Practice Plus Group work with Gamma to remove legacy systems, to improve reliability and to lower costs across its critical services.

What value should we put on professional and personal integrity? For Barry Nee, chief information officer at Practice Plus, the UK’s largest independent provider of NHS services, the only answer is: “the highest”.

There’s no equivocation. An experienced executive of the IT industry who has worked both as a supplier and a customer, Nee has zero time for people who nurture an ego or play fast and loose with the truth in order to dodge responsibility for mistakes.

It’s a key reason he joined Practice Plus, recognising in the company’s approach a genuine focus on patients, and a culture of openness and accountability that stems from the example set by the directors and pervades the entire organisation down to the most junior colleagues.

It’s an approach that, unsurprisingly, also carries through to Nee’s relationships with his suppliers and is one of the key reasons why he retains Gamma as provider of SIP channels, VoIP hosted telephony, and Wide Area Networking (WAN). Nee notes that Gamma’s technology and infrastructure underpinnings are of the highest order, but so too is the company’s cultural alignment with Practice Plus. He says: “I define integrity as doing the right thing when nobody’s watching – that’s what we get from Gamma and its people.”

Nee’s employer underwent a re-brand in 2020, changing its name from Care UK to Practice Plus Group to better reflect the new corporate focus solely on primary and secondary healthcare. It now operates front-line services such as the NHS 111 telephone service, clinical assessment and out-of-hours doctors, and in secondary healthcare it operates a number of hospitals and surgical/urgent treatment centres.

SIP Trunking and Call Management

Practice Plus Group is contracted by the NHS to provide 111 services to 6.3m of the UK population across a swath of the southern half of England, last year handling some 1.5m calls. In out-of-hours doctor services, the company’s 35 locations cover 5.5m of the population. Also in primary care, Practice Plus Group operates consultation and treatment centres at 47 prisons across the UK.

In secondary care, Practice Plus Group operates nine hospitals / surgical centres and two urgent treatment centres where its doctors, consultants, and ophthalmologists treat more than 1m patients a year, taking the load off of NHS hospitals as well as treating insured and many ‘Self-Pay’ private patients. The company’s 111 Bristol call centre was the first anywhere in the UK to receive an ‘outstanding’ rating from the government’s Care Quality Commission (CQC) and all of its hospitals and surgical centres all have services rated as either ‘good’ or ‘outstanding’ by the CQC.

The relationship with Gamma began when the then Care UK was looking to replace the legacy technology feeds to its 111 call centres with SIP channels – seeking greater reliability and lower costs. Nee recalls that the list of possible providers was short; there were not that many around at the time, and Care UK had two key requirements that had the effect of automatically excluding some contenders right from the off. He explains: “we need reliability because 111 is a blue-light service, and flexibility because we are effectively in the contract business with workload expanding and shrinking as the needs of the NHS change. Call-centre handlers might be giving callers live CPR instructions over the phone so we cannot have any downtime, and you’d be surprised that flexibility, even today, is not something you always find in the industry. We needed a SIP channels partner with a robust service offering and the pragmatic flexibility to work with us.”

Gamma, with the ability to offer a robust service level agreement as well as the ability to ramp the number of channels up and down as required, was Nee’s choice. “We have around 800 SIP channels at the moment feeding into Avaya switches at our call centres, but that number has fluctuated over time.”

Does he have any regrets? “No. We have reduced our costs, partly by paying only for what we need, and over the time we’ve been with Gamma I can’t remember a single problem with the SIP service.”


Hosted Voice

Two years later Nee’s team began to look at the company’s on-premises telephony. At the time the company’s voice infrastructure consisted of some 2,000 lines together with on-premises PBXs at its hospital and back-office sites across the UK.

Some of the telephony estate was ageing and costly to maintain, but the newer elements posed their own challenges, among them the need to keep track of and implement multiple different systems updates. By then, it was clear too that the company’s needs were evolving, adding the immediate need for IVR functionality, hunt groups and legislatively mandated call recording on some lines, with a general requirement for more flexible operation that was expected to only increase over time.

The decision was made to move to a hosted telephony solution, with Gamma’s Horizon coming top in an evaluation of the then contending offerings. “We liked Horizon compared to some of the alternatives, not just because of its evidently strong technology underpinnings, but also because of its intuitive management console that would give us the ability to manage the system ourselves,” says Nee. “But, again, Gamma’s cultural flexibility and alignment with our own values were also key factors in the decision.”

