By Tony Collins
Nicola Blackwood, minister for public health and innovation at the Department of Health, yesterday described failings on Capita’s GP support services contract as “entirely unacceptable”.
Blackwood told MPs at an adjournment debate on failures relating to Capita’s £1bn Primary Care Support England contract,
“It was always clear that Capita’s services needed to be at least as good as those that they replaced… Capita put forward the most credible of any of the bids accepted on the short list, and at the time both the Department and NHS England had every confidence that the programme would be a success.
“However, it is evident that Capita was inadequately prepared for delivering this complex transition.”
Under its contract with NHS England, Capita is responsible for providing GP medical supplies such as needles and syringes, transferring medical records when patients switch GPs, payments to GPs and “performers list” applications.
Capita won the “Primary Care Support England” contract in 2015, amid unheeded warnings from some GPs that the private sector would be unable to successfully deliver the complexity of support services to GPs that were being provided by the NHS.
Blackwood said yesterday that MPs were “right to be concerned that the service provided by Capita under the primary care support services contract … has so far fallen well short of the standards that we expect, and GPs have borne the brunt of these failings, as we have heard today”.
She added,
“We need to make sure that GPs and their patients receive the service to which they are entitled.
“We want to restore acceptable services, and the contract contains sufficient financial incentives to ensure that Capita shares that goal, which is an important part of the contract and process.
“Let us be clear that the problems encountered with medical record transfers [in which thousands of records have gone missing, says the BBC] and overdue payments are entirely unacceptable. The Department shares that view.
“Both Capita and NHS England are co-operating fully with the Information Commissioner’s Office in order to address the implications for information governance, and I accept the need for urgent action in order to address the impact that this is having on patients and practitioners.
“That is why I have been holding regular meetings with Capita’s chief executive for integrated services, Joe Hemming, its new managing director for primary care support, Simon England, and NHS England’s national director for transformation and corporate operations, Karen Wheeler, and I will continue to hold such meetings.
“Both NHS England and Capita openly acknowledge that the service has not so far been good enough.
“NHS England has demanded and received rectification plans from Capita for the six most affected service lines, and has embedded a team of seven experts within Capita to support it as it resolves these issues…
“… it is also about having the right resources in the right place at the right time. Capita has informed me that it is adding around 500 more full-time equivalent staff to the service, at its cost, and that it is improving the training provided to ensure that new staff understand the importance of the service to both patients and practitioners.”
The minster denied that patients had been harmed (by GPs not having patient records).
“I know that these problems have caused great inconvenience and distress, but with reference to risk NHS England has assured me that it is not aware of any direct cases of patient harm that can be attributed to service issues.
“However, NHS England is working closely with regional and local medical directors so that we can be assured of patient safety. In particular, Dr Raj Patel, medical director of NHS England Greater Manchester, has joined the embedded team to ensure that clinical risks and concerns are appropriately addressed.
Backlogs
“The priority now is to deal with any backlogs, particularly with medical record requests, and to ensure that services are stabilised with the capacity to deal properly with new requests.
” There has been progress on that, which is encouraging. The backlog of medical record requests has reduced from 17,262 to 3,465 in the past two weeks. Capita assures me that it has an effective triage system in operation for new requests and is confident that the situate”ion will not recur. However, I will be monitoring the situation closely.”
Shortage of supplies
Blackwood continued,
“I am aware that some GPs were left short of basic supplies as a result, including syringes, and that they have had to source those from other suppliers at their own expense.
“NHS England tells me that it has reimbursed practices for any costs incurred from having to buy local supplies of needles and syringes.
Contact centre shortcomings
“I know that many of the members’ GP constituents have experienced frustration with Capita’s contact centre. I share those frustrations.
“Capita assures me that the contact centre has improved the way it responds to urgent queries by investing in more staff, improved processes and enhanced training. Capita is confident that these measures will deliver a quality service to customers. We will monitor its progress closely, including through meetings.
Late payments – compensation?
“I recognise that GPs, and ophthalmologists in particular, have suffered financial detriment as a result of late processing of payments.
“NHS England is working with Capita to explore what can be done to support affected stakeholders, and I have made it clear to Capita that I expect it to consider compensation as an option.”
Absence of medical records
Another Coventry MP Colleen Fletcher said that people who have requested a copy of a late relative’s medical records from the primary care support service have had to wait for more than twice the maximum 40 days that it should take to process such a request.
“It is utterly unacceptable to put anyone through that kind of delay, but it is inexcusable for it to happen to anyone who is already in an extremely vulnerable position following the death of a relative.”
New charges to the public for medical records
Geoffrey Robinson said,
“I have nothing against the private sector making profits—I am all for it—but the irony is that the companies cannot make a profit from a proper service, so they turn to such measures as imposing a £40 charge for access to a deceased relative’s records …
“They do not have to impose that charge. I think it used to be left to the GP’s discretion — but they now insist on it, and people have to pay postage and delivery charges on top, which is a disgraceful pursuit of short-term gain at the expense of the people they are meant to serve.”
Reinstate the old NHS support service?
Blackwood said,
“Some have suggested that the old model for provision of primary care support should be reinstated, but we must remember that it relied on localised services that did not connect with one another, with much duplication across processes.
“The quality of these services varied greatly—in some areas, it was outstanding; in others, it was quite poor. That was simply unsustainable.
“Furthermore, the system was unable to generate useful management information and so, honestly, issues such as the ones that we now face would be very unlikely to have surfaced. They would have gone unreported.
“A new model, with efficient and modernised processes, is the right approach to deliver to our primary care providers the service that they deserve.
“The Department and I will continue to closely scrutinise Capita and NHS England as they work to resolve current problems and build a quality service that is sustainable.”
A long way to go
“I acknowledge fully that there is a long way to go before the service can be considered acceptable and that Capita has much to do to earn the trust of practitioners and patients.
“This is clearly a live issue. I want to be clear today: I am listening. The issue is at the top of my priority list and will remain there until I am satisfied that an efficient and effective service is being delivered that meets the needs of patients and providers.”
Lessons
Coventry Labour MP Geoffrey Robinson, who secured the adjournment debate, told the minister,
“These contracts are gaily handed out to companies that do not have the skills, preparation or sheer commitment necessary to provide the service.”
He questioned whether the contract would make the intended 40% savings.
“… the irony is that we have ended up with a terrible service that is costing more than the previous service ever would, because the company was not properly prepared, did not have a commitment to providing the service, and was unable to do so, and because of the competing and irreconcilable claims about short-term gains in the form of profits and illusory savings for the health service…
“We should not have badly planned impositions from the private sector, which does not know what it is going to do or how to do it.”
He said that minsters and civil servants pride themselves on awarding a contract that they have won a hard-nosed negotiation.
“We got them down from Y to X and we saved all this. It is great. We really screwed the private sector, didn’t we? That is all a total illusion.”
Labour MP Kate Green said that NHS England trialled the new system in west Yorkshire and it provided unsatisfactory. “Yet the contract was rolled out regardless.”
Savings?
Robinson said,
“How can the Minister talk of savings? How can any savings have been made when 9,000 patients records have been missing for more than two months, without which they cannot attend doctors surgeries? It is illusory to speak of savings.”
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