2Responding to the backlog of clinical correspondence
12.NHS England set up a National Incident Team (NIT) immediately after it was told about the backlog in March 2016. In April 2016 the NIT reviewed the unprocessed correspondence. High priority items, including cervical screening results and child protection notes, were assessed and returned to GPs as a matter of urgency, with a request that the NIT be told promptly if the patient had come to harm as a result of the delay. Lower priority items were sorted and returned to the correct GP practices by the end of December 2016. GPs were again asked to tell the NIT if any patients had come to harm as a result of the delay.13
13.NHS England agreed with the British Medical Association that GPs would be paid in advance for reviewing the backlog of correspondence. In doing so, NHS England broke with its own policy of not normally making payments in advance. In February 2017, NHS England paid a total of £2.5 million to 7,330 GP practices for the time spent assessing the potential harm to their patients.14
14.By October 2017, around 2,000 of the 7,330 GPs had not confirmed whether they had reviewed the clinical correspondence about their patients, despite NHS England having paid them to do the work. The unreviewed correspondence relates to over 100,000 patients. We were concerned to hear that NHS England has given up trying to find out whether there is any patient harm from those GPs who have not complied with the NIT’s instructions. NHS England told us that it discussed its approach with its national clinical leads and agreed that this was an appropriate response. The NIT has written to those GPs to inform them that it is assuming that they have reviewed the correspondence and identified no patient harm.15
15.By October 2017, NHS England had identified 5,562 cases from the 709,000 items of backlogged clinical correspondence which required further clinical review as there was evidence of harm suffered by the patient. Of these, the further review of 1,938 cases is not yet complete. These cases are awaiting a final clinical review to decide if the patients involved have suffered harm as a result of the delay. This figure excludes the items of correspondence where GPs have not responded to the NIT. The NIT aims to complete the process by the end of December. As yet, there has been no evidence that any patient has been harmed by the service failure.16
16.When dealing with the original backlog, NHS England relied on third parties to assure it that all material had been found. NHS SBS also used its internal auditor to check whether the process it had followed had successfully identified all archived materials. In September 2016, NHS SBS’s auditor concluded that it could provide reasonable assurance that all unprocessed correspondence had been found. However, when NHS England had its internal auditor check that the NHS SBS internal audit report was reliable, it said that there was no assurance that all misdirected correspondence held by the company had been identified. This was because NHS SBS had used a risk-based approach to a search of NHS SBS archives, not a finger-tip search. Despite this, NHS England did not order a further search.17
17.The overall cost of identifying and reviewing the backlog of 709,000 items is in the region of £6.6m. This sum may go higher as it does not include the cost of any potential future fines (for example, from the Information Commissioner) or negligence claims from patients who may have suffered harm.18
18.NHS SBS has agreed to cover NHS England’s costs in dealing with the original incident. This amounts to £4.34 million. It covers the £2.5 million direct payments for clinical reviews and £1.84 million of additional costs. However, NHS SBS is not paying any compensation over and above NHS England’s costs. In addition, NHS SBS is paying its own costs which it estimates at £2.26 million.19
19.Further service failure in the redirection of clinical correspondence
20.Since the C&AG’s report was published in June 2017, NHS England has reported a further 162,000 cases of misdirected correspondence that need to be reviewed. NHS England told us that it had identified 150,000 items of unprocessed clinical correspondence. It explained that even though NHS England’s contract with Capita for primary care support services does not include a mail redirection service, some GPs have mistakenly continued to send misdirected correspondence to Capita. The correct procedure is to return these documents to sender. NHS England estimates that around 5% of GPs are not adhering to the new process. NHS England has yet to ensure that GPs understand and follow the new process properly, though it accepts that it is NHS England’s responsibility to make that happen. It told us that these cases would be reviewed by GPs in the same way as the first backlog.20
21.NHS England has also found a further 12,000 items relating to correspondence that had not been processed by NHS SBS. NHS England told us that this additional backlog came to light as a result of a finger-tip searches of boxes of paperwork that had been sent from NHS SBS to Capita at the end of NHS SBS’ contract. The additional correspondence has since been held in Capita’s document management storage facilities. Capita had assumed them to be records for filing and therefore had not done anything with them.21
22.NHS England is continuing to search for further unprocessed correspondence. As a result, the number of patients impacted by the service’s failure to properly handle clinical correspondence may increase. NHS England told us that its search technique is “pretty rigorous” and includes searches in areas it would not have had a prior reason for thinking may contain such records. We welcomed NHS England’s committment to informing the Committee if any further cases are discovered.22
23.The National Incident Team (NIT) plans to assess all 162,000 additional items and return them to the relevant GPs. NHS England committed to having completed this process by the end of December 2017. GPs will be asked to review the documents and report if any of their patients have been harmed as a result of the delay. As with the original backlog, the NIT is prioritising the high priority cases. The NIT will then ensure that there is a more detailed clinical review of any cases where GPs think patients may have been harmed. NHS England estimate that the whole process will take until March 2018.23
24.NHS England expects to it will cost at least another £1 million alone to have GPs to review the further 162,000 items of misdirected clinical correspondence. The total cost will depend on how many more cases are found and how complex they are to resolve.24
13 C&AG’s Report, paragraphs 3.3, 3.6–3.9, Figure 5
14 Qq 103, 111–114
15 Qq 93, 95–99
16 Qq 1, 3
17 Qq 122–126; C&AG’s Report, paras 3.21–3.22
18 Qq 45, 115
19 Qq 45, 103, 115–116
20 Qq 6, 75, 80; C&AG’s Report, para 1.8
21 Qq 6, 59, 61
22 Qq 54, 59
23 Qq 6, 50–52; C&AG’s Report, Figure 5
24 Q 59
27 November 2017