Outsourcing primary care support to Capita was a 'shambles', say MPs

NHS England's decision to outsource primary care support services to Capita was a 'shambles' and potentially put patients at risk of serious harm, MPs have said.

(Photo: iStock.com/majaiva)
(Photo: iStock.com/majaiva)

In a report published on Wednesday, the public accounts committee said that NHS England’s ‘short-sighted rush to slash by a third the £90m it cost to provide these services was heedless of the impact it would have on the 39,000 GPs, dentists, opticians and pharmacists affected.’

The committee told NHS England to write to it by January and explain what it has done to compensate primary care practitioners for the disruption caused. 

Its report revealed that 1,000 GPs, dentists and opticians had been delayed from working with patients due to problems with processing new applications and making changes to the performers' list.

NHS England is assessing an incident to see if there has been actual patient harm, the report said. Meanwhile, delays in moving medical records affected patients’ ability to access care, while 87 women were incorrectly notified that they were no longer part of the cervical screening programme. There had also been ‘inappropriate handling’ of patients on the violent patients' scheme.

Neither NHS England nor Capita understood the service that was being outsourced and both misjudged the scale and nature of the risks, the committee said.

The report added that they ignored many of the basic rules of contracting and when problems emerged they did not do enough to stop the issues getting worse. Rather than resolving problems, NHS England and Capita have spent ‘too long disputing basic elements of the contract and are still in disagreement over future payments’.

Many of the performance indicators set by NHS England were focused on speed and efficiency rather than quality. The report said that the performance measure for payments to GPs assesses whether Capita is making payments on time, not whether they are accurate.

Risks to patients

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.

In May, GPC chair Dr Richard Vautrey wrote to NHS England chief executive Simon Stevens urging him to bring parts of the primary care support service outsourced to Capita back in-house.

The public accounts committee acknowledged that Capita had apologised for the failings, but said that it would hold the company ‘to its commitment to improve services over the remaining life of the contract.’

As part of its recommendations, the committee said that in future NHS England must ensure that basics ‘such as appropriate mechanisms to intervene in service changes if they do not go as planned, are part of any contract’. It should also assesses the likely impact on users of a service before outsourcing.

The committee asked NHS England to report back to it by January 2019 with an update on whether there is evidence of any harm to patients and explain how it will improve future contracting. Both NHS England and Capita have also been told to inform the committee of how their working relationship has improved.

The report echoes findings of National Audit Office (NAO) investigation earlier this year, which found that NHS England’s decision to outsource primary care support services was ‘high-risk’ and left patients in serious danger of harm.

'Complete mess'

Public accounts committee chair Meg Hillier said: ‘NHS England made a complete mess of what could have been a responsible measure to save taxpayers’ money. It is clearly unacceptable that poor procurement should put patients at risk of harm and undermine the ability of GPs, dentists, opticians and pharmacists to do their jobs.

‘NHS England needs to rethink its approach to outsourcing and invest time in getting its contracts right. That means listening to concerns from the frontline and properly considering the impact changes will have on services and public health. But it also means establishing an effective relationship with the supplier. The dismal fall-out here, with NHS England and Capita squabbling over details that should have been agreed in 2015, tells its own sorry tale.'

GPC chair Dr Richard Vautrey said that GPs had experienced two years of chaos as a result of the contract. ‘It’s clear that Capita were incentivised by the contract awarded by NHS England to close support offices and cut staff as quickly as possible regardless of the problems that were quickly developing. Prioritising money over services has been very damaging for general practice,' he said.

'The BMA repeatedly pressured NHS England to urgently address the problems with PCSE delivery. We hope this assessment of its failures will finally make NHS England and government sit up, listen and learn from past mistakes.'

A Capita spokesperson said: ‘Capita has apologised for unacceptable failings in relation to the initial delivery of this contract. We are now meeting the vast majority of key performance targets, and have put in place a new governance arrangement with NHS England to ensure improvement continues.

‘Capita is committed to delivering this contract and its vital purpose: digital transformation for NHS support services that were previously paper-based, fragmented and without national standards. We are focussed on delivering a 21st century digital service that works for NHS practitioners.'

An NHS England spokesperson said: ‘We will continue to work with medical professionals and Capita to resolve the historic issues which this look-back report reviews, but by making this change over the past two years, the NHS has successfully saved taxpayers £60 million, which has been successfully reinvested in frontline NHS patient care, funding the equivalent of an extra 30,000 operations.’

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