The National Audit Office has said NHS England’s decision to outsource primary care support services to Capita ‘potentially compromised patient safety’, and has instructed it to consider taking services back in house.
Pulse has reported on GPs suffering severe disruptions to services – including with payments, pensions, performers list registrations, records movement and medical supplies – since the contract was awarded in 2015.
Now, the NAO has recommended that Capita and NHS England should put any further changes to support services on the back foot whilst stabilising current delivery, as primary care practitioners are still experiencing ‘widespread failures’.
The same report revealed that Capita has made losses of £125m to date from the contract, while NHS England has saved £60m.
The seven-year, £330m contract to provide services including GP payments, National Performers List updates, administering of GP pensions and patient record movements, was awarded to Capita after a tender process in 2015.
Key findings of the NAO report
- NHS England’s decision to hand a contract to Capita both to run existing services and also simultaneously to transform those services, was ‘high risk’.
- NHS England did not have sufficient knowledge the amount of work related to primary care support services to set Capita achievable targets (at the time it was handled by 1,650 staff in 47 local offices).
- Both Capita and NHS England ‘underestimated’ the scale and nature of the task of transforming the service.
- Capita was incentivised through the contract to close existing services to minimise its losses.
- NHS England has made £60m in savings in the first two years of the contract – broadly in line with targets.
- Capita has made losses of £125m in the same period, more than the £64m it anticipated.
- NHS England’s assessment of the contract risk focused on the likelihood of it failing to achieve its financial savings target and did not adequately assess the risk of Capita being unable to provide the service to a good standard.
- NHS England has fined Capita £5.3m for poor performance, and expects to pay £3m to primary care providers in compensation.
- Practitioners are still experiencing ‘widespread failures’, with key concerns including Capita’s management of the National Performers List, GP pensions and payments.
Failings affecting GPs, many of which were first revealed by Pulse, included issues with moving medical records between practices as well as delayed processing of updates to the National Performers List.
The latter resulted in GPs being unable to work, with associated lost earnings, and the NAO report said it also ‘potentially compromised patient safety in cases where practitioners should have been removed’.
The NAO now recommends that NHS England ‘determine whether all current services within the PCSE contract are best delivered through that contract or whether some should be taken in-house’.
It also said the parties should now ‘prioritise the stabilisation of existing services’ and, when it did continue service changes, it should listen to feedback from primary care providers, pilot significant changes and create ‘a joint risk register’.
The report said: ‘The lack of stability in delivering existing services was in part caused by premature site closures and the push to secure savings from transformation.
‘NHS England should carefully consider the operational readiness of each service before agreeing to the implementation of any further transformation changes.’
Public Accounts Committee chair Meg Hillier said: ‘Trying to slash costs by more than a third at the same time as implementing a raft of modernisation measures was over-ambitious, disruptive for thousands of doctors, dentists, opticians and pharmacists and potentially put patients at risk of serious harm.
‘Neither NHS England nor Capita properly understood the scale of the challenge before agreeing the contract and are still in dispute over future payments.
‘Yet again this is poor contracting by Government with one of its major suppliers and it must learn lessons.’
An NHS England spokesperson said: ‘While not without its difficulties, by making this change over the past two years the NHS has successfully saved taxpayers £60m, as the NAO themselves confirm.
‘This £60m in lower administrative cost has all been successfully reinvested in frontline NHS patient care, and has helped fund the equivalent of an extra 30,000 operations.’
The BMA’s GP Committee has written to NHS England’s chief executive Simon Stevens today to demand that he sets out an action plan for resolving the issues.
GPC chair Dr Richard Vautrey said: ‘While NHS England may have hit its financial targets, the two years of chaos experienced in practices up and down the country by both patients and GPs – whether this is to do with records, supplies or payments – sits completely at odds with this definition of “success”. It’s GPs and patients who have paid the price for this.’
He added: ‘For the last two years the BMA has repeatedly pressured NHS England to urgently address the problems with PCSE delivery, and now that the NAO have so clearly backed our concerns we hope this assessment of its failures will finally make NHS England and government sit up, listen and act.’
What Capita says
‘As today’s NAO report concludes, the complexity of the support services being let by NHS England was not fully understood when the contract was signed.
‘The report notes that several organisations and legacy issues all contributed to underperformance. It has been acknowledged that performance has improved and Capita will continue to work with all parties to address the remaining service issues. We have accepted accountability for not meeting our high standards of service previously.
‘Our new chief executive has made it clear that Capita previously has taken on some contracts that contained too many unknowns. Our new strategy will ensure we focus on doing fewer things better and securing business that we know can be delivered well.’