Fast drive to recovery

Fast drive to recovery

A once modest co-op of GPs from Northumberland is now a £65.5m turnover service ready to help 10m-plus patients up and down the country get urgent medical care when needed. Chief executive John Harrison explains the transformation to Brian Nicholls.

More than 10m patients up and down the country, though they may not realise it, depend on John Harrison and his strategically spread team for certain urgent medical care. He is not a doctor but he is a chief executive of the fast growing Newcastle based organisation Vocare that works closely with NHS and local health care providers to deliver integrated urgent care through GP out of hours and NHS 111 services.

He is in fact a chartered electrical engineer, and while most patients requiring urgent care will be familiar with hospitals, clinics and ambulances, they may not perhaps be familiar with the structure behind the NHS badge. Hardly surprising either, since the structure continually changes. Vocare, for example, from 1996 till 2004 was a modest GP co-operative, Northern Doctors’ Urgent Care, run by family doctors in Northumberland who were then responsible 247 for their patients. Looking at how best to cover their on-call responsibilities and share shifts, they started bringing in some of the infrastructure now regularly emplaced for urgent care.

The year 2004, in John’s words, became the “game changer.” He recounts: “The British Medical Association negotiated an opt-out for out-of-hours. All doctors in the North East opted out, handing authority back to the commissioners. Northern Doctors were approached, and by early 2005 we were suddenly a £10m turnover business. A small co-op had become a significant sized operation.”

Even more so today. Within a few years the once regional enterprise has become a national provider serving, besides the North East, Staffordshire, Somerset, Yorkshire, Leicestershire, the West and East Midlands and part of London.

Its two contracts in London underscore its national role – an urgent care centre at St Mary’s Paddington, and a joint venture to deliver integrated urgent care – 111 and GP out of hours – in South West London. “It has taken a while to get our foot in London’s door but we’re delighted to have done so this year,” John says. “We feel that’s an area where we can develop further. Things are done differently in London. So there are different opportunities.”

Thus, in its 20th year, it has become a £65.5m turnover business, with a payroll list of around 2,600 names, many part-timers, with about 45 of the staff being Vocare’s backroom force at the Balliol Business Park nerve centre. And with its surge of new contract wins it will now create 70 more jobs at Newcastle base – nurses, paramedics and call centre personnel.

John’s background helps him to take a broad view of the country. Born in Bury St Edmunds, Suffolk, of an Irish mother and a Kentish father, he was raised in Lancashire. However, having lived in Newcastle since he was 18, and resident nowadays in Ponteland with his wife Sue and their four children aged 23 to 17, he acknowledges that more of his 55 years have been spent in the North East than elsewhere.  

So how did he cross the bridge from micro-processors and information technology to urgent health care? One time cleaner of public rooms at a Pontins holiday camp (a student then in a summer job), he joined his present organisation as project manager in 2006, when development work was needed to align changing standards, processes and regulations.

“I came in to help develop some of this,” he explains. “One thing led to another. I became chief executive in 2008 and we started expanding.”

He’d gathered sackfuls of experience since Pontins, of course. Studying at Newcastle University, he had become a chartered electrical engineer, mostly on micro-processors. Then he did a succession of engineering jobs in the North East. He worked for Mari, had been technical director of RTC North for five years, then joined a management buy-in of a company, a teletext travel agency, later taken over. After further experience in holiday management, he set up a firm doing website analytics, which is still running.

Vocare 03“I was asked if I had some capacity to work here, then it mushroomed,” he recalls. “As it became a lot bigger I had to make a decision. I threw my hat in here. From engineering to travel to health, you learn things that you can bring with you, and sometimes ideas and methods of doing things in other industries can be usefully re-applied in a different area.

“We don’t do emergency departments’ stuff, but we do work with them. We operate walk-in centres where patients can be seen, a new trend the NHS has promoted to put some such centres next to emergency departments.

“This is because emergency departments aren’t necessarily the best places for some patients to be dealt with. They could better be seen in urgentprimary care by a GP or adult nurse practitioner in a primary care setting, rather than in a full scale emergency department. We did the first of those at United Hospital, Bath, which has been very successful.

