was once Chief Executive of the British Medical Association, a big cheese investment banker and a non-executive director of Southern Housing Group and the cerebal palsy charity, Scope.

This will be where they get their spiel about how their business is helping the NHS deal with all the pressures on it, which Bob Holt slipped in with a smirk more than once in his IGTV interview.  The interviewer obligingly concluded that Totally plc was

“helping the NHS along”

Our NHS has become a gambling chip for sellers and buyers of company shares

The bottom line is the reality. Totally plc:

“has recently raised new equity capital through the markets and has an impressive shareholder base.”

The shareholders are large institutions. Totally’s share price shot up in October 2017, and then plummeted. This whizz bang seems to have more or less coincided with the company’s General Meeting on Oct 23rd for shareholders to vote on the acquisition of Vocare Ltd. It has risen sharply since the beginning of January 2018 – although not to the level before the October 2017 spike and plummet.

The 128 page document that gave notice of the shareholders’ General Meeting to vote on the acqiusition of Vocare Ltd warned,

“The Ordinary Shares should be regarded as a highly speculative investment and an investment in Ordinary Shares should only be made by those with the necessary expertise to fully evaluate the investment.”


Corporate rides on Sustainability and Transformation Plans’ gravy train

In March 2017, Totally plc announced a ‘sustainability partner’ agreement for a  £90,000 six-month contract with the Blackburn with Darwen Clinical Commissioning Group, as the CCG reviewed its long-term arrangements for community dermatology services. The contract was through Totally plc’s subsidiary About Health Ltd , a community-based dermatology services company and provider of GP Referral Management Services.

Wendy Lawrence, CEO of Totally plc, said,

“The continued success of About Health since we acquired the business as part of our buy-and-build strategy is a clear demonstration that it’s regarded to be a market leader in community based dermatology services.  We look forward to updating the market further on the progress being made across the Group as our subsidiaries target new contracts with the NHS, providing care to patients in local communities to prevent avoidable hospital admissions.”

Lol and behold: Cornwall Sustainability and Transformation Plan’s Public Private Partnership for a £48m 5 year contract with Vocare Ltd for the GP out-of- hours service and NHS111, with a start date of 1 December 2017.

The other parties to the “Partnership” are Royal Cornwall Hospitals Trust and Kernow Health Community Interest Company – a GP-owned provider.

This is in line with the government’s 2015 Spending Review settlement for the NHS which committed the government to encouraging long-term partnerships with the private sector in a number of key areas including:

  • development of new models of care including Accountable Care Organisations
  • the upgrade of diagnostic capabilities
  • hospital groups and acute care collaborations.

Sustainability and Transformation Plans – with their “overall trend” of moving “less acute or critical” hospital services into the community  (as Totally’s Chair informed shareholders), have made Vocare Ltd an attractive speculative acquisition for Totally Ltd.

Vocare operates in Somerset, Devon,Staffordshire, SW London, Yorkshire, the North East and Wolverhampton, and since 1 December 2017, in Cornwall – where NHS and social care services are shortly due to become an Accountable Care System,  designated by  NHS England as a “fast follower” to the 8 areas the quango has already fast-tracked to become Accountable Care Organisations.

(However, in the face of mounting public challenges to the creation of Accountable Care Organisations and Systems in the NHS, the quango announced recently that it has put plans for the award of ACO contracts on hold until it has consulted on them at some unspecified date.)

To cut costs in line with a projected £246m funding shortfall in 2020/21, the Cornwall Sustainability and Transformation Plan says:

“radical change is needed in the way we deliver our services across the entire health and care system, as well as the way people use them.”

As part of this “radical change”, community hospitals will be replaced by “Integrated Community Hubs” (p42) “co-located with Urgent Care Centres to ensure workforce and financial viability, working in partnership with the acute trusts.” (p42). This is to cut £24m costs.

Reconfiguring the NHS 111 and out of hours GP services, through the new Public Private Partnership, is

“an essential component of a wider urgent care pathway which is aligned, efficient and appropriately resourced.”

More public private partnerships

This requires the sell-off of “surplus” NHS estate and the development of “innovative ownership” models through the Cornwall Sustainability and Transformation Plan estates strategy – part of the One Public Estate scheme.

Watch how the Totally plc Chair spins its pursuit of NHS contracts as “helping the NHS along”, in the obliging words of his interviewer.

Update 2021 – Big opposition to York Hospitals Trust plans to hand York A&E Minor injuries, assessment and triage to Vocare

Staff working in the A&E department of York Hospital Foundation Trust have set up the Keep York Urgent Care Public group to fight Trust Executives’ plan to outsource to Vocare some of the work they currently do in the A&E department – the streaming of patients who attend the A&E department to more appropriate services, and the care of patients with minor injury.

