By Tony Collins
A seven-year £330m contract signed by NHS England and Capita last September has run into problems.
The difficulties and complaints by GPs raise a question about how officials at NHS England considered it possible that Capita could save 40% in the first year, transform services for GPs, and make a profit – all concurrently.
Pulse reports that the true cost of NHS managers’ bid to save money by contracting Capita to carry out support services for GP practices is “now becoming clear”.
It’s emerged that NHS England expected Capita to help cut costs while contractors were learning the exact nature of the range of services they were contracted to deliver.
On 1 September 2015, Capita took on responsibility for the delivery of NHS England’s primary care support services for GPs. It included the transportation of paper-based records when patients move home.
NHS England’s vision was to create “modern, easy to use administrative and business support services, which are consistent across England and which help lower the administrative burden on primary care”.
NHS England asked Capita to look at cutting costs in year one by:
- Moving the delivery of all services from over 40 sites across England to three
- Opening a new national customer support centre for all customer queries
- Introducing a new online portal.
In a succession of articles this year Pulse, the magazine for GPs, says the outsourcing has led to some GP practices
– buying their own clinical supplies to continue running patient clinics
– not receiving payments they are due
– experiencing delays in the manual transfer of patient records
– reporting that they that they have been sent the wrong patient records or those of patients who have been recently deceased.
– stockpiling the records of patients who have moved home
Pulse says that the Information Commissioner’s Office is now investigating whether patient records have gone missing. The ICO will question Capita on the matter.
The magazine says Capita has come under fire from NHS England, the General Practitioners Committee of the British Medical Association and GPs.
The General Practitioners Committee said in a letter Capita had been “considerably underprepared for the level of work and resource required for the rollout”.
NHS England told Pulse there were “transition issues” that need to be fixed. Capita said it had been tasked with “transforming” a previously “ fragmented” system, and that initial teething problems were inevitable.
“Capita are in the process of delivering a range of changes to primary care support services which are designed to make services more efficient, more reliable and ultimately better for GP practices.
We will continue to work closely to monitor, review progress and investigate any issues raised by users… reported issues are routinely logged and investigated to determine root causes and the appropriate remedial action in line with NHS England information governance procedures.”
The General Practitioners Committee has asked for GP practices to be compensated for the disruption.
Problems have continued despite various assurances they were being addressed.
In April Pulse reported that “GP practices are missing thousands in payments following the outsourcing of a national primary care support service.”
An anonymous healthcare professional on Pulse’s website asked why it had taken so long for officials to “realise the situation is so bad”.
Even before NHS England received bids for the outsourcing contract, the then head of the contracts and regulation subcommittee of the GP Committee of the British Medical Association, Dr Robert Morley, told Pulse,
“The portents are absolutely horrendous for general practice I’m afraid…There’s nothing at all that reassures me this isn’t going to be an absolute bloody disaster.”
Last month, in a letter dated 11 May 2016 to NHS England, the head of the GP Committee of the BMA, Chaand Nagpaul, said
“Practices have advised that due to a failure in the provision of medical supplies (such as syringes, needles) and prescriptions stationery, patient services have been disrupted.
“Clearly this presents a significant risk to the care provided to patients.
“We understand that measures are being put in place to mitigate against the lack of supplies, but often these mitigations increase workload and cost to practices and despite the reassurances we received some weeks ago there does not seem to be improvement.”
The letter added:
“NHS England made this change to a reliable and trusted NHS service with the explicit intent of making significant financial savings through the use of a commercial provider.
“The result has been an unacceptable transfer of unfunded work on to already hard-pressed practices.
“Therefore every practice should receive recurrent recompense for the extra workload related to the new Capita services, in addition to compensation for increased workload and inconvenience caused by the unsatisfactory introduction of these services.”
Dr Richard Vautrey, deputy chairman of the GP Committee, told Pulse the BMA has ‘been contacted by more practice managers on this issue than anything we’ve ever had’.
The letter said that there has been much trepidation about the future transformation of the service. There needs to be “vigorous testing and scrutiny” and acceptance by the end-user. Robust contingency planning needs to be in place.
Paul Cundy, the IT voice of the BMA’s GP committee, said on Pulse’s website,
“What has happened is that NHSE [NHS England] has given a contract to Capita for 40% less than it used to pay PCSS [Primary Care Support Service] services.
“That 40% has been re-couped by Capita and NHSE by expecting GP staff to do the sorting , collating, bagging and labelling of individual medical records in our surgeries. In other words we are now doing their work for them and for no extra money.”
An NHS manager Emma Bravery told Pulse:
“Medical records are being delivered to the wrong practices and being returned to the originating practice.
“As notes only get requested once a patient has moved practices, and this is updated on the spine, surely if Capita’s working systems were fit for purpose this simply couldn’t happen?
“In once instant the same set of notes was returned to the orginating practice twice!
“This is a massive IG breach, and it needs to be sorted now before we see medical notes being discovered in skips, or floating down the Trent.”
Paul Attwood, a GP partner, wrote on Pulse’s website,
“Our practice is winding down (retiring) and we had something like 200 sets of notes bagged and ready to go. Despite several telephone calls with the Capita lady assuring us they would be collected they took 3 weeks…”
He said support services for GPs were by no means perfect but have been made worse by attempts to save “only to find they have to spend that money and more to rescue the mess that they have helped create”.
He called for the names of those who awarded the contract to be made known.
There’s a silver lining.
Outsourcing problems don’t always reach the public domain. Suppliers and their clients sometimes keep quiet (especially in local government) because any difficulties are usually the fault of both sides.
But when GPs have problems it doesn’t get hidden. GPs – rightly – will not think twice about criticising anything that gets in the way of their caring for patients.
When bad news leaks out in the world of local authorities and central government, officials and suppliers will say that media reports are wrong. All problems however serious and enduring will be said to be teething.
One result is that outsourcing still has a generally good reputation. This is, perhaps, how it was possible for officials at NHS England to see a large hole opening up before them and still walk into it believing it didn’t really exist.
It was obvious to some others that you could not cut costs by 40%, transform services and make a profit. Something has to give.
Why then do officials at NHS England who awarded the contract to Capita still have their jobs?
They would probably says it is normal in outsourcing to cut costs while transforming services. But what’s normal doesn’t always make it right.
The Space Shuttle “O ring” disaster was caused in part by NASA officials doing what they thought “normal”. Bad practice at NASA had become what Diane Vaughan called “normalised”.
Is irrational optimism made credible by the exercise of financial creativity in writing business cases? There are experts in writing business cases in Whitehall, local government and the NHS.
One council built a credible business case for saving millions of pounds by outsourcing IT and other services and, a few years later, when the deal turned sour, presented a new business case showing how many millions could be saved by taking services back in-house. At least those officials have a sense of humour.
I would hope problems on the GP support services contract will give officials the chance in future outsourcing talks to put enthusiasm and over-optimism aside and look more sceptically at exactly what is and is not achievable, whatever the business case says.