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GPs still mistakenly sending clinical correspondence to Capita

Around 5,000 to 10,000 items being redirected to NHS England every month

Caroline White

Friday, 02 February 2018

GPs are still continuing to erroneously send between 5,000 and 10,000 items of clinical correspondence to Capita, the current provider of primary care support services for NHS England (NHS E), confirms the spending watchdog, the National Audit Office (NAO) in a report* published today.

This is despite guidance issued by NHS E and the fact that Capita has no contractual responsibility for redirecting correspondence.

As a result, NHS E is now planning to mount an awareness campaign to ensure that GPs understand how they should handle correspondence for patients that are not registered at their practice, says the NAO.

The NAO report details its investigation into the events surrounding a cache of misdirected clinical correspondence, which followed NHS E’s admission to the Public Accounts Committee that it had discovered a backlog of 162,000 such items.

NHS E introduced new arrangements for handling misdirected correspondence in May 2015, which obliged recipients to return mail to senders to comply with legislation and NHS E information governance.

But between 1 June 2015 and 31 March 2016 an unknown number of GP practices continued to send clinical correspondence to their previous Primary Care Services (PCS) centres for redirection, says the NAO.

Capita told the watchdog that during this period, it operated procedures it inherited from the 36 PCS centres it was then managing. As these sites were closed under Capita’s PCS transformation plans from March 2016 onwards, Capita made an inventory of all records at each site and shared this with NHS E.

The inventories made reference to ‘clinical notes’ but no-one identified these notes as unprocessed clinical correspondence.

In October 2016, Capita formally reported the incident to NHS E, estimating that there were 580,000 items. Capita told the NAO that, with hindsight, it believes it could have reported the backlog sooner.

In November 2016, Capita and NHS E carried out initial checks on the reported backlog which identified an estimated 170,000 items of clinical correspondence.

NHS E considered the clinical correspondence to be low risk, and advised internally that Capita should return the correspondence to the relevant GPs. But it did not ask or contract Capita to do this, says the NAO.

By July 2017 Capita and NHS E had identified and logged 277,000 items. But NHS E paused the review in August 2017 after an information governance incident.

NHS E’s National Incident Team has now identified and clinically reviewed 374,000 items of unprocessed clinical correspondence. Most required no GP action to be taken, but NHS E identified 1,811 high priority items (such as documents deemed to be related to screening or urgent test results).

By 20 November 2017 NHS England had sent 18,829 items of misdirected clinical correspondence to the relevant GPs, so that they could assess whether there had been any actual harm to patients.

Clinicians within the National Incident Team reviewed another 8,343 items for patients that had died or didn’t have a GP.

“The key fact is that there is no evidence that any patient has been harmed by this, and by March every piece of correspondence will have been reviewed and refiled by GPs and the relevant NHS archive," commented NHS E.

NHS E plans to complete its clinical review by the end of March 2018, estimating that this will cost £2.4 million, which includes £0.3 million that it will pay to GPs once they have completed their reviews. It had been paying them in advance.

However, NHS E has not yet been able to stop GPs from sending clinical correspondence to Capita in error. It is therefore planning an information campaign to address this, says the NAO.

In November 2016 and January and March 2017 Capita continued to request guidance from NHS E on how to handle the correspondence it receives, prompting an interim process to be set up. NHS E has not yet finalised this process, says the NAO.

But NHS E has agreed a process for assuring itself that there are no more boxes of unprocessed correspondence in the archives. This was due to have been completed during January 2018, says the NAO.

*Investigation into clinical correspondence handling in the NHS. A report prepared by the Comprtroller and Auditor General, February 2018.

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