‘THIS NEWS is extremely concerning, but not altogether surprising considering the continued warnings the BMA has given over Capita’s shambolic running of backroom services in GP practices throughout the country.’
Dr Richard Vautrey, BMA GP committee chair, was responding to Capita’s share price dropping 40 per cent in early trading following a profit warning on Wednesday. He continued: ‘Just this month our own research found multiple failings across all areas operated by Capita in surgeries, including the handling of patient data.
‘GPs will be rightly worried about the future of these services – which have a real impact on patient care – and the government must provide assurances of what plans are in place to protect them should Capita suddenly be unable to deliver. With the collapse of Carillion earlier this month, we saw the problems that can arise when public services are outsourced to a private company, and this must not be allowed to happen again. I will be meeting with the chief executive of NHS England Simon Stevens today to discuss these issues.’
Dr Vautrey wrote the following letter to Stevens just two weeks ago, on 16 January, following the publication of the BMA’S damning survey. He wrote:
‘Primary Care Services England
‘Dear Mr Stevens
‘Following the meeting between the BMA General Practitioners Committee and NHS England on 11 January 2018, I am writing to you to express our disappointment that we have not seen the necessary substantial improvement in the outstanding issues we have continuously raised about the service delivery of PCSE (Primary Care Support England).
‘In a meeting on 7 November, we asked NHS England for significant progress to be made to resolve the issues by 31 December 2017. Although we appreciate the updates we have received, we feel that due to the severity of the issues and impact which it is having on primary care services across the country the lack of progress, and indeed deterioration, is unacceptable.
‘In December, we conducted a survey of practices and individual practitioners. The results show that there is little improvement, if any, across all service lines, when compared to our previous survey in October 2016; in fact, there appears to be a significant deterioration in some services.
‘While any new organisation takes time to take over services effectively, the situation has gone from bad to worse since Capita took over the PCSE service almost two and a half years ago. The BMA has engaged with NHS England to resolve these issues for over two years. Despite this, the failures of the service continues to have a major impact on practices, practitioners and patients (direct and indirect).
‘In fact, the reality is that rather than making progress, the system for resolving issues, both directly between practices/GPs and PCSE, and when escalated through the BMA to NHS England, has significantly slowed down over the last two months. We are also concerned with the severe delays and insufficient service experienced by those seeking compensation for loss of earnings due to the failing of PCSE.
‘This situation is completely unacceptable. As a result of the lack of improvement in the service delivery of PCSE we are now left with no option but to support practices and individual doctors in taking legal routes to seek resolution.
‘While this is taking place, we believe it is imperative that NHS England conducts a transparent and comprehensive review of all policy, procedures and processes used by PCSE across each service line.
Practitioners Committee England’
This letter, which excoriates the Tory appointee Stevens for presiding over Capita’s disastrous two-and-a-half year tenure in charge of primary care support, followed a devastating survey, the conclusion of which is printed below.
Conclusions and further considerations
‘Despite the 18 months (since our last survey) of commitments and assurances from NHS England and PCSE, and supposed improvement, there has been little to no improvement across all service lines, with some showing significant decline.
‘The impact this is having on practices is being reported on a daily basis to LMCs and to the GPC. Not only are the problems persisting and indeed worsening, but the ability of PCSE to resolve (and communicate to practices and practitioners about the resolution) is also worsening.
‘All types of GPs are reporting issues with the services provided by PCSE, covering a wide geographical spread across England. This is not a localised or limited problem, but is widespread and profound. Reports to GPC suggest that while some issues may be resolved within a short timescale (for example some issues with payments to practices may be resolved in the next monthly payment) further issues are occurring for that same individual or practice (for example the next month’s payment to the practice will include a different error).
‘NHS England awarded £1bn of taxpayers’ money to Capita to deliver these services, but not only are the services not being delivered appropriately, a further significant amount of taxpayers’ money (in addition to the £1bn) is being spent on resolving problems that should not have occurred in the first place.
‘Capita must stop benefitting from taxpayers’ money and inject more money and human resources into delivering an appropriate and safe service to practices and their patients.
‘While PCSE is the organisation responsible for the delivery of these services, and is failing in this respect, NHS England is ultimately accountable for commissioning this service, and must take action to ensure that taxpayers’ money is spent appropriately. NHS England must ensure PCSE is delivering a good standard of service, using any levers at its disposal, and prepare an alternative plan in the event that Capita is unable to improve its performance and unable to continue to hold the contract for providing support services to general practice.’
PCSE survey results Background
Since 1 September 2015 Capita has been responsible for the delivery of NHS England’s primary care support services, under the name Primary Care Support England (PCSE). GPs and LMCs have identified serious issues with the service from the outset and the GPC has been engaged with NHS England to provide and monitor resolutions to the issues.
Despite assurances from PCSE and NHS England, the situation does not appear to be improving.
• There has been little to no improvement since the previous survey held in October 2016 across most service lines.
• Some service lines have significantly worsened since 2016 (particularly practice payments, patient registrations and customer service support).
• While 69% of practices say the new labelling system for patient records transfer is working effectively, a significant number of these (73%) report that it has increased the associated workload.
• Meanwhile, the BMA has also responded to Dr Sarah Wollaston’s letter to NHS Digital calling for an end to the ‘memorandum of understanding’ (MoU) with the Home Office over patient data
Dr John Chisholm, BMA ethics committee chair, said: ‘The BMA has raised serious concerns over the MoU since its introduction. We are delighted to see Sarah Wollaston’s intervention and strongly back her calls for NHS Digital to immediately cease use of the MoU and carry out a thorough review of how it discloses NHS data.
‘We know this agreement is already having a real effect on patients – and in turn their relationship with doctors. That relationship is built on a foundation of trust, and the arrangement between NHS Digital, the Home Office and the Department of Health is eroding this.
‘If patients are refusing to visit the doctor for fear of repercussions from the Home Office, it is not only a danger to that individual’s health, but it could also pose a threat to the wider wellbeing of the public if communicable infectious diseases are being diagnosed and treated at a later stage.
‘One major area of concern for us is that such an agreement sets a precedent for lowering the threshold at which health providers must hand identifiable information over to authorities, potentially leaving all patients unsure about whether the information their doctor holds on them is truly confidential.
‘These disclosures to the Home Office are well below the threshold for disclosing confidential information in the public interest, set for doctors by their regulator the General Medical Council.’