the virtual doctors Trustees report and financial statements for the year ending 31° December 2021 Registered Charity Number 1129924 Company Registered Number (England and Wales) 06848059 *ABDFll4BM* 2710912022 COMPANIES HOVSE A13 #181 Table of Contents TRVSTEiS REtY>RT........ -12 -13 14 ..1>20 STATEMENT OF FINANCIAL AcT￿￿[ES..........................................................................._........ .. BALANCE SHEET.............................................................. ... . ..... . .... NOTES TOTHEFtNANCIAL STATFMENr&........... ... .. Trustees Report 2021 The Virtual Doctors is the UK'S leading primary health care intematK)nal telemedicine charity. Its principal airn is to improve primary healthcare and prevent unnecessary referrals to hosixtals in Africa. Using a proprietary Smartphone App, the Se￿1￿ ￿Trenty enhances the kncmledge ofclinical off￿erS in isolated health ¢enters in Zamtrfa and Malawi vAth NHS {Nats'onal Healih SeNce) volunteer dc*Xors. The result is that the combined knthvledge of the virtual NHS Doctors and the Clinical Officer on the ground improves the Ireatmenl options for the patienL Our Governance Structure The Virtual Do¢tor$ UK Charity raises funds, manages volunteers, devebps the technology, and govems the mission and organisat¥)n. It then provides funds and direction to Virtual Doctors Ltd Zamkn"a a registered Virtual DoGtors.NGQ in Zambia and a registered non-profft Company to deliver the on the ground in Zambia and MaLgwi. For rewrting purposes this reFort details the financial arKJ Ynpact perfornance of The Virtual Dodors UK through its aclivits'es and as sole funder of Vwtual Doctors Zambia Ltd. Virtual tjoclors Zambia Ltd also has to submit rts own accounts in country. The UK twstees who are also directors of the charity for the purFrt)ses of the Companies Act 2006, present their report with the financial statements of the charity for the year ended 31st December 2021. The trustees have adopted the provisions of Acwunting and Reporting by Charilies.. Statement of Recommended Practice applicable lo ¢harities preparing their accounts in accordance wrth the FinancJal Rep)rting Standard applicatAe in the UK and Republic of I￿land {FRS 1021 (effective 1 January 20151. The Trustees are satisfied that they have complied with the duty in section 1715) of the Charitie5 Act 2011 to have due gard to public benefit guidance published by the Cornmiss￿n. The Virtual Doclors UK has the followng Directors and Trustees in place Mr Graham Precey Mr David Dutton Mr James Phiri Mrs Kathy Burke Mr Naggib Chakhane Mr Davh4 Callcott (aFwinled 0111112021? Chair Trustee Trustee Trustee Trustee Truslee We have hvo new addibons to the Board providing us with deeper experb.se into emerging technologies and the Pharmaceutical industries. Ms Isabelle Widmer lapwinted 1013r21) Mr Jon Crouch (appointed 101Y21) Trustee Trustee And three trustees Step￿ down in 2021. We would like to thank them for their SUPFQrt and work. Mr lan Clarke (resigned 1611r21} Dr D Forrest MB.CHB,DRCOG.MSC.FFP Retired DR (reS￿ned 11Y3121) Mr Lamder (resigned 19111r21) Tnjstee Trustee Trustee Other Parties Independent examiner Parkers. Comelius House 178-180 Church Road Hove. BN3 2DJ Bankers Covoperative 8ank PO Box 250 Delf House. Skelmersdale. V4W8 61 Charity Registered Off￿e Sussex Innovation Cent Universty of Sussex Falmer, Bnghton BN19S8 .Structure, Go.vernance and Management,Structure In the UK there is one full time member of staff. the Executive Director l Founder (Huw Jones). and a part4ime Executive Business AssislanL The Olfte is SUFP)rted by several consultants, pro bono partners. and volunteers. In Zambia there are 3 full tirrE staff. SUPFQrted by a team of volunteer5. Board Governance The Board of Directors and Trustees have the resFonsibility for all governanee, p)licy, strategy and financial matters. Appointment of new trustees is at the discretion of the existing Board of trustees. The Board of Directors held 4 Truslee Meetings during the period 1 January -31 December 2021. An annual general meeting was not ¢onvened during the Per￿1. Instead a number of Operational discussions with the CEO and Fundraising team on a regular baws. The Board includes Trustees with eXperIe￿e in not-for-profit Management. finance and accountancy, medicine. public health. global business, technology and fundraising. The nomal tem) of office is two years before review. The Charity's Constitution dictates that only Trustees may be appointed in any one year with lem of t)ffice reviewable every years from the anniversary date. The Charity seeks to recruit based on relevant skills and expertise. Proposed