The move to Horizon delivered on its promises, not just adding to the cost reductions already resulting from the switch to SIP channels from legacy connections, but also enabling Practice Plus Group to self-manage the telephony estate, rather than relying on often slow-to-respond and costly legacy providers.


The switch to Horizon proved so seamless and beneficial that the focus of Nee’s team could move on to the wide area MPLS network that transported data between around 100 of the company’s sites.

The network was in the hands of a single provider, but Practice Plus Group was not convinced that the arrangement was resulting in the most competitive pricing. Opening up the network to alternative providers would require Practice Plus Group to make a £30k-plus investment in a network bridge, but a cost/benefit analysis showed the capital expenditure would rapidly be repaid. As Nee recalls, Gamma’s abilities in WAN technology were already well known, the company had more than earned its place as a trusted supplier to Practice Plus Group, and so Gamma was invited to tender as individual contracts came up for renewal, its regular pricing for like-for-like service level agreements notably lower than that of the incumbent.

Gamma now provides some 30 of the wide area connections and as Nee notes, the introduction of an element of competition has resulted in a reduction in WAN charges right across the estate with no loss of reliability. “It’s about foundational underpinning. Our job is to make sure that the people delivering the care to patients have the right tools and infrastructure. We need to know that our colleagues can look at the computer and have the information they need. Strong, grown-up and dependable partners like Gamma help us to do that.”


How has reliability and technical support across all Gamma services been? “Really good. The SIP service has been solid. In the early days, Horizon suffered a national outage but I’m a big believer in the concept that you can build stronger relationships with people when things go wrong. I worked at Accenture as a service provider myself, so I get the buyer/supplier dynamic, and I was really impressed with how Gamma dealt with that problem.”

“Gamma’s CEO made a point of getting in touch and apologising, explaining openly what had happened and how the issue had been resolved. They faced up to it, acknowledged the impact on our business, were communicative, constructively apologetic and showed us how they would make sure it didn’t happen again. For me, it was a gold standard response.”

In light of that comment it’s perhaps no surprise that the first Gamma name Nee mentions should be that of their Customer Advocate. In almost any other company they would have the title of sales executive, but Gamma’s choice of job label reflects the fact that she – and her colleagues that have the same job title – are empowered in a highly unusual way. They are paid to sell, certainly, but also to represent the interests of their customers within Gamma. For confirmation that this is not commercial sophistry but a genuine attempt to do things differently, who better to ask than Barry Nee?

“For us, she is a member of our team. I think of her as a Practice Plus Group employee. I know in a 50/50 situation in Gamma, she is there to represent us. If there’s a discussion in Gamma that needs my voice, then she does that. We don’t have that with any other supplier. We trust her to have our backs and that’s a real differentiator.”

Crunch time came when Gamma wanted to give her more responsibility, in the process moving her to handle other customer accounts. Nee and his team were dismayed at the prospect of losing someone they saw as their colleague. “It was really serious for us,” he says. “For us, she is Gamma and we really value the relationship.”

“I did something I’ve never done before and called a supplier to make the case for leaving things as they are. We did not want her to be replaced and moved away from us. I told Gamma: ‘She provides a lot of value to both you and us. She is your brand.” I expected the call to be brushed off, the move to be ‘a fait accompli,’ but they listened and said: “OK, she will continue to work with you.”

The future

Practice Plus Group is weighing a move to Horizon Contact. Nee says: “Horizon is a very good hosted service, but the standard offering was never intended to be used in the contact centre role. Each of our hospitals and surgical centres has a customer cohort that it deals with regularly. Now that Horizon has built-in contact centre functionality we are quite excited about the possibilities.

It’s early days, in fact we are still at the pricing stage, but we know that Gamma would not move into that part of the market unless it was confident it had the right solution. Horizon Contact will, for example, make it much easier for receptionists to call customers back. It’s about how we can tailor our services to make them even easier for people to access.”

And what of the future? Does Nee anticipate a change of supplier? “As long as I have a service provider that is honest, open, reasonably priced and is working well then why would I move?”

“When I look at the people in Gamma that we interact with I see pragmatic, honest people who are interested in helping me out. They are great to work with, and the concept of customer advocacy is unique. I don’t see Gamma as a sales engine but as a customer champion.”