Clinical correspondence handling in the NHS Contents

1The scale and impact of the incident

1.On the basis of a Report by the Comptroller and Auditor General, we took evidence from NHS England on clinical correspondence handling in the NHS.1 Clinical correspondence is a record of a patient’s interaction with a healthcare professional or service. It includes clinical papers, child protection notes, treatment plans and changes to a patient’s medication regimes. On occasions clinical correspondence is misdirected, for example when patients have changed GP practice or correspondence is sent to the wrong practice. In all such cases, the mail needs to be redirected to the correct recipient.2

2.Up to 31 May 2015, NHS Shared Business Services (NHS SBS) was one of a number of NHS and private providers responsible for redirecting correspondence about patients that was sent to the wrong GP. In March 2016 NHS SBS informed NHS England and the Department of Health that it had discovered a backlog of approximately 435,000 items of unprocessed clinical correspondence. NHS England declared a national incident as soon as it had discovered the backlog.3 We took evidence on this issue in October 2017 and issued a report on 29 November 2017. During the course of that inquiry NHS England informed us that it had discovered a new backlog of 162,000 items of clinical correspondence that had not been redirected. NHS England stated that a small proportion of GPs had not been complying with guidance and had erroneously been sending clinical correspondence and other material to Capita.4

3.NHS England is responsible for arranging primary care support services in England and for the process for redirecting clinical correspondence. In May 2015 NHS England introduced new arrangements and since that date GPs are to return misdirected correspondence to the sender. Capita is the current provider of primary care support services for NHS England but has no contractual responsibility for redirecting correspondence. At our March 2018 evidence session we examined how NHS England had allowed another backlog of unprocessed clinical correspondence to accumulate.5

The scale of the new backlog

4.NHS England told us in October 2017 that a small proportion of GPs had not been complying with proper practice and that, as a result, there were probably about 150,000 items of correspondence that needed to be returned to the correct GP. It added that there were also 12,000 items of unprocessed correspondence that transferred from NHS SBS to Capita as part of the transfer of primary care services.6 However, by July 2017, NHS England had identified a total of 277,000 items of mishandled clinical correspondence and, by November 2017, this had increased to 373,868 such items. Of these, some 27,172 of the 373,868 items needed to be returned to the relevant GP so that they could assess whether there had been any harm to patients. NHS England told the National Audit Office that the 150,000 figure represents the number of items of correspondence which it had identified for further triage at that point, having discounted other non-clinical correspondence items that had been identified.7 In March 2018 NHS England told us that it had, in fact, overstated the figure in October 2017, as there turned out to be only 30,328 items that required “clinical triage”.8

5.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. It said that following the NHS SBS incident, it had looked back at the processes used for the correspondence items not processed by NHS SBS on a “belt-and-braces” and “abundance-of-caution” basis. It added that it had also looked at whether GPs had been following the new processes for redirecting clinical correspondence and had identified the new pieces of unprocessed correspondence.9 However, the National Audit Office found that the new correspondence had in fact been identified by Capita and disclosed to NHS England in May 2016 and again in October 2016.10

The impact of the two incidents on patients

6.NHS England has identified a total of 1,132,043 documents that needed to be reviewed following the NHS SBS incident and discovery of the new backlog of clinical correspondence. So far, it has identified two cases where expert consultant review had concluded that patient harm cannot be ruled out.11 NHS England told us that in one of these cases, the GP has spoken to the patient about a referral that should have taken place. It said that in the other case, the patient is now deceased and NHS England is trying to find the family to inform them of the incident. It told us that it aimed to have dealt with that particular case by April 2018.12

7.Following clinical review, NHS England has ruled out the possibility of harm to patients for 1,016,378 of the 1,132,043 cases. However, there remain 1,821 outstanding cases where further information, such as clinical notes, is required before the review can be completed. There are also an additional 4,070 cases where NHS England has not yet gained the necessary patient consent to allow it to access the patient’s clinical notes.13 NHS England told us that, in most cases, the GP has attempted to make contact with the patient on a number of occasions, and NHS England has also written to all these patients by recorded delivery to ensure that they had the opportunity to ask for a review. It said that a note had been made on the medical records of these patients to prompt a review when they next contact their GP.14


1 Report by the Comptroller and Auditor General, Investigation into clinical correspondence handling in the NHS, Session 2017–19, HC 778, 2 February 2018

2 C&AG’s Report, para 1.1

3 C&AG’s Report, para 1–2

4 Committee of Public Accounts, Fourth Report of Session 2017–19, Clinical correspondence handling at NHS Shared Business Services, HC 396, 29 November 2017

5 C&AG’s Report, paras 2–3

6 Committee of Public Accounts, Fourth Report of Session 2017–19, Clinical correspondence handling at NHS Shared Business Services, HC 396, 29 November 2017; Q 6

7 C&AG’s Report, paras 7, 3.7–3.9

8 Q 64

10 C&AG’s Report, paras 4–5

12 C&AG’s Report, Qq 15–17




Published: 6 June 2018