A number of support services in the NHS are outsourced to private companies, this includes hospital maintenance and a large amount of administration, such as letters for cancer screening programmes. All this work is vital for the smooth-running of the NHS and for patient safety and when it goes wrong then patient safety can suffer. One of the most notorious contracts with a private company is the primary care support services contract, which was awarded to Capita.

Capita took over the coordination of primary care support services in September 2015. The contract with NHS England was designed to save £40 million per year by bringing together a previously fragmented service to a single national provider for Primary Care Support England (PCSE). Capita’s bid hinged on making a £21 million per year saving. The contract is worth £330 million over seven years. Capita immediately began centralising support services to three national hubs and implementing a single online ‘portal’ for practices to order supplies and ‘track’ the movement of patient records.

However, since the contract began there has been an never-ending series of problems – ranging from things as mundane as surgeries running out of prescription pads and syringes to far more serious problems with the secure transfer of patient notes around the country, with notes going missing or delivered to the wrong surgery, and women being dropped from the cervical cancer screening programme. The problems encompassed GPs, dentists, opticians and pharmacists. The most recent issue, which surfaced in mid 2018, was that Capita had failed to send out nearly 50,000 letters as part of the cervical cancer screening programme and although the company discovered this issue in August 2018, it neglected to inform NHS England of the issue for two months.

A campaign by the GPC (General Practice Council) has been ongoing since early 2016; in May 2016 chair of the GPC Dr Chaand Nagpaul wrote to NHS England demanding practices be compensated for extra workload due to the ‘systematic failure’ of PCSE, and indemnified against any claims as a result of support service issues. In September 2016, NHS England had to intervene, serving default notices on Capita and increasing the numbers of staff.

In November 2016 the GPC reported that the support services remain a ‘chaotic mess’ despite nearly a year since the services were outsourced to Capita.

Finally, in May 2018 the National Audit Office (NAO)  produced a report on the contract noting that patients had been “put at serious risk of harm” due to Capita’s failures. The report  noted how both parties grossly underestimated the size and complexity of the task and the risks involved. The NAO report was particularly critical of NHS England and its inability to control Capita’s “aggressive” programme of office closures and redundancies, even when it became clear “it was having a harmful impact on service delivery”. In response NHS England highlighted the £60 million the contract had saved; the NAO report noted that the extent of harm to patients will not be known for some time to come.

In an excellent analysis of the contract by Richard Vize in The Guardian, he notes that the contract was “a textbook example of how to set up an outsourcing contract to fail. Pretty much everything that could have gone wrong went wrong.”

Under the contract Capita was expected to make massive losses in the first two years in return for later riches. Vize notes that “With a big upfront loss, Capita had a massive incentive to cut costs quickly, so by the end of 2016 it had shut virtually all the local offices it had inherited and halved the staff. Vital local knowledge was lost.”

Furthermore, as things went wrong, Vize notes how everyone argued rather than focusing on fixing the problem. Capita is reported to have lost £125m in the first two years – double the target and Capita and NHS England are still arguing over the contract. The NAO notes: “two and a half years into the contract basic principles are still not agreed, which limits NHS England’s ability to hold Capita to account. NHS England and Capita have still not agreed how to calculate 11 performance measures, and how these data should be used to calculate payments owed to Capita for delivering the services.”

One of the ways patients could potentially have been put at risk was the problems with the “performers list” of GPs, dentists and opticians practising in the NHS, including whether they are suitably qualified and have passed other relevant checks. According to the NAO report, problems with the list also led to around 1,000 GPs, dentists and opticians being unable to work, 200 of whom have sought money for lost earnings.

Another part of the contract was pensions administration for GPs. Delays have been reported to the payment of pensions as well as confusion surrounding many of the administration processes for the pensions. Despite Capita being in charge since 2015, in April 2018 there were still many ongoing issues.

Capita have had long standing issues with payroll and pensions nationally, in 2016 they were a year late submitting Barnet Council’s pension scheme to the Pensions Regulator, resulting in a fine.

Problems are still ongoing with the contract, the NAO notes that “users continue to experience poor delivery with seven severe service failures in February 2018.” In mid-2018 the issue of Capita’s failure to send letters as part of the cervical cancer screening programme came to light.

Dr Richard Vautrey, chair of the BMA’s GP committee, said his members want elements of the service to be taken back in-house. “With this as an option, we are now asking NHS England how it plans to resolve the shambles that is Capita’s running of Primary Care Support England,” he said. The NAO also recommends that NHS England should determine whether all current services within the contract are best delivered through that contract or be should taken in-house by NHS England.

There have also been issues with other support services, such as cleaning and wheelchair services.

See below for further reading on contract failures.

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