Analysis: The drive to outsource PCT services
Full details from across the country of the problems reported by GP relating to NHS Shared Business Services.
Just six months ago NHS Shared Business Services was named ‘Central Government Supplier of the Year'. But while the unique ‘joint venture' between the Department of Health and private firm Steria has been lauded by Whitehall chiefs, GPs have reported a 'catalogue of problems' across the country.
Issues reported in Nottinghamshire:
- Payment errors
- Significant delays in payment
- Delays in patient registration
- ‘Unacceptable error rates' in processing work outsourced to India
Nottinghamshire LMC's newsletter warned: ‘Practices are having to wait four to seven days for information they were wont to receive on a daily basis and worrying reports have reached us about operating procedures within Shared Business Services suggesting an unacceptable error rate following processing work being undertaken in India.'
Chris Locke, chief executive of Nottinghamshire LMC, told Pulse: ‘NHS Shared Business Services took over a lot of payment arrangements from PCTs in the East Midlands in April 2010. From April 2011 they took over patient registrations and some screening services.'
‘We and other LMCs in the region have seen a catalogue of problems with financial administration and handling of payments. The major concern is over the handling of GP registrars pay – there have been significant delays and practices have not been getting the reimbursement they need.'
‘NHS Shared Business Services have reassured us they are addressing it as a matter of urgency. Other issues have been delays in patient registration. GPs are treating patients without being paid for it as they aren't registered on the system to get the capitation fee. There is a danger with all of this that practices miss out on payments and end up with cashflow problems.'
‘The SHA justified the move to NHS Shared Business Services on efficiency and cost saving grounds. A lot of people that worked in PCT finance and patient registration departments have been made redundant. There were always going to be administrative challenges but we're concerned they may have cut it too much in terms of the staff who were handling these things. Another issue is that NHS Shared Business Services is 50% owned by the NHS and 50% by a private provider. Is there a vested interest in having that organisation as the provider of choice?'
Dr Greg Place, chair of Nottinghamshire LMC and a GP in Kirkby-in-Ashfield, said: ‘The main problem is we've had rather slow financial things coming through, they are not being every quick with note transfer either.'
‘We would say they are too slow, but we haven't seen any gross errors yet, but I know other practices have.'
‘There have been quite a lot of disquiet and a number of practice managers have been informing the local medical committee office about specific issues and they have been sent back to Shared Business Servuces to be looked at and there has been more problems with Shared Business Services then there were with the old FHSA before them. So yes, there are concerns, and we are keeping a close eye on things.'
Minutes from an NHS Derby City board meeting in June showed that auditors had identified ‘a Serious Untoward Incident' involving NHS Shared Business Servuces. The incident involved NHS Shared Business Services sending ‘person identifiable information' to the wrong person at the wrong PCT.
The board minutes stated: ‘All control weaknesses had been included…with the exception of an incident regarding NHS Shared Business Services. Remedial action had been taken immediately by Shared Business Services and the PCT and East Midlands SHA and the DH had been informed. The SHA…had disclosed this as a Serious Untoward Incident.'
An NHS Derby City spokesperson told Pulse: ‘NHS Derby City was alerted that an error had been identified regarding an NHS.net email containing an attachment with person identifiable information. The email had been sent by NHS Shared Buisness Services to Central and Eastern Cheshire PCT rather than NHS Derby City.
‘NHS Shared Business Services took full responsibility for the incident and immediately launched a full investigation and made an immediate change to their checking processes. NHS Shared Business Services have taken steps to ensure that this incident will not happen again by re-designing and automating their procedures, implementing a more rigorous checking procedure and developing an automated procedure to eliminate human error.'
Issues reported in London:
- List management problems, with one PCT wiping 38,000 patients from practice lists
- Problems contacting NHS Shared Business Services to resolve problems
- Delays in transfer of patient notes
- Incorrect and delayed payments
Londonwide LMCs reported problems with list management services handled by NHS Shared Business Services, including a list cleansing-drive, first revealed by Pulse in March, which saw 38,000 patients stripped from practice lists in Brent. Meanwhile GPs in Tower Hamlets have been hit with delays in transfers of patient notes, incorrect payments and difficulty contacting NHS Shared Business Services to have the issues addressed.
Dr Michelle Drage, chief executive of Londonwide LMCs, told Pulse: ‘NHS Shared Business Services can pick up two types of arrangements with SHAs – some are for payroll services and some are for core family health services, which incorporate patient records and registration. In London we had major problems in the North East Cluster surrounding list management, including a very severe problem in Brent. For us the most important thing is that these problems impact patient wellbeing, not just GP pay.'
Tower Hamlets LMC newsletter stated: ‘We are continuing to work with the PCT and Shared Business Services to ensure that improvements can be made to address concerns and issues which have been reported by Tower Hamlets Practices. Although there have been some improvements, there are still concerns in the following areas: Delays in transfer of patient notes, delays in and incorrect payments and difficulty in contacting and obtaining responses from Shared Business Services.'