members are expected to already possess experien￿ in a range of areas whth are of relevance to the actrvibes and priorities ofthe charity. Referen￿S are requested as a matter of routine and a COnfl￿1-Of￿nterest register is maintained. Strategy & Management Our mission by 2025 is to provide 750 rural health worf(ers in Africa with access to medical knowledge that will improve the health of 18.000 peoFAe per year. The Executive Director and Founder of the Charity. Huw Jones. has been resFonsible for the overall management and co-ordinat￿￿ of ts Virtual Ooctors actNiti'e$ ni line with this rfmss￿ in 2021. In December 2021 the Founder and Execulive Director (Huw Jones) inrtiated a succession plan with the 8oar(I to allow him lo play a more ambassadortal role wrth the charity and lo alh)w a new CEO to come in and wn the organisation. James Phiri (Trusteel was asked by the Board to be Interim CEO from March 2022 because of his excellent management expenence and work in Africa. Financial Management The Executive Director has been res￿nsib￿ for the management of the Virtual Doctors finanual and administrab'¥e procedu￿$ during the in close consutstion with the Honorary Treasurer and other Board members. Book- keeping and financial records offunds sent overseas are rnanaged by a wofessional accountant in Zaff￿la. Risk Management The charity Trustees have considered the major ri$k$ lo which the charity is ex￿Sed and have eslatlished systems and procedures to manage those risks. Regular assessments are undertaken lo ensure sufficient funds are available to cover the unexpected variartt of Inc￿ arKI expendrture. The Risk register was reviewed at the Trustee meetings. Our main risks as an organisation to be mrtigated can be surrffiarised as folk)ws The risks associated with medical advice being used to Mnprove patient health The risks assccialed with hokling Med￿01 records The Tisks assooialed vthh keeping remote volunteers and dinical offThrs motivated and en9￿ed The risks aSS￿lated wrth keeping donors engaged The political and policy risks of ever changing heatthca￿ standards by natA)nal govemments. The emerging risks that climate change is playiThJ in negatNely impa¢ting human heatth. The trustees have a risk managemenl strategy which comwises: ' a regutar review of the risks the charity may face the establishment of systems and prcKedures to mitigale these risks in the plan: and the implementation of procedures designed lo minimise any polentsl wnpact on the charity $I￿uld those risks matenalise. The nsk areas identified are monitored at an alyropriate level of resp)nsitslty by the Trustees. Summary from the Chair- Graham Precey I'm pleased to let you know that 2021 has been our biggest Impa￿ year ever as a charrty thanks to you our donors, investors, volunteers. and our team led by Huw Jones your CEO and Founder. With the backdrop of COVID travel reStr￿110ns, changing of govemments in the countries in which we work in Africa and climate change impacting human heamh in our clinics the team have done an amazing job on your behalf. Ifs a good job we are the Virtual Oo¢tors! Together we have improved the health of over 3,11)O patients attending rural clinics in Zarn￿.a and Malawi this year, up by over 5% on 2020 numbors. This is our bread arKI butter and rt ts great to see our impact continue to grow. The stories of our NHS volunteers working together with Clinical off￿ers a￿ayS puts our essential Servi￿ and rts impact into perspective. I keep in mind the familEs whose hea￿h outcomes were improved by the expertise of our volunteers and whose lives would have been significanYy impacted by historically un-treated ¢hroni¢ ¢ondrtions, snake brtes, burns arKI ¢omplKations in chikllxrth vmhout that wiput. Our doc1c￿ volunteer5, many of them worknng in the NHS. have grown to 240 across the UK up from 191 in 2020. It continually amazes me that these professionals can finish their bLFSy shifts in UK hospitals & GP surgeries then consult on cases our Virtual Doctors telemedicine app to provide their advio and exper￿'se to front line health workers in Africa. We are one of the bvJgest expjrters of NHS kn¢￿edge and expertise out of the UK through our amazing volunteers. A massive thank you lo Dr Dan￿1 Grace and team who keep this wonderful volunteer workforce motivated, looked after, and growing in strength. Thanks to you we have generated an income of £475k in 2021. a 56% incr•ase over the prevlou$ year. This includes securing a major inveslmenl from Johnson & Johnson's c￿t￿enShip Foundation to revamp our technology and accelerate our work in 2022 - 2024 in Malawan Health Centres. We work very hard to ensure that