By Tony Collins
In the House of Commons today MPs will debate the Capita Primary Care Support Services contract.
It has been secured by Coventry North West MP Geoffrey Robinson, who wants GPs to be compensated for the failures arising from the outsourcing contract.
The debate comes a day after the BBC reported that “more than 9,000 patients’ records in Norfolk, Suffolk and Essex have gone missing” since Capita took on the task of transferring files.
As part of its contract Capita took on the job of transferring patients’ records, when people move from one GP to another.
A BBC survey of 78 GP practices showed that 9,009 records had been missing for more than two months.
Capita told the BBC it did not “recognise these claims”.
An NHS England spokesman said, “We know there have been serious issues with services delivered by Capita which have had an unacceptable impact on practices. We are ensuring Capita takes urgent steps to improve services.”
Patients “at risk”
Paul Conroy, a practice manager in Essex, has started a House of Commons petition on the delays, which has been signed by more than 3,000 people. It calls for an inquiry into the Capita contract and the impact it has had on GP practices.
“GPs rely on that full medical history in order to make key clinical decisions on patient care,” he said.
“If they can’t get hold of that physical record there could be vital information there could be vital information that puts a patient at risk.”
James Dillon, director of Practice Index – an organisation bringing together practice managers – told the BBC,
“GP practices are getting more and more frustrated by the missing patient records.
“Not only is this debacle putting the health of their patients at risk, it is putting added pressure on already stretched practices.”
In a statement, Capita said it had taken on the “challenging initiative” to streamline GP support services and there had been “teething problems”.
“[But] medical records are now being delivered securely up to three times faster than under the previous system,” it said.
“We do not recognise these claims regarding thousands of files being missing whatsoever.
“We request and move on average 100,000 files a week from multiple sites including GP surgeries and also third party run storage facilities which are contracted and managed by NHS England.”
GP magazine Pulse quoted MP Geoffrey Robinson as saying that the secretary of state should intervene directly “as this is extremely dangerous”. Robinson said that some medical records are not being delivered at all, or delivered late or delivered to the wrong practices.
Dr Richard Vautrey, deputy chairman of the British Medical Association’s GP Committee said that the problems arising from the outsourcing contract “are directly impacting on the ability of many GPs to provide safe, effective care to their patients in the area”.
He said, “They are in some cases being left without the essential information they need to know about a new patient and the tools to treat them.”
In August 2016, NHS England published the results of a User Satisfaction Survey of primary care support services over the previous six months. Only 21% of GPs were satisfied with the outsourced service, giving it an average overall score of 2.91 out of 10.
An anonymous GP told Pulse how the problems are affecting him. He refers to the “performers list” that assures the public that GPs are suitably qualified, have up to date training, have appropriate English language skills and have passed other relevant checks such as with the Disclosure and Barring Service and the NHS Litigation Authority.
Said the GP,
“I moved 12 months ago and still haven’t been able to transfer performers list. I am 6 months late for my appraisal and unemployable except for my current salaried job as a result.
” It would have been easier to emigrate. The department responsible for the performers list at Capita is uncontactable except via a national email that isn’t responded to and a phone line that isn’t able to put you through to anyone.
“… As it is it’s virtually impossible to move region if you a UK GP. I am basically a slave bonded to a geographical region, forbidden to move house and work anywhere else other than short periods. Totally at the mercy of a faceless uninterested bureaucracy incapable of helping. Lunacy and utterly depressing. Why the hell did I become a GP? I curse the day.”
“I urgently need my medical records”
A patient who wrote to Campaign4Change said,
“My medical records were requested at the beginning of June 2016 when I changed to another health centre about 2 miles away.
“[I] phoned Capita today and was told there was no record of this request and to get my solicitor to contact them. Then they put the phone down. I don’t have and cannot afford a solicitor.
“I urgently need my medical records with my new doctor and am feeling helpless and extremely stressed by this.”
Pulse magazine reported yesterday (7 November 2016) the results of a snapshot survey of 281 GP practices carried out by the BMA’s GP Committee. It found:
- 31% of practices had received incorrect patient records;
- 28% failed to receive or have records collected from them on the date agreed with Capita;
- 58% reported that new patient registrations were not processed within the required three days.
- 81% of urgent requests for records were not actioned within three weeks.
GP practices also noted a reduction in the number of incorrect payments and fewer delays in registrations of the “performers list”.
It would be a pity if MPs today, in criticising Capita, lost sight of the bigger picture: how such outsourcing deals are considered and awarded.
The root of the problem is that before the contract is awarded officials concentrate their attention on the minutiae of the benefits: exactly how much will be saved, and how this will be achieved.
Pervading the pre-contract literature and discussions are the projected savings. This is understandable but wrong.
It’s understandable because it’s the projected savings that justify the sometimes-exciting time and effort that go into the pre-contract negotiations and discussions.
Large amounts of money are at stake. For officials, the pre-contract work can be a euphoric time – certainly more interesting than the day-to-day routine.
But what happens to negotiation and discussion of risk?
Risk is a table or two at the back of the reports. It’s a dry, uninspiring vaguely technical and points-scoring analysis of the likelihood of adverse events and the seriousness of the consequences materialising.
Sometimes the most serious risks are highlighted in red. But there’s always a juxtaposed “mitigation” strategy that appears to reassure. Indeed it appears to cancel out any reason for concern.
Risk is mentioned at the back of the internal pre-contract because it’s a cultural anathema. It’s the equivalent of visits by Building Regulations inspectors at a theme park under construction.
Who wants to talk about risk when a contract worth hundreds of millions of pounds is about to be awarded?
A bold official may dare to point out the horror stories arising from previous outsourcing contracts. That hapless individual will then be perceived by the outsourcing advisory group to have a cloud over his or her head. Not one of us.
And the horror stories will be dismissed by the officer group as the media getting it wrong as usual. The horror stories, it will be explained, were in fact successes.
Even when big public sector outsourcing deals end in a legal action between the main parties, officials and the supplier will later talk – without explanation or detail or audited accounts – of the contract’s savings and overall success.
We’re seeing this on the Southwest One outsourcing/joint venture contract.
No doubt some will claim the GP contract support contract is a success. They’ll describe problems as teething. Marginalise them. And later, when it comes to the awarding of future contracts, supporters of the GP outsourcing contract will be believed over the critics.
And so the cycle of pre-contract outsourcing euphoria and post-contract rows over failure will be repeated indefinitely.
It would be of more use if MPs today debated the role of NHS England in the award of the GP support contract.
Blaming Capita will do little good. The supplier will face some minor financial penalties and will continue to receive what it is contractually due.
Countless National Audit Office reports show how contracts between the public and private sectors, when it comes to the crunch, strongly protect the supplier’s interests. The public sector doesn’t usually have a leg to stand on.
A focus today on Capita would be a missed opportunity to do some lasting good.
NHS England letter on Capita contract – September 2016
Capita NHS contract under scrutiny after “teething” problems – June 2016
GPs decry Capita’s privatised services as shambles – The Guardian
Did NHS England consider us in the Capita take-over?
NHS England vows to hold Capita to account
Capita mistakenly flags up to 15% of GP practice patients for removal
Capita primary care support service performance “unacceptable”