In April in northeast Essex, GPs declared victory in their campaign against PCTs transferring contractor services to NHS Shared Business Services after Essex LMCs said it was ‘extremely concerned' over SHA ‘pressure' for PCTs to shift backoffice functions to the joint venture. The campaign, which was backed by local MPs, led to a new contract being awarded to North East Essex Provider Services rather than NHS Shared Business Services.
Essex LMCs newsletter stated: ‘It appeared that PCTs were under pressure from the SHA to transfer these [contractor] services, with their preferred provider being NHS Shared Business Services. The LMCS were extremely concerned at what was being proposed. The response rate [to the campaign[ from practices and support from local MPs was excellent. Thank you to all practices that supported this successful campaign.'
Dr Brian Balmer, chief executive of Essex LMC and a GP in Chelmsford, told Pulse: ‘We resisted the NHS Shared Business Services attempt to take over and still have our local contractor support service. We used practices and local politicians.'
LMCs in the South West have launched a campaign against PCTs across the region transferring work to NHS Shared Business Services. The campaign has forced the SHA to consider an alternative model to NHS Shared Business Services.
Dr Philip Fielding, chair of Gloucestershire LMC and a GP in Cheltenham, told Pulse:
‘The LMCs in the South West have been robustly fighting a campaign against the introduction of NHS Shared Business Services for the entire region. We are questioning whether we've seen the full business case for NHS Shared Business Services? Is it a fait accompli? Is there not time for a comparative tendering process to compare NHS Shared Business Services's offer with the local services already in place?
‘We now have a concerted effort to see whether we can introduce a more favourable locally run service rather than outsourcing to NHS Shared Business Services. Thanks to the LMCs' strong intervention we have forced the issue of competitive tendering, so the SHA is considering an alternative model. This part of our local structure works well already – it shouldn't be the area the PCTs and SHAs want to reform as part of a cost-cutting exercise. Why pick on the bit that's working well?'
An NHS South West spokesperson told Pulse: ‘Primary care trusts across the region are looking at how they can improve the efficiency of back office functions to release more funds for frontline health services.
‘The South West Strategic Health Authority is facilitating regional discussions but all decisions will be made locally by primary care trust boards. Alongside the Shared Business Services proposal, an alternative proposal for Family Health Services administration is being considered by individual PCTs, but no decisions have yet been made.'
NHS Shared Business Services' response
Pulse put a series of questions to NHS Shared Business Services, and the chief executive John Neilson responded as follows.
1) Does NHS Shared Business Services acknowledge issues GPs have been having with delays in getting patient records, delays in payments for GP registrars and delays in registering patients? What are you currently doing to address these issues?
We were very pleased to meet recently with a number of GPs and GP representatives to discuss how we can better meet their requirements and work more closely with them going forward.
Our service contracts are primarily with NHS Trusts, including PCTs, but we recognise the importance of engaging directly with GPs to ensure that we meet their expectations. There were concerns around some specific areas of the service and we are dealing with these particular issues. We will of course review operational procedures and make changes where necessary.
We work hard to have open and collaborative dialogue with all our stakeholders - indeed this is a really important aspect of our approach to working in partnership with clients. On this note we hope to continue discussions directly with GPs around how we can support them as they move towards clinical commissioning.
2) For how many SHA's or PCTs does NHS Shared Business Services provide a) hamily health services and b) back-office financial processing?
NHS Shared Business Services provides Family Health Services to 16 PCTs and back office financial processing for an additional 46 PCTs. SHA's do not take family health services but nine SHAs receive back office financial services from NHS SBS.
3) How many clinical commisioning groups does NHS Shared Business Services currently support?
Clinical Commissioning Groups do not yet exist, so NHS Shared Business Services does not currently provide services to them.
4) Can you provide a copy of a template agreement between an SHA and NHS Shared Business Services for these functions that are provided for public bodies?
NHS Shared Business Services were awarded a Government framework under competitive tender in 2005 which covers the agreements between SHAs and NHS Shared Business Services. However, NHS Shared Business Services does not wish to provide this information as it is commercially sensitive to our business operations.
In a further additional statement addressing some of the specific concerns reported by GPs, an NHS Shared Business Services spokesperson said: 'Each PCT within the East Midlands region has its own contract with NHS Shared Business Services to deliver back office functions, and there are in place a range of Service Level Agreements to ensure quality and performance. These back office functions include finance and accounts, payroll and family health services.'
'Early issues which you might expect with service transitions have always been dealt with in a timely and efficient manner, with corrective actions being agreed with the trusts and being implemented as appropriate.'
'NHS Shared Business Services has in excess of 1,120 service-level agreements across our client base of 140 NHS trusts, and has achieved in excess of 99% of those service-level agreements in July 2011.'