everything that you invest in us makes a drfference to real peoF4e's INes in rural Africa. In 2021 we also secured funding from the Chalker Foundation for Africa lo carry out a comprehensive evaluation of our service. This enabled us to ask our teneficiaries. din￿1 offKers across Zambia and Malawi and the ministries of health, how we were doing in supporb.ng them with patient cases & improving primary health care. The clear message Came back that enhancing their knowledge wth that of volunteer do¢tors in a timely manner on specific Complex cases was key and we also know we have some adjustments to do on our processes and teChnolog￿S lo be even more effective going forward. So where are we headlng In 20227 We have a number of things to focus on in 2022 Malawian expansion thanks to our donors. who have been patient as we transstioned out of the Covid Telaled reslriclions and our ongoing discu55ion$ the new goverriment in Malawi on how.to proceed with the next stage of our efforts in Malawi. Our work in Zambia and expansion to additional dislrth. A strategy review by the Board to look at where next beyond Malawi and Zambia in temB of impact Revamping our technology to enhance the learning and deveknpment offering for our dini¢al officers Some opportunits'es to work with new partners alongside us. induding htt '.Ih￿.n50 ro ect.or oking to bring new technology into difficutt lo reach parts of the wortd. . An OFeratM)nal review of how we can support our NHS volunteers and Ck"ntcal Offws better in reviewing cases. Key Operational Highlights from 2021 Every day we mal¢h UK NHS Volunteer Doctors wtth Clinul Officers serving rural Clin￿ in Africa. To do this we need to keep our volunteers and clinical officers motivate¢Y and provide technology to connect them together to improve patient outcome5. Here are a few thing5 we are proud of a¢hiewng in 2021 to make this happen. 1. Patient Case Reviews The result of all our work is that where we are involved patients in Africa benefit from the combined knowledge of our NHS volunteers and the Ir)cal Clinical Officer in their treatrnent plans. The Virtual doGlors handkd the following case numbers over the last three years". 2019.. 2,049 cases 2020.. 2,980 cases 2021: 3.142 cases In 2021 we increased the number of pat￿nt cases that our volunteer NHS dcclors reviewed by another 5% on 2020 numbers and by 53% since 2019. Th￿ represents our highest number ever of cases reviewed in one singk year. We continue to support 233 health facilities across 37 Districts in Zambia and six health f&ilities in Malawi with our telemediune service Covering a F)opulation calchment area of 3.5 millK)n people. The service connects clinical officers ICOS) faced with complex cases with over 240 volunteer Doctors, most of them UK based, who support them with diagnosis and treatment advice for their patients. This leads lo more patients being treated in their own communities, a reduction in referrals to distant and hard to reach hospitals and improvement in the skills and knowledge of dinical officers. This means that the next time a complex case presents. they can deal with it on their own. Over 10,000 patient eases have been handled by our volunteer dc£tors. rnany of them life changing for the patients. The work of The Virtual Doctors continues Io SUFPOrt of the improvement of primary health care for rural communities. Our team in Lusaka have been working very ck)sely with the district health directors {DHDsl arKI din￿1 care offices ICCOS) of each district we work with in the process of change rnanage￿nt to ensure they take on more responsibilty for the OPerat￿nal oversight of the Virtual Doctots seivice in their Districts as well as training new COS onlo the Virtual Doctors telemedicine platfo￿. The team mnitor the numter of ¢ases and the number of COS onsulting on the platfomi weekly. They share the monthly performance data of each District with the DHDS and CCOS keeping them up to dale wrth the overall impact of the Virtual Doctors service in their Districts and where usage of the service 1$ low for example. They can follow up with their COS to understand and address any issues. Technical issues are passed onto the team in Lusaka to address and the team continue to run a dinical offr￿r and CCO support groups for both tech troubleshooting and solidarity building and sharing of non-case specfft medical discussions. 