Category Archives: NHS England

Capita said to owe thousands to pharmacies

By Tony Collins

Capita owes some pharmacy owners thousands of pounds, according to Chemist+Druggist.

One pharmacist Salim Jetha of Lewis Grove Pharmacy in Lewisham told Chemist+Druggist he had emailed Capita in February but it “bounced back because the inbox was full”. He said that if emails are unanswered and there is no phone number to ring “what are you supposed to do?”

Under its Primary Care Support Services contract with NHS England, Capita is due, among other obligations, to reimburse some of the costs of pharmacy trainees. The trainees are termed “pre-registration” pharmacists because they have not yet passed a General Pharmaceutical Council assessment.

Pharmacy owners can apply for an annual grant from NHS England for up to £18,440 for every pre-registration trainee taken on.

Capita took on responsibility for delivering NHS England’s primary care support services in September 2015, including overseeing the pharmacy training grants.

In response to the article, Capita spokesperson said it is aware of “some isolated issues” and that all claims that meet “the required checks” have been backdated, as will any further claims.

The spokesperson said that one of the “key improvements” under Capita has been the introduction of a centralised process for dealing with primary care.

The old system was localised, meaning grant claims “came in from various sources on an ad hoc and irregular basis”.

Chemist+Druggist article

Jeremy Hunt is prepared to end Capita’s NHS contract if necessary

 

is London Ambulance Service’s back-up system “public endurance”?

By Tony Collins

In November 2016 London Ambulance Service had its busiest week for seriously ill and injured incidents in the history of the Service.

“The Service is …expecting demand to increase even further throughout December,” said London Ambulance Service at the time.

A few weeks later, on one of the busiest nights of the year, the systems went down, from 12.30am to 5.15am on 1 January 2017. The result was that 999 calls were logged  by pen and paper.

When systems are working normally  an incoming 999 call displays the address registered to that number – if the address is registered.  The London Ambulance operator confirms the location, assesses the severity and an ambulance can be despatched within seconds, with the address on its screen and a satnav pointing the way, according to a comment on The Register.

Pen and paper takes longer because the address and other details need to be given over a radio, which can take minutes.

But pen and paper is the London Ambulance Service’s back-up for IT failures.  Whether it can cope with unprecedented demand – or with a major incident in London – is in doubt.

A former London Ambulance Service paramedic told the BBC there had been waits of an hour for ambulances on 1 January 2017. He said call handlers had been “amazingly helpful”, but it was “easy to become overwhelmed especially in the midst of high call volumes”.

London Ambulance Service declined to answer any questions on its latest system failure.

Malcolm Alexander of the Patients’ Forum for the London Ambulance Service said: “We want to know why it is that this system that cost so much money and is supposed to be so effective is not fail-safe.”

He added: “If this system fails at a time when there is huge pressure in the system, for example if there was a major disaster or a terrorist attack, we are going to be in trouble. We really need to make sure it doesn’t collapse again.”

1992

A report into the collapse of London Ambulance Service systems found that they had had failed for many reasons. The Service had taken a “high-risk” IT approach and did not test systems thoroughly before putting them into service.

(Some may question how much has been learned since then.)

2006

In 2006 the London Ambulance Service systems crashed nine times in a fortnight. Each time staff reverted to pen and paper.

2008

In 2008, when systems failed,  repairs took 12 hours. Again the Service reverted to pen and paper.

2011

In June 2011 an IT upgrade caused the system to go down for about three and half hours. Pen and paper was again the back-up “system”. At the time the London Ambulance Service was upgrading the Commandpoint system, supplied by Northrop Grunman, which the Service deployed in 2010 and still uses.

2013

In 2013 on Christmas Day and Boxing Day the systems went down for separate reasons for several hours each day, with staff reverting to pen and paper.

2015

The Chief Inspector of Hospitals, Mike Richards, recommended that the London Ambulance Service be placed into special measures.

He said at the time,

“The Trust has been performing poorly on response times since March 2014. This is a very serious problem, which the trust clearly isn’t able to address alone, and which needs action to put right.”

Comment

It’s becoming the norm for parts of the public sector to regard the public as captive customers when it comes to going live with new IT or upgraded software.

Rather than test new systems, procedures and upgrades thoroughly before introducing them, some parts of the public sectors are going live with a “let’s see what happens and fix things then” approach.

This has become the semi-official approach to the introduction of Universal Credit – with long delays in payments for some claimants.

