Annual Report May 2015

MYLCD“We must look

at how we can support

the change to provide better

and more integrated 24/7 Primary Care”

SocietyAGM

1.00pm - Monday 15th June 2015

Make your voice heard!

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Welcome to the 2015 Local Care Direct Annual Report.It has been another successful trading year with an outstanding level of performance which is thanks to the excellent staff we have and despite the unprecedented demand on our services and the difficult funding regimes imposed on us.Our annual round up shows yet again that in spite of these pressures there were successes, achievements and developments.These included a number of changes in the Board structure, among them agreement on the appointment of a Member Non Executive Director. This generated a great deal of interest with a number of able candidates putting themselves forward for the process of election/appointment which took place over the winter 2014/15.The subsequent election of Alison Russell has been widely welcomed and she has now taken up her seat on the Board. You can read more about Alison’s aspirations in her new role on Page 11.By the time you read this Annual

Report we will know the outcome of the General Election but there will inevitably be continued uncertainty about the direction for healthcare as a new Government is formed and the detailed health policy takes shape. We know that both major parties are articulating policies which would impact significantly on LCD and other social enterprise providers in the health economy - not necessarily advantageous.The Board recognises the uncertainty and is planning for a number of options resulting from the election results and to support the team to pursue business opportunities and contracts nationally and locally.I wish to thank all the LCD staff whose hard work has continued to ensure LCD’s reputation is of the highest order and whose motivation is always the patients’ welfare and best interests.

Chair Stan Hardy TD DL

Chair’s Remarks

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The following pages contain a potted review of some of the key milestones of the LCD year. As always a great deal more has happened than we can possibly squeeze into the review but it is important to reflect on our achievements. Once again our financial statements

show that performance for the year ended 30 September 2014 was strong; however, there was continuing pressure on our services from increased demand now 72% above the contract baseline and emerging competition from new primary care services for clinicians.

Our 2014-15 Annual Review

April REDESIGNING SERvICES

Workshops started with our 10 Clinical Commissioning Group commissioners and NHS111 to develop new approaches to manage the growing level of demand for urgent care. During the year we were able to introduce a number of changes to the pathway and our operational and clinical protocols which helped minimise risks to patients, but we were not able to secure the “big changes” needed to match our capacity to demand.

May IMPROvEMENTS IN TECHNOLOGY The last 12 months has seen major investment in technology to make our services more efficient and effective. In May our new management information software produced its first performance reports whilst new software and operating systems brought improvements across the business.

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June STAMP Of APPROvALUrgent Health UK – the federation representing out of hours providers across the country conducted its first audit of LCD as a new member and with a couple of minor improvements, we passed with flying colours.

July YORKSHIRE WELCOMES LA TOURYou had to be hiding in a cave not to know that the Tour de france came to Yorkshire on the first weekend in July! One of the world’s largest sporting events brought with it numerous challenges for our services which had to contend with huge numbers of visitors, road closures and restricted access to several of our centres. Months of meticulous planning paid off with an amazing event which few will forget.

August GOODBYE TO SCHOOL HOUSE PRACTICEIt was with sadness that our School House primary care service closed its doors after local commissioners decided not to continue the service. Patient numbers had been growing but had not reached a viable level and a review of walk-in services identified opportunities to centre this on the walk-in service provided at Dewsbury Hospital. Registered patients were able to re-register with other nearby practices and we were pleased to redeploy staff to other roles within LCD.

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September BOARD GOES PUBLICLCD Board meetings are opened up to members in an effort to improve engagement and involvement. These sessions have proved interesting and successful allowing the management team to discuss some of the key issues and opportunities affecting our organisation.

October INvESTING fOR THE fUTUREIt’s a new financial year and our Business Plan makes a bold statement of intent to develop our services, win new business and invest in the organisation in key areas such as our telephony and IT infrastructure and contact centre.

November CELEBRATING TEN YEARSStaff, clinicians and guests gather at the Cedar Court Hotel, Ainley Top near Huddersfield where it all started in 2004 for a celebration of the first 10 years of Local Care Direct. The event also doubled as the annual staff awards ceremony which recognised some of the outstanding individual and team contributions during the year.

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January ExTENDED HOURSNew extended hours schemes in primary care start. These have the potential to reduce demand for urgent care from patients with routine health needs; LCD is keen to work with practices and GP federations to support these schemes so that issues such as competition for clinicians is managed.

february DEMENTIA fRIENDLYAn ageing population with long term health conditions including dementia are a feature of the society we live in, and along with other organisations we commit to becoming a dementia-friendly organisation, reflecting our social enterprise values and with the aim of ensuring we can respond effectively to this growing area of patient need.

