BMA slams 'confusion, chaos and failures' behind misdirected clinical letters

GP leaders have blamed confusion around the outsourcing of NHS primary care support services to Capita for thousands of items of clinical correspondence being misdirected.

NHS England continues to receive between 5,000 and 10,000 items of clinical correspondence a month that have been sent in error by GP practices to Capita, according to a report by the National Audit Office (NAO).

Under rules introduced in May 2015, GP practices that receive clinical correspondence that does not relate to patients on their practice list are meant to return it to the sender. This marked a departure from previous arrangements, under which practices passed this data to their local primary care support service for processing and redirection to the correct practice.

The GPC says NHS England 'has still not launched an effective information campaign aimed at GPs' despite continuing confusion among practices two years after the rule change. And despite thousands of letters continuing to be sent to Capita, the private provider's primary care support contract does not require it to redirect letters.

Clinical data

Uncertainty over how practices should handle clinical correspondence sent to them by mistake was compounded by changes to processes and problems with primary care support since Capita took over from previous providers from April 2016, the GPC says. 

The NAO report comes just months after MPs criticised NHS England's 'lack of grip' on problems that left hundreds of thousands of unprocessed letters needing triage to confirm whether patients could have been harmed.

A national incident team set up by NHS England has now 'identified and clinically reviewed' 373,000 items of clinical correspondence that had not been processed. Almost 19,000 were sent to GP practices for review, and more than 8,000 that related to patients who did not have a GP or who had died were reviewed by the central team, the NAO says.

GPC chair Dr Richard Vautrey said: 'It’s no surprise that with the now longstanding confusion, chaos and failures of these support services for general practice, that a small number of practices may have, in good faith, sent on misdirected correspondence to the Capita/PCSE service, particularly as this would have been the normal arrangements before NHS England tried to cut costs by commissioning this service two years ago.


'What is clear from this investigation is the inability of both NHS England and Capita to get to grips with a problem they have now known about for years.

'Capita itself admitted it failed to officially disclose the scale of the backlog to NHS England in good time, and both are yet to decide whose responsibility it is to return records to the right practice.

'Further, NHS England has still not launched an effective information campaign aimed at GPs, despite continuing to receive misdirected correspondence almost two years after it became aware of the problem.

'This is a further indictment of Capita’s shambolic running of GP backroom services and the real effect its failings are having on the safe care of patients.'

An NHS England spokeswoman said: '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.'

A spokeswoman for Capita said: 'As the NAO report states, Capita has no contractual responsibility for redirecting clinical correspondence. Capita informed NHS England in May 2016 that there was a problem with an unquantified accumulation of clinical notes.

'In October 2016, Capita then formally reported the incident to NHS England and has continued to report on the issue. NHS England has not yet finalised its process with Capita for handling any correspondence that Capita receives in error.'

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