2. Operational Challenges Our resolve has been tested but remains undaunted. However, some issue$ have been beyond our control.. Concems around Covid in Malawi set back considerably the eXpans￿)n of our service in Malawi. We had planned to commence expansion into 56 health faciltties in the Cenlral Province of Malawi this year, h¢)wever, this will now be ommencing in early 2022. • We had planned field visits to all the he2￿h faalthes we SUPFth in Zambia, however, these were put on hold as Covid infection rates increased in Zambia and our Zamts'a board took the deCis￿n to restrict slaff travel outside of Lusaka until infects'on rates dropped in keeping with Zambian 9ovemrrtht gumdelnes. We are having some g¢x*J conversations potential new partners. including h .'Ilwww.n50 ect.o and lobal that we believe can help us lo put our service into deeFer parts of Africa where data signals are poorer and eleclricity scarcer. These should start to see frurtion in 2022. 3. Clinical Officer Innovation - Healthcare show and tell sessions (HCST) The HCST sessions ran until the end of October. We had a 60% turnoul rate of COS taking part as well as several CCOS. This is where clinical offi￿r5 showcase their refeThals. interad and share their knowledge with colleagues from other districts across the country as well as benefftb.ng from feedback from their peers and volunteer Doctors from Zambia and the UK. The Lusaka team hosted 13 Su￿ssful shows and plan to stsrt them again in January 2022. Participants look forward to the HCST because gives them an opwrtunity to leam beyond their telernedicine ¢on$ultations with doctors on how to better manage cases. Since users don't have access lo each other's cases {that are consulted orb via the telemedi¢ine appl, the HCST session helps them to see and beam about the condrtions their peers are handling in other di$tri¢ts. Some of the cases presented are very complex and new to the dinickqns. The HCST sessions grves them enotsjh to be able handle such cases when they are ￿nfrOnted ¥￿th them. It was dwing a case presentation about a breast abscess that dini¢ians leamt that they use k)cally sourced honey to clean the wound because 11 has great ants"septr properties and promotes healing. The HCST was also an opportunity for the team to encourage user5 to make better use of the telemedicine service for earty treatrnent and dBgnosis of cnmplex patient condrtKJns. 4. Technology update Our volunleer tech developmenl team has been Y40rknng- harder Ihan ever- w) preparation for the handover to the Zambian MOH, more specifically to engineer the telemediune app to be available via Google Play so that COS can download it on their per$onal devi￿$. The team carried out a survey of the ownership of smartphones by COS with 90tr￿ of respondents stating.they owned a smartphone. If we can achieve a shfft from the provision of smartphones devices to providing the telemedtine app direety to COS own devices for future expansion il will not only save us considerable costs and logistical challenges of maintaining and replau'ng fauty devtis, but it will allow considerable scaling up of the service. In 2022 our work with Johnson & Johnson means that our technw can be up3raded and scaled to se￿e existing and futsJ￿ countries for expansion. 5. 2021 Independent Monitoring & Evaluation Results In 2020 the Chalker Foundation for Afrlca kindly provided the finan￿ for the VDrs to conduct a professional and comprehensive Monitoring and Evaluation IM&E) study of the sery1￿. The Impact Evaluation was developed to assess the extent lo whth the VDrs Servi￿ was Re￿Vant. Effective, Efficient, Impacfftjl. and Sustainable. Study Populations included Primary and Secondary Beneficiaries. Front line health care workers (FHCW) were the top recipients ofthe eValuat￿n. and these included OHDS, CCOS, COS, and nurses. Patients We￿ also Intervitrwed. Thts is a of the results. Programme Relevance Overall, the study found the Wirtual t)octors NDrsl servti to be extremety relevanl to humanity's needs. part￿uladY in improving human health. The service was deemed well-aligned wth national and global instruments on E-Health. inequality reduction, and high-quality Primary Health Care IPHCI services. The common occurrence of a lack of diagnostic equipment. qualified staff. and technology underscores the need for programme implementation in Su Saharan AfrKa. Programme D•mand There is sufficient demand for the VDrs servtt. according to nearfy all the respondents. Non-participaling Health Care Workets {HCWsl inquired Ilhe bulk of which were not recorded) aiM)ut joining the Servi￿, indicating a high level of interest. Further. nearly all the resFondents feel other govemments other than Zambkg and Malawi should adopt the VDrs programme, thereby demonstratsng the services usefulness once again. The number of community members who used the service in the year 2020 aknne demonstrated demand. In the