NHS England did not understand primary care support services well enough to set contract targets and failed to assess adequately the risk that Capita would fail to provide the service to a good standard, a report published on Thursday by the NAO warns.
The £330m contract awarded to the private outsourcing giant in 2016 did not contain performance measures for the full range of services Capita was expected to deliver, and NHS England had no contractual mechanisms to intervene in some service changes, the report says. The NAO warned that NHS England's ability to hold Capita to account remains limited because 'basic principles about the contract are still not agreed' - two and a half years after the contract began.
GP leaders said the decision to press ahead with outsourcing Primary Care Support England (PCSE) as part of a 'massive cost-cutting' exercise despite opposition from within general practice was scandalous. They warned that Capita's failings had increased the burden on GPs, left doctors unable to work during a chronic workforce crisis and put patients at risk.
GPonline has reported on delayed pension payments, problems with patient record transfers and delayed payments that have left practices facing cashflow problems among other concerns.
GPs are continuing to experience 'widespread failures' with primary care support, the NAO report warns, despite some recent improvements. It says that Capita 'underestimated the scale and nature of the task and the impact of closing sites and losing local knowledge'.
As part of its winning bid for the service, Capita said it would slash staff involved in primary care support from 1,390 to 314 to reduce the cost of the service by 69% - well above the 40% saving required by NHS England. While NHS England has 'largely achieved the financial savings it expected' - with £60m saved in the first two years of the contract - Capita has 'absorbed significant additional costs'.
GPC chair Dr Richard Vautrey hit out at 'two years of chaos' for GP practices, warning: 'This damning report lays bare the scale of the failures impacting patients, services and GPs due to this poorly thought-out and woefully-run programme delivered by Capita.
'That NHS England ignored the BMA’s serious concerns and went ahead with massive cost-cutting by commissioning Capita to take charge of PCSE – with the expectation that they’d have to strip resources to the bone – with no thought of the consequences is nothing short of scandalous.'
RCGP chair Professor Helen Stokes-Lampard said: 'This is a damning but fair account that highlights how NHS contracts have been awarded to private companies, such as Capita, for work that is substantially more complex than had been assumed, and that they have failed to deliver effectively as a result – with GPs, our teams and our patients suffering the consequences.
'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.'
House of Commons public accounts committee chair Meg Hillier MP said: 'Trying to slash costs by more than a third at the same time as implementing a raft of modernisation measures was over-ambitious, disruptive for thousands of doctors, dentists, opticians and pharmacists and potentially put patients at risk of serious harm.
'Neither NHS England nor Capita properly understood the scale of the challenge before agreeing the contract and are still in dispute over future payments. Yet again this is poor contracting by government with one of its major suppliers and it must learn lessons.'
Doctors in Unite chair Dr David Wrigley said the union was 'appalled but not surprised at the damning report'. He added: 'GPs have been saying for a very long time that the service from Capita is not fit for purpose, is impacting negatively on patient care and causing unacceptable administrative burdens for practices are already struggling with the unprecedented funding squeeze imposed on the NHS by this government.'
Dr Wrigley demanded that 'primary care support services should be brought back into the public sector immediately'.
A Capita spokeswoman said: 'As today’s NAO report concludes, the complexity of the support services being let by NHS England was not fully understood when the contract was signed.
'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 remaining service issues. We have accepted accountability for not meeting our high standards of service previously.'
An NHS England spokesperson said: 'While not without its difficulties, by making this change over the past two years the NHS has successfully saved taxpayers £60m, as the NAO themselves confirm. This £60m in lower administrative cost has all been successfully reinvested in frontline NHS patient care, and has helped fund the equivalent of an extra 30,000 operations.'