Within the NHS, at some hospitals introducing new patient record systems, there has been an internal acceptance that patients may suffer from delays,  perhaps with tragic consequences, at least for three year-old Samuel Starr.

The NHS e-referral service was launched with nine pages of known problems.  And when NHS England launched a streamlined GP support service with Capita, officials knew of the possible problems. But it launched anyway.

After the London Ambulance Service’s IT failure on New Year’s Day, it’s clear that many emergency workers did their best to give a normal 999 service. St John’s Ambulance helped.

But to what extent does senior management at the London Ambulance Service have a “stuff happens” mindset when IT goes seriously wrong?

There’s no individual accountability and no commercial imperative to learn lessons from any of the failures.

And there’s no fervent business or political will to ensure the same or similar mistakes don’t recur.

Every time systems fail, the London Ambulance Service promises an investigation. But where are the results published so that lessons can be learned?

Pen and paper is tried and tested. But demands on the London Ambulance Service are much greater than in the past.

With an unprecedented demand for its services how is it London Ambulance Service’s senior management can comfortably rely on pen and paper as its back-up system?

It can – if nobody in power requires an earnest answer to the question.

Another wider question is whether it’s acceptable to use the public as guinea pigs for new or upgraded IT, with potentially serious or even tragic consequences.

London Ambulance Service suffers New Year’s crash – Computer Weekly

London Ambulance Service hit by new year fault – BBC online

 

 

MPs to debate Capita NHS contract today

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.

Lunacy?

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”.

Comment

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”

 

 

 

“Teething” problems on Capita’s NHS contract turn more serious

By Tony Collins

capitaA senior official at NHS England has said that problems on a contract to outsource GP support services to Capita have “put patients at risk”, according to GPs magazine Pulse.

In June 2016 NHS England said problems on Capita’s £330m seven-year contract to provide primary care support services to GPs were “teething”.

The contract started in September 2015.

Directors at NHS England’s September board meeting said that problems with Primary Care Support England had ‘escalated’ this summer and that the problems were ‘creating some risks for patients’.

Karen Wheeler, NHS England’s national director for transformation and corporate operations, is reported by Pulse to have told the board,

“I just want to recognise that obviously this has impacts for users, which include of course primary care contractors – GPs, ophthalmic and dental practitioners – and recognise that that’s difficult for all those users, and indeed creating some risks for patients as well.

“So we are doing everything we can to make sure that we escalate, and address the risks particularly for patients, and we will be communicating with practitioners how we are planning on, with Capita, to try to improve services as quickly as possible.”

Problems include undelivered patient notes, which has led to GP practices chasing records. There have also been delays in GP payments and clinical supplies.

Angry GPs

NHS England’s chairman Professor Malcom Grant has angered some GPs by praising NHS England’s directors, and their teams, for the “huge amount of work” they have put in “trying to ensure people aren’t harmed by this at all.”

Pulse quotes Professor Grant as saying,  “As you know the board takes this extremely gravely. When we say unacceptable, we mean unacceptable. I think we need to pay tribute to you [Karen Wheeler] and the team for the huge amount of work that has gone into trying to ensure that people aren’t harmed by this at all.”

A Capita spokesperson told Pulse: ‘Across all PCSE [Primary Care Support England] services our focus is to ensure that GPs and primary care providers are supported so they can concentrate on patient care.

“We fully recognise that the administrative services we provide play a key role in supporting primary care providers and ensure that urgent work is always treated as a priority.

“We have openly apologised for the level and varied quality of service we have provided across a number of PCSE services. As NHS England acknowledges, we are working very closely with them, supported by their subject matter experts, to implement step changes to improve current services.”

Responses to the article on Pulse’s website criticised NHS England’s chairman for praising his officials when it was NHS England that had made the decision in the first place to outsource GP support services.

One comment: “Apologies aren’t worth anything currently. We are struggling at [GP] practice level and NHSE [NHS England] don’t give a damn.”

Another said, “So ‘hubs’ and combining ‘back office’ functions not always the cost saving, efficiency panacea then… Let’s hope we learn the lessons and value our ‘back office functions’ more highly.”

An anonymous NHS manager said the decision to outsource to Capita had been taken “behind closed doors, without any meaningful staff consultation and with zero knowledge of what primary care support services actually do”.

The manager added,  “NHS England is part of the problem. It’s about time they were held to account.”

Capita’s share price is currently less than half its 52-week high, for a range of reasons.