period under evaluation. the programme assisted 2,977 communty memters. It is reasonable lo assume that the sarrE number of ¢ommun'ty members lineluding their dependents) would suffer from ill heallh or wovse rf the servKe were to be terminated. Programme Effecliveness Al least 93 percent of HCWS have improved their alxlty to diagnose drfficult and chronic cases through interaction with VDrs service, therefore showing effectiveness in this sector. Furtherff￿Ie. resulis show that 92 percent of HCWS consulted on the initiative, leading to the Ifealmenl of complex ¢hronic condtlions for approximately 2,918 communty members. Evaluation results further show that roughly 851 referrals lo distsnt hospitals were prevented lin the visited locations only, otherwise the figure is greater at the prc*3ramme ￿Ve1). Progromm• Impa¢t The service'5 imp&t has been positNe. At least 91 percent of Hcvls tsel￿Ve the program has aKled in the provision of high- quality Health Care in Zambia and Malawi. The impact was measured in temis of the number of su¢cessfvl consultations. client sats"sfaclion, and averted health care costs. Based on successful consultats'ons. a 1cvJ% impact was rea￿zed. From the perspective of the Hcvts. all ￿￿nsUlta110fts were $u¢¢essful. Nevertheless, it was up to Ihe community memters lo follow the supplied advice and obtain the essential medication. which proved lo be dIff￿1t ￿ most cases. FUrtheftr￿re, 1CKI% of the patients were sats'sfied with the healthcare advice they received. They stated thal Ihey had been able to save resources by avoiding being referred and traveling vast distances to the hospilal. HCWS gained expert'se in dwnosing com*x chronic SrtUal￿n$, in addition to ￿eIng satisfied that they had assisted their pat￿nIs. Several srbjations were hKJhlighted as some of the cases that HCWS have learned to diagnose. including general rned￿.ne. neurology, gynae¢obgy, and paediatrics. 'amon9 others. The Mlnlslry of Health defined salisfaction as the abilty lo reduce referral cases to the dL8lrict hospital, which they asserted was being accomplished. 'We (the districl hospital) used lo receive SO to 100 referraL8 every week. putting a strain on our stsff and requiring a lot of resources. Wh￿ have now been redL¢ced to less than 10 thanks to the VDrs program.. stated the Katete district CCO in Zambia. This cx)rrment from the Kalete CCO demonstrates the wogram's importance. which cannot be emphasrled enough. Programme Sustainability The service is in the process of reinforcing rts sUstaina￿.1rtY in its eurrent operating countn'es. The evaluation highlighted how some acbons were implemented. esFeaally just before the period under investigation. These included holding meetings with the MOH & HQ to advO￿te for the programme. The VDrs board of directors. sustaina￿'lty aspiration is to have the programme ntegrated into mainstrean MOH of the countries in which we operate. Likewise, stakeholders. opinion of the programme's integration into the mainstream MOH in Zambia was 1LNJ% positive. Their rationale included the fact that the MOH is promoting E-Hea￿h through tts E-Heahh strategy. The govemment's willingness to inlegrale Telemedicine technolog*s is eviden￿ by the integration of other programmes such as the UnNersty Teaching Hosprtals ECHO health system. Concluslon8 from our M&E Study The VDrs service is making a signifKanl contributton to providing qualty PHC. reducing referrals, and reducing isolation in zamI￿a and Malawi. Overall, the study found that the Vors program is relevant. efficient, and effective. and that it has had a positive impael on the INes of HCWS and paI￿nts. While efforts lo mainstream the prograrn have begun. more work is needed in tem1$ of advocacy and extension into other sectors. The study also noted area$ of improvement for the service. Tumaround time of case consultaltons, being in constant onlact with the MOH. replacement of users 'devices when they become faulty, and Consol￿atIon of govemance manuals are some of the areas where the serV￿e needs improvement 6. Feedback from our Clinical Officers During the year we were also happy to receNe gry)d feedback from our benefwries on the impacl that our NHS volunteers knowledge and exFertise is having on their INes and their pat￿nts. Here are just a few comments that highlight our work. Musampl Zulu. registered Nurse at Kabunda Rural Health Centre in Mansa Di$titt, LuapuLa province .1 remember Seeking consultation on this platfomi on how lo manage a pattnt who came in with pus discharge from the nose which was foul smelling. Previously the patient was put on various medication wh￿h included antifungals and both oral