March TIME TO REfLECTIt’s the end of another contracting year in the NHS and LCD has dealt with 516,000 patient contacts across all our services. All services have seen increased demand.

December BREAKING RECORDSActivity records in our urgent care service rose to new levels over the Christmas and New Year period in spite of a relatively mild winter. A new single day highpoint was reached with more than 2000 patients seen.

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In 2014 Local Care Direct celebrated our 10th anniversary and what a party we had! Our organisation was one of the first social enterprises (SE) in the health and social care sector, and whilst it is great news that there are now many more organisations with SE status, the value and aims associated with our position remain as important as ever. It is critical to everyone at Local Care Direct that people remain the focus of everything that we do – this applies to both patients and our fantastic team of staff and clinicians, a significant number of whom have been with the organisation for a large number of those ten years!Care pathways must evolve to meet the health needs of a changing population and Local Care Direct needs to embrace this.We must recognise that the West Yorkshire Urgent Care (WYUC) contract that was the purpose of our organisation will almost

certainly change significantly when next procured and we must look at how we can support the change to provide better and more integrated 24/7 Primary Care in the future. We are also actively bidding for opportunities in the areas of Dental, Telehealth, Primary Care and the newly emerging Urgent Care Centres.The past twelve months have been tough for us all, particularly with the huge level of activity experienced in the WYUC contract. But we’ve worked together and managed the challenges, always putting patients’ interests first . Working together I am certain that we can continue to thrive and develop for the next ten years!

Helen Carr

The view from the BridgeHELEN CARR, CHIEf ExECUTIvE

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Meet the Board &Management Team

Dr Georgina HaslamRole: Non Executive DirectorBackground: Georgina worked for 26 years as a GP in Bingley until her retirement in 2013. She has over 20 years’ experience of commissioning new services and in the development of patient participation, including working as a regional Clinical Lead for the Yorkshire Cancer Network. Georgina has previously chaired Clinical Executive committees in Bradford and Airedale and more recently was the Urgent Care Lead for Bradford City and District CCGs. She was acting Clinical Director for Local Care Direct from 2010-11. In addition Georgina is Chair of the Shipley based charity Health Action Local Engagement (HALE) and an Honorary Tutor for the University of Leeds.

Dr John SinghRole: Advisory Council representativeRetired from the Board 9th June 2014.

Dr Neil BowringRole: Chair of the LCD Advisory Council and Advisory Council representative on the Board.Retired from the Board 20th November 2014.

Kevin BondRole: Non Executive DirectorBackground: full time CEO of NAviGO community interest company, a multi-national award winning social enterprise that runs mental health, social care and associated services in North East Lincolnshire. Kevin has held several senior posts within large NHS trusts, PCT as an executive director and other ‘third sector’ bodies as a non executive. He has sat on several inter-departmental government groups (e.g. employment and violence and aggression) and numerous regional and topic based groups.

Mike LockwoodRole: Non Executive Director; Chair of the Audit & Risk CommitteeBackground: Executive and Non-Executive Director roles across several business sectors. He currently holds several NED, Company Director and Advisor roles in commercial, government and charity organisations.

Alison RussellRole: Member Non Executive Director Background: As LCD’s Quality Manager, Alison deals with complaints management and incident reporting, ensuring that any learning outcomes or actions are implemented. She also ensures that the legitimate interests of service users, staff and clinicans are protected. Alison is a member of the West Yorkshire Palliative Care Group and represents LCD at the Sub Regional Clinical Governance and Quality meetings.

Stan Hardy TD DLRole: Board ChairBackground: After a career spent in manufacturing both in the UK and overseas, Stan took early retirement and became the Non-Executive Chair of the West Yorkshire Probation Service, a position which he held until recently. He is a member of the Yorkshire Ambulance Service Governance forum, a Board member of the Duke of York’s Community Initiative and a Deputy Lieutenant for the County of West Yorkshire. He was formally a fellow of the Institute of Directors and a member of the IoD National Council.

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Denise StevensRole: Director of Urgent CareBackground: Denise is an Advanced Nurse Practitioner with extensive background in healthcare management. She has spent the last 13 years in both management and clinical practice in acute and urgent care settings. She has built strong relationships across the local health economy to support the redesign of care pathways which improves patient care. Denise is a valued member of local Urgent Care groups looking at clinical governance and urgent care transformation.

