Clinical correspondence handling in the NHS Contents

Conclusions and recommendations

1.NHS England understated the problem at our evidence session in October 2017 by not disclosing the full extent of the new backlog of clinical correspondence. NHS England told us in October 2017 that there were about 150,000 items of correspondence that needed to be returned to the correct GP, in addition to 12,000 items that transferred from NHS SBS. However by July 2017, it had actually identified a total of 277,000 items of mishandled clinical correspondence and, by November 2017, this had increased to nearly 374,000 items. NHS England now states that the 150,000 represented the number of items of correspondence that it had identified for further triage at that point, having discounted other non-clinical correspondence items that had been identified. However, NHS England should have told us about the full extent of the issue when it first disclosed the problem. It now says that, in fact, it overstated the figure in October 2017, as there turned out to be only 30,328 items that required clinical triage. Furthermore, NHS England led us to believe in October 2017 that the new cases of mishandled correspondence had been discovered as a result of checks that it had carried out following the NHS SBS incident. However, the new correspondence had in fact been identified by Capita and disclosed to NHS England a year before our October 2017 evidence session.

Recommendation: NHS England should write to the Committee in November 2018 and again in May 2019 with an update on:

2.NHS England has not communicated effectively with GP practices about how they should handle misdirected clinical correspondence. GP practices have been required to return misdirected correspondence to the sender since May 2015, but practices are still sending around 5,000 to 10,000 items to Capita each month in error. NHS England tells us that it has previously communicated the arrangements for handling misdirected clinical correspondence to GPs, but acknowledges that its previous attempts did not have the required effect. It is planning a new communication campaign from May 2018, three years after the new arrangements were put in place.

Recommendation: NHS England should set out in its November 2018 update what it has done differently to ensure that its planned communication campaign is more effective than the last, as well as the impact the campaign is having on reducing the volume of correspondence that GPs are sending to Capita in error.

3.NHS England expects to spend £2.4 million attempting to resolve misdirected correspondence because some GP practices are not handling clinical correspondence correctly. We recognise the pressures that GPs are under but nevertheless they do have staff that are responsible for providing administrative support. NHS England says that, because there is such a large number of practices that are not handling clinical correspondence appropriately, it is not realistic for it to use its powers to intervene in individual cases. In practice, it is not clear whether NHS England has the levers that it needs to ensure that GPs comply with the requirements. NHS England cannot yet identify the worst offending GP practices, but plans to analyse data on which GPs are not complying following its communication campaign in May 2018. It estimates that it will cost £2.4 million to review the new backlog of clinical correspondence for evidence of harm caused to patients as a result of the issue.

Recommendation: NHS England should report back to the Committee by November 2018 on what it is doing to identify consistently non-compliant GP practices and how it is going to work with GP representative bodies to ensure GP practices are following the correct correspondence handling procedures.

4.The problem got worse and remedial action for patients was delayed because it took NHS England too long to escalate the issue internally. NHS England first learnt about the new backlog of correspondence in May 2016, but the issue was not escalated internally until August 2017. It tells us that, between October 2016 and August 2017, its primary care support team reviewed the correspondence to understand the scale and nature of the issue, but that this “took them a fair while”. During this period, the size of the backlog grew as Capita continued to receive clinical correspondence from GPs in error. Capita and NHS England’s initial checks in November 2016 identified 170,000 items of clinical correspondence, but by November 2017 this had reached 373,868. NHS England recognises that the issue was escalated “rather belatedly internally” and is carrying out an internal review of what went wrong.

Recommendation: In its November 2018 update, NHS England should set out what it has done to ensure that issues and risks get escalated promptly in the future.

Published: 6 June 2018