and intravenous antibiotics. despite being on that treatrnenl regime, the patienl's condition did not irnprove. But after consulting the Virtual Doctors platfomi I was advised to start the patient on doxycycline which was to be given 100 mg onee a day for 6-weeks and to do nasal washoul wth nomal saline or salty water. After using those re¢ommendatson$ from this platfomi. the patient is now fine. Thanks to Ifirtual Doctrys platforn for the help.. Purity Wambinji, Clinical Nurse at Golden Valley Rural Health Centre in Chibombo District, Central provin￿. Purity has been in the service for 4 year$ and a VDrs benekiary since March 2020. She is currenlty working in all departments at her facility such as OPD and MCH be¢ause she's alone. ￿en asked a￿ut the imwrtance of the service and her experience consulting on i( this 1$ what she said... 'The virtual doctors services helps Me to gain more kntywledge arKI understanding on how lo manage condits'ons that I have little or no knowledge about. espeoally that l am alone at my faa"lty. indeed the servti is imp)rtant, I rernember seeking ¢onsultatDn on how to manage a pattent who came with comFlainls of foul vaginal dI￿harge which wa5 long standing, gravindex was negative and she had used several anbfungal Med￿tiOnS before but not responding to treatment. after consutb.ng from the VDrs I was guKled on to manage the ¢onditron and type of counselling to give the patient, after followng the advice I was given, the pat￿￿1 is now completely fine. l am appreciating the VDrs for the selfless support that they are offering to us health providers and the Zambian Communrty at large.. Joel Buleya. Registered Nurse at Luili Rural Health Centre in Mumbwa Distrrt Central Provin￿. °A few months ago. I had an opportunity to attend to a paknt who h￿1 Ma￿ urethral discharge for a long perh)d of time. and I had to give him some antib￿lIC$. but the problem coukln't resofve. So, I had to consult from the Virtual Doctors platform and I was advised lo pul the pat￿nt on tn.ple therapy and ￿ftriaXone injection. later on I had an opportunity to review the patient and he was completely healed.. thanks a k)1 to the Virtual Doctors for the wonderful Sponses they have been giving on the platlonn." 7. Our NHS Volunteers We have welcomed 34 new medical volunteers into our ranks since the beginning of the year. As of November 2021, patient cases from Zambia and Malawi are now handkd by more than 240 volunteer doctor5 across the UK, covering 25 medKal specialit￿. The virtual community platform SFack has recently been introduced to improve the way we connect ￿ volunteers, $0 they can interact wth each other and share interesting learning p)ints and inf¢)m)ation. All of the volunteer doctors receNed a COVID utxjale in the middle of October and are awa￿ of what to do rf they are referred a rAential COVIO case through the VDrs system. The Medical Team have successfully recruited several ENT consultants and have also been targeting paediatricians, obslelricians. gynaecologisls, and sexual health spectalists. They are worknng to mobilise more volunteers for the medical specialties that need more Doctors. This has been harder because of the added demands placed uFon all NHS staff with the ongoing pandernic. Imih expansion and growing case numbers come an urgent need to rKruit rrL)re volunteer doctors. We appreciate this challenge as a collateral of growth and extend our heartfeft gratitude to the Virtual Doctors okl and new who make our telemedicine service possible. We know that from our M&E study and talking to our advisors thal the COVID pandemic and technok)gy adoption curve and iys asscciated drop off wll put pressure on case numbers aThl volunteer numbers in 2022. More than ever. we want to thank our volunteer doctors for their indefatigable support at an unprecedenlly challenging lime for the NHS. They are the ba¢kt4)ne of our free telemedicine service.. we could not bring it to rural communrties without them. Two final year Cambridge University medical students have been taking their ele¢tives with us. In a normal year. final year medical students often take up the opportunity to travel abroad for their ele¢ts"ves, which has not been possible under current Covid travel restr￿lon. Ovr med￿al Govemance team focused their ethtives on supporting our research and education projects for zaM￿a and Malawi. One of Ihe students. Moe Takenoshits, embarked on a research project on infeCt￿U5 diseases mentored by Dr Graziella Quattrocchi from our Medical Govemance leam & Dr Davhl Hettle an infectious disease consultant and a VDrs volunteer d(xtor. Moe's paper is on antimicrobial resistsnce (AMRI and is titled. Antibiotic prescribing practtes in primary healthcare in sub- Saharan Africa-. A systematic review and our experience on the use of telemedicine in Z3mbia'. The paper has been accepted by the British Society for Antimicrobial Chemotherapy and was presented at their annual conference in London on Decernber 10th. The team abo hope to publish the paper in a medical journal or similar. io In 2022 our leam are planning to worf( very Close￿ Wbth our NHS volunteers and Clinical Officers to look at cases submitted, active users and further support needed in 2022 to see rf we can slow this down and further grow our impact. 