York NHS campaigners report,

“Lots of anger and frustration in York about Vocare expanding into Minor injuries, assessment and triage in York A&E dept especially the Nurse Practitioner (NPs)who fear being absorbed into ‘a for profit’ private company. NP’s in Scarborough have TUPE ed into Vocare on different shift patterns etc. which they dislike and the time allocated to assessing patients is limited.

The standard of care seems worse. Vocare have provided GP out of hours service  managing minor illness in the Dept and now use the NPs to care for minor injuries but Vocare’s IT system of making  appointments cannot order X rays, plaster room  nor further appointments  with NHS orthopaedic consultants if there are complications. Reports of fast and inadequate care, with NHS A&E staff dealing with the aftermath.”

Rachel Maskell MP has started a petition to Parliament to stop this privatisation. You can sign and share it here.

The Director for Primary Care, NHS Vale of York Clinical Commissioning Group told York Adult Health and Social Care Policy and Scrutiny Committee that York Hospital Foundation Trust and Vocare had been working together to make York’s Urgent Treatment Centre compliant with the national specification that minor injuries and minor illness should be delivered as a single service for direct booking by NHS111. The Clinical Commissioning Group described the “provider to provider arrangement between the Trust and Vocare” as an “emerging Provider Collaborative“.

Totally Ltd Annual Report 2019/20

The Annual Report says Totally Ltd has three divisions:

  • The Urgent Care Division provides services across England “in partnership” with the NHS, including NHS 111, GP Out of Hours, Clinical Assessment services and Urgent Treatment Centres.
  • The Planned Care Division provides outpatient and referral management services to the NHS, delivering physiotherapy and podiatry services to patients in GP surgeries, community centres and prisons across England.
  • The Insourcing Division reduces hospital waiting lists in multiple clinical specialities by delivering bespoke insourcing solutions to hospitals across the UK and Ireland.

In 2019/20 Totally Ltd expanded by:

  • Completing acquisition of Greenbrook Healthcare – a primary care “business” that provides urgent care services, walk in centres, Greenwich GP Out of Hours Service and Hounslow Intermediate Community Response Service ( hospital admissions avoidance) for NHS patients.
  • Securing the new Urgent Treatment Centre contract in Watford.
  • Securing the largest dermatology contract to date for About Health in Manchester. A wholly owned susidiary of Totally Ltd, About Health provides community dermatology services to 18 clinics across Lancashire, Dorset and Hampshire. Totally Ltd notes that the UK’s “dermatology market” is estimated at around £600 million annually. And there was I thinking it was an NHS dermatology service, not a shareholder opportunity.
  • Launching their new Insourcing start-up business, Totally Healthcare, delivering so-called Insourcing services across the UK and Ireland. What this means is a form of privatisation whereby NHS hospitals subcontract their services to be carried out in their premises by Totally Healthcare’s staff, with the aim of reducing waiting lists:

“Hospitals subcontract medical services/procedures to Totally Healthcare’s practitioners who utilise spare capacity within the host hospitals – using their premises and equipment for service delivery to reduce waiting lists.

Totally Healthcare works across specialties such as endoscopy, ophthalmology, ear nose and throat (ENT), orthopaedics, urology and plastics with activities including diagnostics, day-case surgery and outpatient activity.”

WHY is NHS workforce planning so shit that there aren’t enough NHS hospital staff to make full use of NHS hospitals’ premises and equipment?

Totally Healthcare is on the approved suppliers list for NHS Shared Business Services for both England and Scotland

NHS Shared Business Services describes itself as

“the market leader in corporate services …[providing] services to around 40% of the NHS.”


“A trusted partner to the NHS [e]stablished by the Department of Health and Social Care (DHSC) in a unique partnership with digital experts Sopra Steria

NHS Shared Business Services provide their corporate services to every NHS commissioning organisation in England. That means they’ll be pushing their “insourcing” Totally Healthcare business to every Clinical Commissioning Group/Integrated Care System in the country.

NHSforSale has a very good webpage on Totally Ltd, including financial info.


  1. I read that Scope is selling some of it’s bricks and mortar facilities, and going in for being a leaflet and information charity. Maybe it will ‘support commissioning’ of services for people with cerebral palsy in the future, getting in on the NHS funding stream bandwagon.. Who knows.


  2. I find the content here to be rather a distorted view. It is unfortunate that you appear to trivialise the very real issues facing the NHS in this way.

    In my view it is naive to believe that there is a magic money tree capable of supporting an ever widening scope of supply.

    We all love the NHS but it’s management of supply has regularly been found to be inadequate- I would hope you agree that that has to change.

    Following the practice of private business, surely it is far better to outsource provision to smaller suppliers that can deliver better value for money to tax payers.

    Also, as far as I can tell, Totally are yet to make a profit for their shareholders. In that regard, surely it is the case that the NHS is a net financial beneficiary of this outsourced service. If Totally can make their business profitable then I would expect it to be through efficiencies rather than short cuts in a contractual supply agreement. If they fail on the latter then they lose the business. If they succeed in the former then it will prove the case for further outsourcing of NHS services I would have thought.


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