Case Study: Primary Care Trust Turnaround


  • This PCT commissioned and provided NHS services worth £400 million for one of the poorest and most diverse areas of the UK
  • The PCT operated in a political environment
  • NHS London perceived this PCT as a highly political organisation in which gaining traction would be difficult
  • At a time when the whole of the NHS was under intense government pressure to demonstrate financial control, the Trust was projecting a £7million deficit
  • Grant Thornton (GT) was engaged to produce a cost savings plan, which set out to deliver targeted benefits of £10m in year one
  • Kingsgate was engaged as Turnaround Director/CEO, via a competitive tendering process, to take on the executive leadership role and to execute the recommendations of the turnaround plan

Project Phases

Phase I – Implementation of cost saving schemes

  • Implementation of the cost saving measures in GT’s plan ahead of schedule and direction of the programme to turn the deficit into a surplus
  • During this period, Kingsgate managed the process to recruit a full-time CEO

Phase 2 – Restructuring of Executive Team

  • Response to the weakness of the senior team, particularly in commissioning and the relationship with the local acute Trust
  • On a reduced-time basis Steve Swayne actively and routinely supported the new CEO. Kingsgate also supplied a Chief Operating Officer and the Director of Commissioning. From that base, over 70% of the senior management group was changed

Phase 3 – Sustainability

  • The final phase of the turnaround identified that the organisation needed to become more self-sufficient in delivering improvement plans
  • Steve continued as lead director for the client and Kingsgate provided a Director of Projects, whose brief was to create and develop an independent Project Office to deliver improvement initiatives without routinely having to revert to the interim marketplace

Results and achievements

  • At each of the stages of the turnaround process, Kingsgate were able to deliver a £3m budget surplus in year one (which has remained) and beat the budget in each subsequent year
  • £7 million deficit turned into surplus in four months
  • Significant performance and productivity improvement
  • £10 Million CIP delivered
  • Retained by the Board in an advisory capacity