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Capita primary care outsourcing was ‘shambles’ say MPs

Call for NHS England to rethink outsourcing

Adrian O'Dowd

Thursday, 26 July 2018

NHS England’s decision to outsource primary care support services to Capita Business Services Ltd (Capita) was a “shambles”, according to a report* by MPs on the influential parliamentary public accounts committee.

MPs described NHS England’s decision as a “short-sighted rush” to cut by a third the £90m it cost to provide these services regardless of the impact it would have on the 39,000 GPs, dentists, opticians and pharmacists affected as well as potentially putting patients at risk of harm.

Primary care support services provide a range of administrative and back-office functions to GPs, dentists, opticians and pharmacists and include:

  • administering payments to GP practices, opticians and pharmacies
  • administering the pensions of GPs
  • administering confirmation that GPs, dentists and opticians in the NHS are suitably qualified
  • sending out letters for those eligible for cervical screening
  • processing patient registrations and de-registrations.
In August 2015, NHS England entered into a seven-year, £330m contract with Capita to deliver primary care support services, now known as Primary Care Support England.

NHS England aimed to reduce its costs by 35% from the first year of the contract and create better quality support services that were more efficient and easy to use.

The new report details how failure to deliver services led to disruptions and extra costs for doctors, dentists, opticians and pharmacists.

Capita’s failures to deliver back-office functions resulted in approximately 1,000 GPs, dentists and opticians being delayed from working with patients, and some lost earnings as a result.

The failure to update “performers lists” (confirmation that practitioners are still suitably qualified to practice) also potentially compromised patient safety in cases where practitioners should have been removed.

Stakeholders had raised concerns about missed and inaccurate payments to practitioners, a backlog of half a million patient registration letters and failures to deliver medical supplies.

The committee’s MPs have recommended that NHS England should write to them by January 2019 setting out what they have done to compensate primary care practitioners for the disruption.

In addition, delays in moving medical records impacted patients’ ability to access necessary care, and 87 women were incorrectly notified that they were no longer part of the cervical screening programme.

A review by one of NHS England’s medical directors in December 2016 noted that the failures had the potential to put patients at risk of serious harm.

MPs acknowledged that Capita had apologised for its mistakes and said they would hold it to its commitment to improve services over the remaining life of the contract.

Neither NHS England nor Capita understood the service that was being outsourced, and both misjudged the scale and nature of the risks, the report concludes.

Committee chair Meg Hillier said: “NHS England made a complete mess of what could have been a responsible measure to save taxpayers’ money.

“It is clearly unacceptable that poor procurement should put patients at risk of harm and undermine the ability of GPs, dentists, opticians and pharmacists to do their jobs.

“NHS England needs to rethink its approach to outsourcing and invest time in getting its contracts right. That means listening to concerns from the frontline and properly considering the impact changes will have on services and public health. But it also means establishing an effective relationship with the supplier.”

Dr Richard Vautrey, BMA GP committee chair, said: “It is only right that the committee be so damning in its assessment of Capita’s running of the PCSE contract. The programme has been run woefully and negatively impacted patients, services and GPs.

“GPs experienced two years of chaos as a result of this contract. It’s clear that Capita were incentivised by the contract awarded by NHS England to close support offices and cut staff as quickly as possible regardless of the problems that were quickly developing. Prioritising money over services has been very damaging for general practice.”

A Capita spokesperson said: “Capita has apologised for unacceptable failings in relation to the initial delivery of this contract. We are now meeting the vast majority of key performance targets, and have put in place a new governance arrangement with NHS England to ensure improvement continues.”

*Supporting Primary Care Services: NHS England’s contract with Capita. A report prepared by The Committee of Public Accounts, July 2018.

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