“This is being rolled out to other places, such as Scarborough, Wolverhampton and St Mary’s Paddington. These centres work in conjunction with emergency departments. So patients in trauma brought in by ambulance do go straight to ED. If they can walk in they’ll be assessed and streamed, either towards us for urgent care by a doctor or adult nurse practitioner, or to emergency.

“That takes a lot of pressure off emergency since we can treat a lot of those conditions quickly and efficiently. It has had a good effect in improving workload performances in the emergency departments. We also operate stand-alone walk-in centres.”
The NHS 111 national service which Vocare also operates has been running for five years.

Under this, call service patients can ring to get to a local provider who’ll talk to the patients, guiding them towards where they should go. Should they see their doctor in the morning, be sent to an emergency department, be seen by a GP out of hours, go to a walk-in centre - or do they need community services? Without this guidance, trying to make the right choice without 111 support would probably be a nightmare now. Vocare in all this is not an ambulance trust, and has no ambulance drivers, though it has a fleet of 40 appropriate vehicles spread around the country. In its home region it has a joint venture with the North East Ambulance Service, and provides the call handling side. “Many 111 calls can be dealt with by the handlers,” John explains. “But where clinical advice is needed the calls are put through to us and dealt with by suitably qualified clinical nurses we provide as part of
the service.”

Competition in providing these services is plentiful. An NHS trust may want to do it, and there are also hospital trusts and community trusts in the reckoning, and smaller out of hours providers. Nationally too there are three or four organisations regarded as direct competition. In the end the NHS basically decides who will do what. So why is Vocare so successful?

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“I think, mainly, our services have a very clinical driven ethos – about 15 local clinical directors – GPs involved in managing the clinical side of service, and about 40 clinical services managers who are senior nurses. So there’s good leadership. Also we’re very much a can-do organisation.

“We’ve some very good staff who roll up their sleeves, and who have worked marvellously, doing the late nights for example, and working hard at setting up services on time. Also, we’re very innovative in making the service more effective and helping patients - making the patient’s journey as good as possible.

“Finally, although a national organisation now, we’re very focused on delivering services locally. We have regions with senior management, human resources, governance, and clinical management. They understand the local economy and can adapt services accordingly as part of the local health care economy. So, while we have a headquarters here, most of the delivery is done from regional centres.”

Victims of ricochet

Social care has been hurt badly in the ricochet of recession, John says. “You see it a lot when hospitals are trying to get patients back into the community. Changes, and reduced capacity for social services and care, have had an impact.” That ugly but realistically named problem “bed-blockers” in other words, though John doesn’t call it such. He simply affirms: “It’s more and more difficult now to get patients out of hospital and into appropriate care they need. While it doesn’t affect us directly, it does have an impact. If hospitals are full and can’t get patients out after treatment it eventually backs up to the emergency departments.” His observation was reinforced shortly after this interview by a National Audit Office declaration that the number of vulnerable pensioners trapped in NHS hospital beds has risen “alarmingly” by a third in two years.

Vocare 04The watchdog believes official figures seem substantially to underestimate the scale of the problem, and that 2.7m “hospital days” a year are being lost to other patients because medically recovered patients lack help to get them home. Around £820m the NHS spends on patients who no longer need to be in hospital is a poor use of resources, the watchdog concludes.

John himself explains how patients in accident and emergency have waited to be admitted to wards full already. “Personally I think that’s an area needing attention. I can’t see how you’ll maintain health care demands by just sending people to hospital. I think in future more patients with high activity must be maintained at home - whether their own home, a care home or a nursing home. There isn’t capacity or resources to keep them in hospital.”

He adds: “An important element around that is also end-of-life care - palliative. Our doctors visit end-of-life patients a lot who are at home and who wish to stay there. We’ve done pilot work in care homes. We think more could be done to maintain patients at home. We’re too small to influence the NHS. But if we see opportunities we’ll avail ourselves of them.”