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GP back-office privatisation 'put patients at risk'

Doctors call for Capita to be stripped of contract to run primary care support

Mark Gould

Thursday, 17 May 2018

In a damning report* on the £330 million contract to outsource primary care back-office support services to the private company Capita, the National Audit Office (NAO) says that NHS England should consider taking some or all of the work back in-house.

The NAO says failings by Capita and other organisations, hit primary care services and, potentially, put patients at risk. Duties transferred to Capita under the seven year contract to run Primary Care Support England (PCSE) which commenced in 2015 included sending out test results, moving patients' medical records, processing patient registrations and paying GP practices.

The report reveals that 87 women were notified incorrectly that they were no longer part of the cervical screening programme, and that delays in processing new applications to the national "performers list " led to an estimated 1,000 GPs, dentists and opticians being delayed from working with patients and some of these practitioners lost earnings.

While no actual harm to patients has been identified the NAO added that failure to update "performers lists" may also have compromised patient safety in cases where practitioners should have been removed.

The NAO concludes that NHS England and Capita misunderstood the risks of the deal resulting in services to 39,000 GPs, dentists, opticians and pharmacists "that were a long way below an acceptable standard".

The BMA’s GP committee has written to NHS England’s chief executive, Simon Stevens, urging him to explain how he intends to address the issues highlighted in the report.

Dr Richard Vautrey, BMA GP committee England chair, said: “For the last two years the BMA has repeatedly pressured NHS England to urgently address the problems with PCSE delivery, and now that the NAO have so clearly backed our concerns we hope this assessment of its failures will finally make NHS England and government sit up, listen and act.

“Earlier this year our members called for elements of this service to be taken back in-house, and this report is now recommending the same. With this as an option, we are now asking NHS England how it plans to resolve the shambles that is Capita’s running of PCSE."

NHS England aimed to reduce its costs by 35% from the first year of the contract and provide a high-quality and standardised service. Capita expected to make a loss of £64 million in the first two years of the contract, which it planned to recoup in later years.

To date, NHS England has deducted £5.3 million from payments to Capita as penalties for poor performance but it expects it may have to pay up to £3 million in compensation to primary care providers.

The NAO says NHS England’s decision to contract with Capita both to run existing services but also simultaneously to transform those services, was "high risk". Capita was incentivised through the contract to close existing services to minimise its losses but the interaction between running, closing and transforming services was more complex than Capita or NHS England had anticipated.

Problems emerged in 2016 shortly after Capita started closing primary care support offices and making other changes to the service. Capita acknowledges that it made performance issues worse by continuing to close support offices in summer 2016 even though it was aware the customer service centre was struggling to meet demand at that time. However, NHS England was contractually unable to stop Capita’s aggressive office closure programme, even though it was having a harmful impact on service delivery.

Users continue to experience poor delivery with seven severe service failures in February 2018. A number of organisations have contributed to underperformance as Capita relies on other organisations to provide some services.

The NAO recommends that NHS England should determine whether all current services within the contract are best delivered through that contract or be should taken in-house by NHS England.

Amyas Morse, the head of the NAO, concludes: “While NHS England has achieved financial savings and some services have now improved, value for money is about more than just cost reduction. It is deeply unsatisfactory that, two and a half years into the contract, NHS England and Capita have not yet reached the level of partnership working required to make a contract like this work effectively.”

Professor Helen Stokes-Lampard, chair of the Royal College of GPs, said: "The long list of failures made by Capita have been incredibly frustrating for GPs and our teams, and we are still dealing with the fallout - including a significant additional administrative burden - at a time when practices are already working under intense resource and workforce pressures."

An NHS England spokesman said the transition, "while not without its difficulties", had saved £60 million which had been reinvested into frontline care, funding the equivalent of an extra 30,000 operations.

A Capita spokeswoman added: "The report notes that several organisations and legacy issues all contributed to underperformance.

"It has been acknowledged that performance has improved and Capita will continue to work with all parties to address the small number of remaining service issues."


*NHS England’s management of the primary care support services contract with Capita. A report prepared by the comptroller and auditor general, NHS England, 17 May 2018.

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