8. Key Financials Our palient cases revieV￿d increased to 3142 in 2021 which was our highest number ever and was up 5% on 2020 levels. In the context of this and l(JJkirnJ to fuel further investrnent in 2022 and beyond in impact her8 are how the linancial supported our v￿rk. Our generated income increased by 156% between 2020 and 2021 fram (£304.845 to £475.937). This was mainly due to the Johnson & Johnson Citizenship Foundation furrfling our project to enhance our lechnology plattorm arKI thus improve our technology to seNe our beneficiarles in Zambia, Malaw and beyond. The Cost of Fundraising reduc&1 from 26% in 2020 to 1￿ in 2021 because of hard work from the team to secure further funding. Both are well within gocmj pr¥tice for chartties looking to furvj medium teryD expansion plans. The cost of running our semce got more effictent in 2021 as we wothed every more virtually between our teams and our volunteers and beneficiaries to d6ploy our serrfice. In 2020 we invested £232.261 in our seprfice (Excluding Fundraising) and in 2021 this reduced to £141.682. Going Into 2022 we have £451.344 to invest in our mission of which £357,482 is reserved expansion in Zambla and Malaw representing 71% 01 our funds available. As at 31 December 2021 the tharity's free reserves are £93.862. The ReseNes Policy currently recommends the holding of free reserves greater than 26 weeks bul less than 52 weeks of operation. This policy will be reviewed at regular intenrfals to ensure it is adequate arKI may be inue&8ed in the future rf the Trustees deem appropriate. This report has been prepared in accordance with the speoal provisions of Part 15 of the Companies Act 2006 relating to small companies. Approved by order of the board of trustees on ..z6.fv)...w￿..￿.Z￿J228nd s￿ned on its behalf by.. J. lof David Callcott - Trustee li INDEPENDENT EXAMINEfS REPORT TO THE TRUSTEES OF THE VIRTUAL DOCTORS Independ•nt examinerfs report to th• trustMs of Th• VI￿1 Do¢tovs Ilhe Company? l ￿pOrt to the charity trustees on my exaThnalir￿ of the accoLnts of ihe c￿￿)￿Y for the year ended 31st Decenknr 2021. Re$ponsibilitie$ and basls of rnport As the tharivs Iwslees of the Ctxrymny (arml also its directors for the purposes of (yjmpany lawl you are responsible for the preparation of the a¢¢rAwts in •)>ydaw wth tlle rewirmwts of the Companies AL* 2C(6 (Ihe Ad). Havff￿ sth.sf￿d mysetl Ihat the a¢count$ of the Cwpary a￿ rKrt reqll￿ to be audited Part 16 of the 2￿6 Act aThJ are eligible for independenl exam1r￿1￿. I repJl in respe¢i of my exaftMnat￿ of your char￿$ a¢¢ounls as ¢anied out under section 145 ol the Charities Act 2011 1.the 2011 A¢t'l. In carryin9 out my examination I have folbwed the Dicections gwen by the Charity conTr￿On under section 14515} Ib) of the 2011 A£t. Indopgndent •xaminerfs slatement Since y￿1 ¢harrfY$ gros$ i￿)Me exceeded £250.IKMI your eXa￿￿ne[ rThJ5t be a wwEmber of a h'sled body. I can confirm that l am qualffied to undertake the eXamina￿n bècause l am a registered Men￿er of FCAwhich 1$ ¢)ne Lrfthe listed bodies. I have ¢ompleted my examination. I confrn) that no matters have corrE lo my attentthi in connection wrth the examination giving n* ¢ause lo telieve". accounting rec4Jrds were Tr)t kept ￿ re¥*d of Il* C¢)mparry as reqwed by sedion 386 of the 2006 the accounts do rtt)l a¢¢ryd ¥rith those records.. or the accounts do not comply with thè accountin9 rerylrements of *ion 396 ofthe 2C(6 Act other than any requirement that the *￿nIS give a In* and fwr vw whth 1$ rnt a nwiter (x)nsidered as part of an independent examinat￿., or the accounts have not been wepared in a)￿rdance with the methods an(J pwinciples of Statement of Recommended Practice for accounlin9 and reF*xts'TrJ by charrtVè5 lapFIKabk lo thar111￿ preparing their a¢￿nts in accordar￿ with th8 FinanL?al Rewting StaTrJard applicable in the UK arKI Rewbh"c of Ireland {FRS 10211. I have no concerns ar￿ have ¢ome a¢rass no other matters in conr*chon with the examination to wh￿h attention should be drawn in this report in cyder to enab￿ a woper under$landiny of the a(￿Unts to be Ann8tte Watson PhD Bsc FCA FCA Parkers Comelius House 178.180 ChLxch Ro￿1 Hove East Sussex BN3 20J Oale-. 