Diane WhaleRole: Director of financeBackground: Diane is a Chartered Accountant with over 20 years’ experience in the profession, having previously worked in public practice and industry. Diane has been involved in acquisitions, business startup and restructures and has worked with audit, banking, legal and pension professionals in both private companies and PLCs.

Tom ColstonRole: Director & Company SecretaryBackground: With a background in operational and project management within the financial services and retail environment, Tom has worked with Local Care Direct since 2006. Tom’s portfolio of responsibilities currently includes Board Governance, Estates, Health & Safety as well as heading up our dental services business arm, Dental Care Direct.

Andrew NutterRole: Deputy Chief ExecutiveBackground: Andrew is a founder member of Local Care Direct who joined after a career which spanned roles in journalism, public relations, general management and consultancy in the public and private sectors. As Deputy CEO, Andrew uses his wide and varied skills and experience to lead a portfolio of disciplines including quality management, risk management, information governance, business planning and development and corporate communications.

Helen CarrRole: Chief ExecutiveBackground: Helen became LCD’s Director of finance in 2010 and Chief Executive in July 2013. Her priority is to sustain the Social Enterprise culture and ethos of the organisation and to make sure that Local Care Direct’s mission statement of ‘We care about people’ is integral to everything the company does. Prior to working with LCD, Helen worked with audit, legal and banking professionals at PLCs, private companies, social enterprises and charitable organisations.

Christine AtkinsonRole: Associate Director of HR & TrainingBackground: Christine is a Chartered Member of the Institute of Personnel & Development with over 20 years’ multi-site HR & training experience in the public, social enterprise and private sectors, mainly in Healthcare and Information Technology. She joined the Local Care Direct team in August 2006 and has a proven track record within all main aspects of HR Management. Christine and her team provide the organisation with a full generalist HR service at both a strategic and operational level.

Dr Mutaz AldawoudRole: Director of Clinical Innovation Background: Taz holds an MBA with specialism in Strategic Management in Life Sciences and Healthcare. He has worked as a GP in Bradford for the last 7 years and is passionate about tackling health inequalities and improving patient outcomes, especially through utilising innovative technologies and digital systems in healthcare. Taz also works at a national strategic level through his role as ‘Digital Clinical Champion’ for NHS England and sits on the Board of the Yorkshire & Humber Academic Health Science Network (AHSN) for Assisted Living Technologies and Telehealth.

Dr Johnson D’SouzaRole: Clinical Director and Director of Primary CareBackground: Johnson is a portfolio GP, who has been a part time Partner at the White Rose Surgery, South Elmsall since April 2011. He is also a Clinical Advisor to NHS England, North (Yorkshire & Humber), along with being a GMC Performance Assessor since September 2010 and CQC Specialist Performance Advisor since September 2014. Johnson was appointed to the Yorkshire and Humber Clinical Senate Council in february 2014.

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Notice of Annual General Meetingof Local Care Direct Limited

THIS IS NOTICE THAT the 10th Annual General Meeting of Local Care Direct Limited will be held at Junction 25 Conference & Meeting venue, Kirkdale House, Armytage Road, Brighouse, HD6 1Qf on Monday 15 June 2015 at 1.00pm for the purpose of transacting the following business:1. To approve the Minutes of the Annual General Meeting held 9 June

2014.2. To receive the Directors’ Report and financial Statements together

with the auditors’ report thereon for the year ended 30 September 2014.

3. To consider and if thought fit, reappoint Grant Thornton LLP as Local Care Direct auditors and authorise the directors to fix the remuneration of the auditors.

4. To re-elect Stan Hardy as a Non Executive Director.5. To re-elect Kevin Bond as a Non Executive Director.6. To transact any other business permitted under the Rules.

By order of the Board

Tom ColstonCompany SecretaryApril 2015

Copies of the Directors’ Report and financial Statements for the year ended 30 September 2014 and LCD Rules will be available at the meeting and can be obtained prior to the meeting from the Company Secretary at Local Care Direct, Sheridan Teal House, Longbow Close, Pennine Business Park, Huddersfield HD2 1GQ (01484 487262).

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New Non Executive Director

Through working in the Out of Hours service for 15 years and for Local Care Direct since its start I have gained an extensive knowledge of the services we provide and the challenges we face.

In my role as Quality Manager I work across all sites, business streams and departments in LCD and in addition to this I work closely with LCD’s partnership organisations.

