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GP practices missing 400,000 clinical letters due to Capita handover

There is a backlog of hundreds of thousands of pieces of clinical correspondence that have not been directed to GPs as a result of NHS England’s failure to resolve problems associated with their contract with Capita, Government auditors have found.

The National Audit Office also found that efforts to resolve the problem had to be halted after NHS England sent patient notes – including child protection details for three children – to a supermarket with the same postcode as a GP practice.

GP leaders said that both NHS England and Capita have ‘failed to get to grips’ with the problem of clinical correspondence that had been sent to the wrong practice.

NHS England admitted that it did not know the level of patient harm that had resulted from these problems, but it will be publishing a report on this in April.

The problems came about following the transfer of primary care support services to Capita. Under the contract with Capita, the company was not obliged to handle clinical correspondence that was erroneously sent to GP practices – contrary to the previous system, that saw GP practices sending the misdirected correspondence to the support services. 

However, there was a backlog of this correspondence already from the previous system, and GPs had continued to send the correspondence to Capita, which saw this backlog grow.

Capita told the auditors that it could have informed NHS England earlier about the growing backlog.

NHS England and Capita did come to an agreement for Capita to review the backlog, which would be sent out to the appropriate practices by NHS England.

However, the NAO also found that attempts to resolve the issue to be ‘paused’. It added: ’This followed an incident in which NHS England sent clinical correspondence containing the child protection notes of three children to a practice without showing the name of the practice in the address. The package was delivered to a supermarket with the same postcode, which then passed the package to the practice.’

Following the incident, NHS England revised its procedures.

The NAO report said that there are still almost 400,000 pieces of clinical correspondence outstanding.

NHS England has said that it will publish a review detailing the amount of patient harm caused by the backlog of correspondence by April, and it is planning an information campaign to ensure GPs understand what to do with correspondence for patients who are not registered with their practice.

But Dr Richard Vautrey, the chair of the BMA’s GP committee said the report showed an ‘inability to get to grips with the problem’ by NHSE and Capita.

He said:  ‘It’s no surprise that with the now longstanding confusion, chaos and failures of these support services for general practice, that a small number of practices may have, in good faith, sent on misdirected correspondence to the Capita/PCSE service, particularly as this would have been the normal arrangements before NHS England tried to cut costs by commissioning this service two years ago. 

‘What is clear from this investigation is the inability of both NHS England and Capita to get to grips with a problem they have now known about for years.’

Dr Vautrey added: ‘Capita itself admitted it failed to officially disclose the scale of the backlog to NHS England in good time, and both are yet to decide whose responsibility it is to return records to the right practice.

‘Further, NHS England has still not launched an effective information campaign aimed at GPs, despite continuing to receive misdirected correspondence almost two years after it became aware of the problem.’

Dr Vautrey was due to discuss concerns about Capita with Mr Stevens this week.

He said: ‘This is a further indictment of Capita’s shambolic running of GP backroom services and the real effect its failings are having on the safe care of patients.’

An NHS England spokesperson said: ‘The key fact is that there is no evidence that any patient has been harmed by this, and by March every piece of correspondence will have been reviewed and refiled by GPs and the relevant NHS archive.’

A Capita spokesperson said: ‘As the NAO report states, Capita has no contractual responsibility for redirecting clinical correspondence. Capita informed NHS England in May 2016 that there was a problem with an unquantified accumulation of clinical notes.

‘In October 2016, Capita then formally reported the incident to NHS England and has continued to report on the issue. NHS England has not yet finalised its process with Capita for handling any correspondence that Capita receives in error.’

Last year, an NAO report found that nearly 2,000 patients could have been put at risk after failures by NHS Shared Business Services to pass on correspondence over five years when a backlog of 435,000 items came to light, triggering a ‘national incident’.

How the backlog of clinical correspondence came about

Until May 2015, GP practices were expected to forward correspondence for patients who were not registered with them to PCS centres for redirection – but this service was not built into Capita’s new contract, and GPs were expected to return misdirected mail themselves.

But the NAO found that ‘an unknown number’ of GP practices still sent mail to their previous PCS centres, and there is still a backlog of clinical correspondence amounting to almost 400,000 pieces. 

NHS England and Capita came to a contractual agreement for Capita to resolve the problems, with NHS England sending the correspondence out to the appropriate practices as part of its review.

However, the NAO said this review was ’paused’ in August 2017 due to patient notes being sent to a supermarket.