12 THE VIRTIIAL DOCTORS STATEMENT OF FINANCIAL ACTMTIES (INCORPORATING AN INCOME ANO EXPENDITURE ACCOUMT) FOR THE YEAR EMOED 31ST DECEhlBER 2021 2021 Totsl fvnd$ 2020 Total funds fvryts INCOME AND EIIDOblTIEPWJ FR Ocnation$ a￿1 legacies 1U7ni 351,167 47S,937 Irwestm￿l irKon 25 Totsl 3$1167 EXPENI)rruRE ON Raisir@ funds 65.334 65.334 78.815 Charitable •¢bviti•s Virtual Dc£tors Servi 78.138 Total 311.076 NET INCOhlEI(EXPENDITURE) m.029 268,951 16,206) RECONCILIATION OF FUNDS Totsl lunds brought fonward 181393 188.599 TOTAL FUNDS CARRIED FORWARD 182.393 The notes forn) part of thes¢ financial statements Page 13 A AIV THE VIMIAL DOCTORS BALANCE SHEEr 31ST DECEMBER 2021 06Pg fOS9 2021 2020 FIXED ASSETS Tangible assets 1,106 888 CURRENT ASSErs Debtors Cash at bank 4,105 180,874 463,847 184.979 CREDITORS Amounts falling due wilhin year I3,￿9) 13.4741 NET CURRENT A8SErs 181,505 TOTAL AS8Efs LESS CURRENT LIABILITIES 461,344 182,393 NEf ASSErs 182 393 FUNDS Unrestricted fvnds Restricted fvnds 10 93,862 367 482 97,940 TOTAL FUhf•S 182 393 charitable company is entiued to exemptim fron audit under Se¢bon 477 of the Compantes Act 2CM16 for the year ended 31st Decemtér 2021. The members have not required the company to obtain an audii of its ffftancial staternnts for the year ended 31 st December 2021 in accordance Section 476 ofthe Companies Act 20c￿. The trustees acknowledge their respon%bilittes for ensuring that Ihe charitabk company keeps accounting records th* com*y with Seclions 386 and 387 of the Companies Act 20C* and Ib) p￿paring financial statements which grrfe a true and fair vpw of the st*e of affairs of ts charitable company as al the end ol each financial year and of its surplus or deftFI for each financial year in accordan￿ with the requirements of Sections 394 and 395 and which otheThvise comply with the requirements of the Compan￿5 Art 2006 relating to fmancial st*ments. so far as applicable to the chatitable (￿1pa￿. These financial statements have been prepared in a￿rdance with the provisions appluble io charitable companies subject to the small companies regime. The finanaal statements were apwoved by the Board ol TnJstees ar￿ authorised lor issue on SO9.E￿..￿￿.. 20ZL and were signed on its behaw by.. David Callcott- Trustee The notes forni part of these financial staternents Page 14 ThE VIRTUAL rK)CTORS NOTES TO THE FINANCIAL STATEPAENTS FOR THE YEAR ENDED 31ST DECEMBER 2021 ACCOUNTING p(￿￿lEs Basis of preparing th• ffinancial slatements The financial ststements of the chariiabk conyany. whth is a benefit entty uTrJer FRS 102, have been prepwed in aco)rdance with the Charibes SORP (FRS 1021 'A¢counting * ReF*)rting by Charities.. Statement of Recxynn*nded Pr#cli¢e to ¢h8ril*s wepariny I￿"r accounts ' a¢¢ordance with the Financkal Report￿￿ Standwd ap￿ica￿e in the UK and RepublK of Ireland IFRS 1021 (effedive 1 January 2019),. Financial ReFKJrting Standard 102 The FInar￿la1 Reporti'ng Standard 8Fph"cable in the UK Republic of Ireland. and the Companies 2(￿. The finanaal statements The ¢haritable ¢oryany has taken advanlage ofthe folbwng disclosure exempts'ons in preparing these financial slateTh*nts. a5 perrrmtted by FRS 102 The Financial Rer19 Rèsponso Fund Avp DevelowrEnt Fund 1C(JO Club 12&476 134.081) 12.S81) 112.000) 14,000) 12.1)00) 123.4761 134.081) 315.586 318.167 11000 12,0001 TOTAL FUNDS 475 967 207 016 Page 18 continued... THE VIRTVAL OWORS IIOTES TO THE FINANCIAL STATEMENTS - continued FOR THE YEAR ENDEO 31ST DECEMBER 2021 10. MOVEMENT IN FUNDS . ¢<*rtlm*d Comparativ•s for m0ven￿ In funds Net At 111r20 in funds 31112r20 Unrestri¢tod fund$ Gewal furKI 146.434 {48.4941 97.940 Restri¢ted funds MonrtOTing Re￿rt F￿ Zambia EXpwsI￿ FLVKI Malawi Pilot Fund Bursary Fun pp Developrrwl FLThJ 23,476 11,f64) 17.796 180 2.500 23,476 36,597 21,219 3.423 42.165 42.288 84.453 TOTAL FUNDS 182 393 Incoming Resources resources expended Movement in fuTrJs Unrestrict•d fund5 General fund 127.694 {176.188) (48.494) onrtorin9 ReFort Fund Zambia Expansi￿ Fund Malawi Pilot Fur Fundraising Consuttancy Fur¥J Bursary Fund COVID-19 ReSpOr￿e FUTr App Development Fund (6.5241 (66,%J41 23,476 11.e641 17.796 64,840 17.7 12.COJ (12,CXJ)I 42.360 10.( {42.360} 177.176 134.888 42,288 TOTAL FUNDS 304,870 311,076 6,206 Pa8¢ 19 continued... THE VIRTUAL DC£TORS NOTES TO THE FINANCIAL STATEMENTS - continued FOR THEYEAR ENDED 31ST DECEMBER 2021 11. RELATED PARTY DISCLOSURES There were rm) related p•ty trans•kn the ye* erM1ed 31st Decen*w 2021. Pag¢ 20