Some GP practices have not received their training grants, and have been forced to cover the shortfall from their wider budgets. Those that employ trainees directly have 'often' not been reimbursed by Primary Care Support England (PCSE) - the service run by Capita - and have been forced either to cover the costs out of practice funding meant for patient care, or to leave trainees unpaid for months, a letter from GPC chair Dr Richard Vautrey to NHS England chief executive Simon Stevens warns.
Many GPs have reported problems with management of the performers list, with significant delays in updating lists leaving them unable to work - in some cases for months at a time, the letter warns.
'Significant delays and faulty processes in both registration and patient removals' are affecting both patient care and cashflow for practices, the letter adds, with patients being inappropriately called or recalled for vaccination and screening.
Patient record transfers
Transfers of patient records continue to be problematic, Dr Vautrey explains, with 'significant delays' for reasons including a shortage of labels supplied to practices, and cases of patients' records 'going missing'. The letter warns that the loss of patient records 'raises alarming questions about potentially compromising patient safety; this is not acceptable and must be resolved immediately'.
Concerns are also raised in the letter about ongoing problems with administration of pension payments for GPs, with PCSE having no record of pension contributions made by some doctors.
Problems with other payments have also continued, with practices denied payments for some services or unclear what payments they have received are for.
Capita has rejected responsibility for many of the problems raised by the BMA, warning that the BMA letter 'does not accurately reflect our involvement and responsibilities in PCSE'.
GPC workforce lead Dr Krishna Kasaraneni said: 'PCSE services remain far below the standards the public should expect. Despite some improvement after sustained pressure from the BMA, unacceptable problems persist in the processing of salaries for GP trainees which have resulted in some doctors not being paid on time. This is not only distressing for the individual involved, but it often forces GP Practices to dip into overstretched budgets meant for patient care in order to pay their staff.
'There are also worrying doubts about whether the new cervical screening service can be effectively delivered. Patient care and safety continues to be damaged by delays in keeping patient lists up to date.
'This combination of flaws is placing further strain on overstretched GP practices which should be focused on providing care to patients. We need NHS England to step in and make sure back office functions provide the support that GPs need to deliver effective, high quality care to the public.'
Concerns raised by the BMA come just a week before the England LMCs conference in London, which will debate calls for the GPC to demand that primary care support functions are taken back in-house by the NHS.
NHS England said: 'We are holding Capita’s feet to the fire on needed improvements, and in the meantime, the lead employer for Health Education England or the GP practice are responsible for paying their GP trainee salaries and are subsequently reimbursed for this. Backlogs are being prioritised by Capita.'
GPonline reported last month on problems with the PCSE services highlighted in a letter from Derby and Derbyshire LMC to NHS England, which echoed many of the concerns raised by Dr Vautrey.
A spokeswoman for Capita said: 'This is a major transformation project to modernise a localised and unstandardised service, which inevitably has meant some challenges. This letter does not accurately reflect our involvement and responsibilities in PCSE, nor does it reflect our recent correspondence from NHS England who have recognised the improvements and significant progress being made across services in 2017, which has been demonstrated through improved and increasing customer satisfaction.
'We are continuing to transform locally managed operations into a modern and efficient national customer-focused service for NHS England and all primary care organisations.'