I am a member of the West Yorkshire Palliative Care Group and represent LCD at the Sub Regional Clinical Governance and Quality meetings. Through working with these groups I have established and maintain strong and resilient relationships with commissioners, health care

professionals, practice staff and service users from around West Yorkshire.

I am keen to engage with members, to encourage them to interact with us, share their views and enlist their support when needed. A members’ “web forum” would be one way of doing this and I would be keen to explore this and other options with members.

In terms of developing our membership another priority has to be developing links with third sector organisations, charities and community groups.

Alison Russell

Alison Russell, the new member-elected Non Executive Director on the LCD Board.

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The principal activity of the Society during the year was the provision of health care services. All dental work is contracted through the wholly-owned subsidiary, Dental Care Direct Limited. The Board is pleased to report the achievement of a surplus before taxation of £904,586 for the year ended 30 September 2014 (2013 - £541,340). This represents a 67% increase over the previous year and further consolidates the performance of the previous three years whilst demonstrating strong management control of costs in challenging trading conditions. Local Care Direct continues to deliver the West Yorkshire Urgent Care Contract as a sub-contractor to the local NHS 111 provider, Yorkshire Ambulance Service. The business has encountered severe cost pressures in this contract, with patient activity to 30 September 2014 60% higher than the baseline levels originally envisaged and a consequential detrimental impact on contract performance. Although the business has been successful in securing some additional funding for the West Yorkshire Urgent Care contract, this was not proportionate to the increased activity. In common with other healthcare organisations, Local Care Direct is finding it increasingly difficult to secure clinical resources within budgeted costs. This problem is compounded by the competing external demands for GPs within the wider healthcare community. To mitigate this diminishing availability of GPs, Local Care Direct now utilises an innovative range of clinical skills to deliver this service. Dental Care Direct Limited delivered a robust performance in the year due to sustained high patient demand. Despite the cost and activity pressures encountered within the West Yorkshire Urgent Care contract, the Group delivered a strong financial performance, which has further boosted reserves and confidence going forward.

Local Care Direct has again been able to reward the contribution of staff through a recognition payment, with a further commitment to a substantive pay increase from 1 April 2015 for employees on Local Care Direct employment terms. Local Care Direct operates in an environment subject to severe pressures, both in terms of patient demand and cost. Political uncertainty and Government targets for savings within the NHS dictate that the organisation must be receptive to the changing and differing demands of commissioners, whilst remaining at the forefront of technological innovation in the delivery of patient care. Local Care Direct is positioned to facilitate the restructure of healthcare provision, particularly in the areas of Primary and Urgent Care. We have a strong local and national presence and are considered by our local commissioners to be their support organisation of choice, having the knowledge, scale and experience to be a credible partner.We are actively bidding for contracts locally and nationally in our core areas of business and are also keen to further develop our successes in dental services and technology-based healthcare.After reviewing the Society’s budget for 2014/15 and the facilities currently available, the Board is confident that the Society has sufficient resources to continue trading for the foreseeable future. for this reason the Society has adopted the going concern basis in its financial statements.A resolution to reappoint Grant Thornton UK LLP as auditors will be put to members at the Annual General Meeting.This report was approved by the Board and signed on its behalf.

S Hardy TD DLChairmanDate: 22 January 2015

Extract from Directors’ Reportfor the year ended 30 September 2014

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BALANCE SHEET 2014 (£) 2013 (£)

Tangible fixed Assets 1,012,273 986,050

Current Assets 6,293,643 5,477,125

Creditors: Amounts falling due within one year (3,623,259) (3,652,944)

Net Current assets / (liabilities) 2,670,384 1,824,181

Total Assets less current liabilities 3,682,657 2,810,231

Creditors: Amounts falling due after more than one year (250,196) (280,961)

Net Assets 3,432,461 2,529,270

Reserves 3,432,461 2,529,270

INCOME AND EXPENDITURE 2014 (£) 2013 (£)

Turnover 23,810,182 20,957,855

Cost of Sales (14,901,798) (13,146,262)

Gross Surplus 8,908,384 7,811,593

Other operating charges (8,003,262) (7,266,889)

Operating surplus 905,122 544,704

Interest receivable 6,974 5,063

Interest payable and similar charges (7,510) (8,427)

Surplus on ordinary activities before taxation 904,586 541,340

Tax on surplus on ordinary activities (1,395) (1,013)

