Nearly 2,000 patients may have been harmed by failures of NHS Shared Business Services to pass on 700,000 pieces of clinical correspondence for at least five years, Government auditors have found.
The National Audit Office report, published today, further says NHS England expects this number could rise as one third of GP practices have yet to complete their investigations into the backlog.
To date, 1,788 cases of ‘potential harm to patients’ have so far been identified by GPs and NHS managers sifting through the recovered test results and consultant letters that SBS failed to redirect to practices.
No cases of actual harm had been identified as of 31 May, but work to review these cases is unlikely to be finished before December 2017 with ‘multidisciplinary clinicians’ reviewing each case alongside patient notes.
GP leaders branded the failings unveiled by the NAO ‘a disgrace’ as the report shows SBS managers were aware of the backlog since 2014 but did not raise the alarm until March 2016.
And the administrative costs alone have spiralled to £6.6m, with SBS footing £2.26m of these costs to date – although NHS England and SBS are wrangling over the final bill.
The NAO’s report says that the review ‘has found 1,788 cases of potential harm to patients’ and 333 of these patients have since died – although there is currently no evidence that this is a result of missed correspondence.
It adds: ‘NHS England is still investigating the cases where potential harm has been identified and another 9,728 high- and low-priority cases where the patient is no longer registered at the practice.’
‘GPs have reviewed around 360,000 documents but their reviews are not complete. GPs have yet to give NHS England an assessment of potential harm for 175,000 items of correspondence assessed to be of lower priority, despite having received payment to review these additional items in February 2017.’
Other issues raised by the report include:
- NHS England was dissatisfied with the NHS SBS response, and ‘in early September 2016, it told the Department of Health that SBS was still being obstructive and unhelpful’ about providing reports to determine the root of the problems.
- The Department of Health had failings of oversight, and a potential conflict of interest as it is a 50% shareholder in the company. The report notes it did not denounce SBS’s contractual failures as ‘any communications stating that NHS SBS was at fault in not forwarding the correspondence could void any insurance held by NHS SBS’.
- SBS inherited an initial backlog of around 8,000 items when it took over from East Midlands PCT in 2011, which was noted in internal reports but not addressed. A 2014 review found a backlog of 205,000 items across three of its centres.
- The problem was ‘considered lower priority than other work’ because although there was a contract requirement to redirect mail ‘there was no performance indicator attached to it’.
Deputy chair of the BMA’s GP committee Dr Richard Vautrey said: ‘The failings of this private company identified in the NAO report are completely unacceptable and it is a disgrace that this service failed so badly that patient care was being compromised.
‘At a time when the NHS is under incredible funding pressure, we can ill afford to spend £6 million to clear up this administrative mess that has resulted from SBS’ failures.’
An SBS spokesperson told Pulse: ‘Today’s NAO report highlights a number of failings in the mail redirection service provided to NHS England.
‘We regret this situation and have co-operated fully with the National Audit Office in its investigation.’
The DH told Pulse that it had made repeated assurances that public safety would trump profits, and a spokesperson added: ‘As the NAO report highlights, patient safety has been our first priority and no cases of harm have been identified to date.’
An NHS England spokesperson said: ‘NHS England was deeply concerned to be belatedly informed by SBS in March 2016 about its backlog of unprocessed correspondence.
‘We immediately set up a team, including clinical experts, to manage the incident, and all relevant correspondence has now been sent back to GPs for review.’
The GP clean-up
Pulse revealed in July 2016 that practices were missing years of correspondence with GP leaders warning there could be ‘huge implications’ if patient care had been delayed.
Mail redirection was part of the support services contract, but was one of a number of services that was not transferred over to Capita when it became sole provider.
In December 2016 NHS England said GPs would be required to review the correspondence to identify if patients had been harmed or put at risk but would be paid for the work entailed from a £2.5m fund.