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In full: GP leaders write to complain about primary care support services

Dear Mr Hardy,

We are writing to you to raise the serious ongoing concerns that Derby and Derbyshire LMC have about the continuing inability of PCSE to deliver an acceptable level of service to general practice.

We met with Simon England (then Managing Director of PCSE) and Jill Matthews (Managing Director, Intensive Expert Management Team, Primary Care Support Services, NHSE) on 14 February 2017. At that meeting we were assured that the backlog of outstanding issues would be resolved by the end of March 2017.

When we met again on 24 April 2017, there had been little improvement, and after offering their apologies, PCSE assured us that the backlog would be cleared by the end of June 2017.

By 19 September 2017, when we put it to Jill Matthews and Justine Burns (PCSE Regional Liaison Manager) that practices had still not seen a meaningful improvement, Jill commented that there is no expectation of any substantive rectification of any service this year. Although Jill did acknowledge there may be some gradual improvements over the next few months, it will not be until next year that things will really be fixed.

This is simply unacceptable and threatens the transfer of intolerable risks onto GP practices, with no mechanisms for them to satisfactorily manage these risks.

The main areas of risks transferred onto GP practices are:

1. The inability to adequately maintain accurate patient records

Maintaining accurate patient records is a requirement of the GMS/PMS Contract and GMC Good Medical Practice (2013). PCSE’s failure to transfer records between practices in a timely manner have left many practices with hundreds of sets of records outstanding that have not been delivered for new patients. This presents potential risks in terms of patient safety and data protection.

2. Prescribing codes and NPL updates

Many practices have been battling for months to get amendments made to the NPL; this is particularly pertinent where GPs have not received their prescribing codes, meaning practices are forced to use workarounds for these GPs in order for them to be able to continue to treat patients.

3. Financial

Payments are still patchy; a good example was a practice which recently checked their Open Exeter statement two days before their PMS global sum payment (c£130k) was due only to find it had been omitted. This risked the financial viability of the practice and places intolerable pressures on partners and practice managers. In addition, following the introduction in July of a lead employer for GP Registrars in Derbyshire, many practices are still owed several thousand pounds of training grants, introducing further financial risks to the viability of practices.

4. Pensions

The inability of PCSE to process pension payments including superannuation is destabilising both practices and the GP workforce and increasing dissatisfaction within the profession. A recent example saw PCSE deducting a full 12 months of superannuation payments from a practice in a single transaction with no notification sent to the practice. This presented a serious financial risk to the practice and could have completely destabilised a smaller practice.

Whilst examples of unacceptable levels of performance by PCSE are legion, perhaps the most frustrating thing for hard-pressed practice managers is the inability of PCSE to respond in a meaningful manner to telephone or e-mail queries when they are trying to resolve problems. Despite reassurances from PCSE that they are meeting their KPIs to answer telephones within 20 seconds this does not reflect the reality; just answering the phone does not resolve the query.

Practices have to repeatedly contact PCSE to get any query resolved and the inability to speak directly to the subject matter expert who could resolve the query quickly is only adding to the frustration. Evidence from practices suggests that e-mailing PCSE is a waste of time as e-mails generate an automatic response but then no further contact or follow up. There are also many examples of practices having to send the same documents on numerous occasions to try and get resolution.

So the question is simple; what are NHSE going to do about this?

At a time when NHSE is heralding the GPFV as the solution to general practice at breaking point, the reality is that practices do not have the headspace to contemplate GPFV since they are wasting so much time every week trying to get day-to-day queries resolved through PCSE.

Our view is that the alleged 40% saving that NHSE made on this £1bn contract must be reinvested into providing core GP support services.

Rectifying this whole sorry mess must be the priority.

Time currently wasted by practice staff trying to deal with PCSE problems would be much better spent looking at collaborative ways of working and changing for the future in line with the ideals of GPFV.

If GPs delivered the standard of performance that PCSE are providing there is a real risk that they would be closed down by CQC, and yet Capita seem to have been allowed to get away with this utter failing for over 18 months with no real indication that we are going to see any improvements any time soon.

On 8 November 2016, the then Parliamentary Under-Secretary of State for Public Health and Innovation stated in the House of Commons that: ‘The Department and I will continue to closely scrutinise Capita and NHS England as they work to resolve current problems and build a quality service that is sustainable. I acknowledge fully that there is a long way to go before the service can be considered acceptable and that Capita has much to do to earn the trust of practitioners and patients.’ This assurance is nothing more than a hollow promise: Derby and Derbyshire LMC demand to know when the Capita fiasco will be resolved?

We have copied this letter to The Secretary of State for Health, The Chief Executive and Chairman of Capita, the Managing Director of PCSE, the Chair of the General Practitioners Committee of the BMA, the Information Commissioners Office and the medical press. The risks to patients following the mismanagement of their personal data and the overwhelming destabilisation of general practice caused by this debacle is in danger of becoming a national disgrace and must be resolved.

Yours sincerely

Dr Kath Markus, Chief executive

Dr Peter Williams, Chair

Derby and Derbyshire LMC Derby and Derbyshire LMC