Surplus for the financial year 903,191 540,327

Reserves brought forward 2,529,270 1,988,943

Reserves carried forward 3,432,461 2,529,270

Consolidated financial Summary

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We have audited the financial statements of Local Care Direct Ltd for the year ended 30 September 2014, which comprise the Consolidated and Society Income and Expenditure accounts, the Consolidated and Society Balance sheets, the consolidated Cash flow statement, the reconciliation of net cash flow to movement in net funds / debt and the related notes. The financial reporting framework that has been applied in their preparation is applicable law and United Kingdom Accounting Standards (United Kingdom Generally Accepted Accounting Practice).This report is made solely to the Society’s members, as a body, in accordance with regulations made under the Cooperative and Community Benefit Society Act 2014. Our audit work has been undertaken so that we might state to the Society’s members those matters we are required to state to them in an auditor’s report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the Society and the Society’s members as a body, for our audit work, for this report, or for the opinions we have formed.Respective responsibilities of the Board and auditorThe Board is responsible for the preparation of financial statements which give a true and fair view. Our responsibility is to audit and express an opinion on the financial statements in accordance with applicable law and International Standards on Auditing (UK and Ireland). Those standards require us to comply with the Auditing Practices Board’s Ethical Standards for Auditors.

Scope of the audit of the financial statementsA description of the scope of an audit of financial statements is provided on the financial Reporting Council’s website at www.frc.org.uk/apb/scope/private.cfm.Opinion on financial statementsIn our opinion the financial statements:• give a true and fair view of the state

of the group’s and of the Society’s affairs as at 30 September 2014 and of the group’s and Society’s income and expenditure for the year then ended; and

• have been properly prepared in accordance with the Cooperative and Community Benefit Society Act 2014.

Matters on which we are required to report by exceptionWe have nothing to report in respect of the following matters where the Cooperative and Community Benefit Society Act 2014 requires us to report to you if, in our opinion:• a satisfactory system of control over

transactions has not been maintained; or

• the Society has not kept proper accounting records; or

• the financial statements are not in agreement with the books of account; or

• we have not received all the information and explanations we need for our audit.

Grant Thornton UK LLPStatutory Auditor, Chartered Accountants, Leeds22 January 2015

Independent Auditor’s Report

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Help Us to Make a Difference

Local Care Direct is a social enterprise. for our patients and partners this means we are a values-driven organisation, focused on serving and caring for people.We value actions above words and this should be evident in what you see and experience when you are in our care.In our teams we value and recognise professionalism, honesty, openness and, above all, caring. We champion diversity and promote equality and teamwork.In business, we measure success by our ability to develop sustainable services which care for people, put their interests first and deliver positive health and wellbeing outcomes for each individual.As a business which is funded by the public we also have a duty to ensure we operate effectively and efficiently, and that we are sustainable, by reinvesting financial surpluses into our services and the community.Our members are a vital link with the communities we serve, providing views, experience and ideas.We want to grow our membership with people who can contribute to our mission to improve the experience and outcomes for people using our services. We offer individual and corporate membership and would love to hear from other third sector organizations and special interest groups who can bring knowledge about vulnerable patients and those with specific needs. If you would like to become a member of Local Care Direct, please complete the tear-off section below and post to vicky Smith at Local Care Direct, Sheridan Teal House, Unit 2, Longbow Close, Pennine Business Park, Huddersfield HD2 1GQ or you can complete the form online at:

www.localcaredirect.orgA welcome pack will be sent to you and please tell your friends. Existing members can use this form to let us know about changes of details.

MEMBERSHIPAPPLICATION

Name:

______________________________

E- Mail Address:

______________________________

Telephone No:

______________________________

Local Care Direct…We Care!

Award-winning innovations to support long term condition management and care closer to home

Specialist health hub offering GP telephone assessment, remote monitoring of patients, telecoaching, call handling and nurse triage

24/7 primary care toolkit including urgent care centres, single point of access, GP out of hours and home visiting

Urgent dental care services

Range of regular and emergency cover for GP practices

Primary care support for A&E

Support for Extended Hours in GP practices

Please let us know if you require this

documentin large print by calling

01484 487262Registered Office:

Sheridan Teal House, Unit 2,Longbow Close, Pennine Business Park,

Huddersfield, HD2 1GQ. Local Care Direct is registered with the

financial Conduct Authority (Registered No 29766R).

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for more information about our products and services please visit us at www.localcaredirect.org website and follow us on Twitter.Or to talk to us please call: 01484 487262