Mishandling of 1m clinical letters wasted millions and put patients at risk, MPs warn

NHS England's failure to communicate effectively with GPs about handling misdirected clinical letters has wasted millions of pounds and may have caused harm to patients, MPs have warned.

Parliament (Photo: iStock/majaiva)
Parliament (Photo: iStock/majaiva)

Between 5,000 and 10,000 items of misdirected clinical correspondence are being sent by GP practices each month to primary care support provider Capita, three years after a change of policy that meant they should simply mark it 'return to sender'.

NHS England was 'far too slow to treat the issue seriously and take action', according to a report by the House of Commons public accounts committee (PAC). Officials 'understated the problem' at an evidence session in parliament in October 2017 despite having been informed about the issue a year earlier by Capita, the report says.

Failure to tackle problems with handling of misdirected clinical correspondence received by GPs compounded an earlier backlog caused by mishandling of letters by NHS Shared Business Services - which forced practices to review hundreds of thousands of items.

Clinical correspondence

NHS England expects to spend £2.4m 'attempting to resolve misdirected correspondence because some GPs are not handling clinical correspondence correctly', the report says.

The damning report comes just weeks after the National Audit Office warned that NHS England's decision to outsource primary care support services to Capita in a £330m seven-year deal was 'high risk' and threatened serious harm to patients.

PAC chair Meg Hillier warned: 'NHS England was slow to tackle this incident with the regrettable consequence that many patients are still in the dark about potentially critical correspondence.

'Up to 2,000 cases are still to be assessed by NHS England; in at least two of those reviewed so far, harm to patients cannot be ruled out. Nor can the possibility of still more cases coming to light.

'There is a grim irony in the fact that a mass breakdown in communication should then be compounded by poor communication between NHS England and GPs.

NHS back-office systems

'Basic administrative efficiency should not be difficult to deliver. The systemic nature of this incident is a big concern and money which should have been spent on patients has instead been spent cleaning up the mess.'

The GPC called the report from MPs 'another damning indictment of NHS England’s inability to deliver basic administrative efficiency in back-office systems'.

GPC chair Dr Richard Vautrey said that given 'longstanding chaos caused by the outsourcing of GP support services' and poor communication it was 'regrettable yet understandable that some practices may have, in good faith, sent misdirected correspondence on to [Capita].

Dr Vautrey said: 'Ever since the scale of the problem became clear, the BMA has been pressuring NHS England to get an action plan in place, including a guarantee of proper funding for practices to deal with the resulting increase in workload. However, if NHS England had managed the situation properly then it would not have needed to spend £2.4m resolving the issue, and this could have been money instead spent on patient services and practices struggling with unmanageable workloads and bureaucracy.

'Overall this report underlines the need for NHS England to get to grips with a problem that has been disrupting general practice for years, and to introduce an effective system that guarantees safe and efficient care for patients.'

An NHS England spokeswoman said: 'In March 2016 NHS England established a team to review a backlog of clinical correspondence, reported at that time, by the SBS company. 'Since then, NHS England and the review team has worked closely with other GPs and contractors to review and assess 99.6% of SBS and primary care support correspondence issues, putting in place clear processes to ensure correspondence is redirected where necessary, without delay.'

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