It has delayed payments to GPs, removed thousands of patients from practice lists and made the eyebrow-raising suggestion that primary care call centres could join PCT back-office functions in being outsourced to India. After six years of quietly providing back-office support, NHS Shared Business Services seems determined to make a splash in 2011.
But then the organisation, ‘a unique joint venture' between the Department of Health and private firm Steria, has never before been in such a position to make its influence felt. As PCTs have collapsed in on themselves, NHS Shared Business Services has been busy hoovering up much of their management work, and securing the title of ‘Central Government Supplier of the Year' into the bargain.
It is a fair guess that GP negotiators were not on the judging panel. The GPC has just entered talks with NHS Shared Business Services over what chair Dr Laurence Buckman describes as the ‘very adverse effects' it is having on GP practices.
LMCs have lodged a series of complaints over the organisation's work – about delays in registering patients, updating capitation payments and reimbursing registrars, and the now-notorious list-cleansing exercise in Brent, north London, where 38,000 patients were wiped from lists in a single week. In another incident, a staff member of NHS Shared Business Services sent patient-identifiable information to the wrong person at the wrong PCT.
But it is not the mistakes in themselves that have so worried LMCs – it is hardly as though PCTs were error-free. What most alarms GPs is the feeling of helplessness they feel when something does go wrong, and no one at the practice has any idea who to contact. Practices were in contractual relationships with PCTs, and when a problem occurred, they knew where each other lived. NHS Shared Business Services is a faceless organisation to most GPs and if they are able to find the right number to call, they have no idea who will pick up.
LMCs in the South West are fighting a rearguard action to prevent NHS Shared Business Services from sucking up local back-office services. But they may have a battle on their hands.
The DH is keen to the point of gushing on competition in the NHS, insisting new services should be placed out to tender or opened to the market via any qualified provider. But there is an exception to this enthusiasm, in the rules governing the award of contracts to NHS Shared Business Services. It is at the discretion of SHAs whether they choose to open up tenders to competitors, and they are quite within their rights to transfer work directly to it without considering alternatives.
But this is an award-winning organisation, and it must be expected to go head to head with competitors for NHS business. It says it offers the health service substantial managerial efficiencies. It is GP commissioners who will be responsible for delivering those efficiencies, and who will inherit any debts incurred over the current financial year. If NHS Shared Business Services can deliver the value for money it claims to, GPs will presumably avail themselves of its services. But it must be their choice whether or not to do so.
