2Impact of service failures, partnership working and engagement
Impact of service failures
12.Capita acknowledged that its execution of the contract was not good and it apologised unreservedly for this.22 Failure to deliver key aspects of primary care support services had a detrimental impact on patients, primary care services and primary care providers. For example, the service was disrupted by delays in processing new applications and making changes to the performers lists (confirmation that practitioners are suitably qualified to practice). This resulted in approximately 1,000 GPs, dentists and opticians being delayed from working with patients at a time when the NHS is in need of people to deliver patient care, and some lost earnings as a result.23 The British Dental Association told us that before Capita took over an application to be added to the performers list typically took about six weeks to be processed. After Capita took over, its members reported delays of five to six months, while some had to wait a year to get their application processed.24
13.Stakeholders also raised concerns about: missed and inaccurate payments to practitioners; backlogs of half a million patient registration letters; market entry delays for pharmacists; failures to deliver NHS stationery and medical supplies; and poor service from the customer support centre. A survey by the British Medical Association, carried out in December 2017, found that: 62% of respondents reported that urgent requests for patient records were not actioned in a timely manner; 64% reported that they had received incorrect patient records in the last three months; 73% reported the new medical records service had increased workload; and 51% reported incorrect pension deductions in the last twelve months. 25 Capita told us that it had not assessed what it has cost GPs, dentists and opticians and pharmacists to install new IT systems and train staff to deal with new processes, but noted that once new systems are introduced they should reduce the cost of the process for everybody.26
14.Some of the service failures have put patients at risk of serious harm. For example: delays in moving medical records impacted patients’ ability to access necessary care; 87 women were incorrectly notified that they were no longer part of the cervical screening programme; and inappropriate handling of patients on the violent patient scheme, which aims to provide a secure environment in which patients who have been violent or aggressive in their GP practice can receive general medical services, compromised patient safety.27 A review by one of NHS England’s Medical Directors, in December 2016, did not identify any situations where serious patient harm had resulted from these service failures but noted the full effect of these failures may not be apparent for some time. Immediately before our evidence session NHS England told us it was currently assessing an incident to identify whether there has been actual patient harm.28
The working relationship between NHS England and Capita
15.Capita’s chief executive told us that that partnership working is key to delivering contracts successfully. He noted that the most successful contracts are those where there is a strong alignment of objectives and key performance indicators between the contracting entity and the provider of the outsourced service. He added that there should be an environment in which either party can challenge the other about performance measures and assumptions about the contract and how it should be executed.29 NHS England also acknowledged that partnership working is extremely important in contracts such as this one, as there is no way that every eventuality can be foreseen and factored into the contract.30
16.However, NHS England recognised that it has not always been having the right conversations with Capita. By May 2018, two and a half years into the contract, basic elements of the contract between NHS England and Capita were still not agreed. For example, they have still had not agreed on 11 performance measures or how to calculate payments owed to Capita.31 There have recently been improvements in their partnership working with a resetting of the way the two organisations work together. This has included the introduction since March 2018 of senior-level meetings that witnesses told us are held on a monthly basis to assess performance against Capita’s remedial plan. Capita told us that they have now agreed seven of the outstanding performance measures, had an agreement in principle for two more, with two yet to be finalised.32
Engagement with stakeholders
17.Stakeholders told us that NHS England and Capita had not adequately involved practitioners in designing services to test whether plans would work. For example, the Optical Confederation and the Local Optical Committee Support Unit told us that they had repeatedly raised concerns with NHS England about service changes, but had been ignored, and tried to help identify workable solutions. The Optical Confederation and the Local Optical Committee Support Unit also told us that they are committed to working with NHS England to help deliver the modernisation of the payments service to opticians but “do not wish to be left shouting unheeded warnings from the side lines a second time”. 33
18.The British Medical Association told us that it has been engaging with NHS England to highlight the ongoing issues with primary care support services, and on several occasions, had been promised improvements. It told us that some progress has been made, but that services still fall short of what is acceptable and there is still an urgent need to resolve these issues to give practices and GPs confidence in the service.34
19.NHS England told us that there has been engagement with stakeholder throughout the process but accepted that some of this engagement had been only “lip service”. Capita also accepted that stakeholders had not been brought in to the process as much as they should have been. NHS England said it is now trying to make sure engagement happens early and that it listens and responds appropriately. Both NHS England and Capita said they plan to get key players, such as the British Medical Association, more actively involved in the future.35
22 Q 42
23 C&AG’s Report, para 10, figure 2; British Dental Association (CPC0007); British Medical Association (CPC0003); Norfolk Health Overview and Scrutiny Committee (CPC0002)
25 British Dental Association (CPC0007); British Medical Association (CPC0003); Norfolk Health Overview Committee (CPC0002); Optical Confederation and the Local Optical Committee Support Unit (CPC0004); British Dental Association (CPC0007); Royal College of General Practitioners (CPC0005)
26 Q 141
27 C&AG’s Report, figure 2; Royal College of General Practitioners (CPC0005); British Medical Association (CPC0005)
28 C&AG’s Report, para 10; NHS England (CPC0009)
29 Q 54
30 Q 133
31 Qq 41–42, 126, 129; C&AG Report, para 16
32 Qq 41, 56–61, 71, 102
35 Qq 62, 146
Published: 25 July 2018