Primary Care Trust – Turnaround

Turnaround of £1bn Primary Care Trust as part of the original national NHS turnaround programme.


I was appointed as the Independent Turnaround Director in conjunction with the National programme.
The PCT, with a budget of £1bn was one of the largest in the UK and had the second largest deficit in the NHS (£55m). It had recently been formed by amalgamating five organisations but had only completed a limited amount of preplanning for this merger.
At the time of my appointment no one had been formally appointed to roles save for an Interim CEO and the Chair.
The National Programme required the compilation of a formal Turnaround plan and weekly reporting against this – both of which had to be approved/signed off by a Regional Turnaround Director.
While some of the pressures of the commercial world did not apply there were very few options to enhance focus by not delivering national and/or political targets.

Key Challenges

For six months the organisation was operating with large swathes of its management structures absent requiring me to use a varied suite of techniques to engage with participants.
The target was enormous and the organisation had started late in comparison to the rest of the country.
Certain key skills were lacking and the overall approach to delivery in full and on time was not in any way woven into the culture.
The financial position was worsening as the Finance team gradually being put into place uncovered historic issues.
As individuals were put into posts it meant constant changes within the workstream and projects.
General cynicism and scepticism from local stakeholders particularly GPs.
The Interim CEO was replaced after 4 months and two key Director posts remained unfilled at this stage.

Main Actions

Produced the Turnaround plan and set up workstreams and project structure around this.
Seconded key Finance people full time into project office to ensure that all plans had firm financial basis and validity.
Drove the  programme extremely hard with attendance at workstream and direct reviews with workstream Directors.
Held a weekly Executive Steering group to drive overall process.
Managed communication with regional Turnaround Director ensuring his overall view was one of rising confidence and assurance of overall delivery.
Met weekly with CEO and Chair around progress but also around key issues evident that required their attention including organisation and management issues.
Guided directors in on-going development of commercially orientated roles and the expectation of them in managing a £1bn operation.

Main Results And Achievements

Delivered return to financial balance within 12 months.
Programme and project approach was widely recognised by the DoH as being one of the most robust in operation.
Achieved grudging respect form GP community that despite the pain we had got the business back onto a level playing field.
Organisation much more aware and compliant with completion of tasks to a timeline, robust challenge and taking a more tenacious approach.
Transformed the original turnaround programme and process into a sustainable but radical management structure – using multi discipline programme boards to manage the overall business of the organisation in contrast to the traditional directorate approach.