Clinical correspondence handling in the NHS Contents

2NHS England’s handling of the incident

Communicating the arrangements for handling clinical correspondence

8.Since May 2015, GP practices have been required to return clinical correspondence about patients that are not registered at their practice to the original sender. However, practices are still sending around 5,000 to 10,000 items to Capita each month in error. NHS England told us that it has previously communicated the arrangements for handling misdirected clinical correspondence to GPs, but acknowledged that its previous attempts had not had the required effect.15

9.NHS England said that it is planning a new communication campaign from May 2018 to ensure that GP practices understand the requirement to return misdirected correspondence to the sender. It noted that it was particularly important that administrative staff working in practices understood this requirement. NHS England said it would not be possible to carry out a targeted campaign, as too many GPs are not following the correct procedure. However, it noted that there are plans to introduce a tagging system which will enable it to produce data on the movement of correspondence, and to be more targeted in its communications in the future.16

Action taken by NHS England in response to non-compliance by GPs

10.NHS England acknowledged that there was a widespread problem with GP practices not handling clinical correspondence appropriately. It told us that it cannot yet identify the worst offending GP practices, but plans to analyse data on which practices are not complying following its communication campaign in May 2018. It said it would share data on the worst offending GP practices with local offices and clinical commissioning groups that manage its relationship with GPs.17

11.NHS England told us that because non-compliance is widespread, it is not realistic for it to use its powers to intervene in individual cases. It said it may make use of these powers if it could reduce the number of non-compliant practices.18 In our November 2017 Report we commented that NHS England had given up trying to find out whether any patients had been harmed simply because 2,000 GPs had not confirmed that they had reviewed correspondence about patients, despite receiving payments for the work.19 In response to our questions about whether NHS England has the levers to intervene where GPs had not provided the necessary information, NHS England was reluctant to identify any additional powers it might need. It responded that in this particular incident, it did not need more levers as the “vast majority” of GPs had done what was asked of them.20

Escalating the issue

12.In May 2016, Capita informed a member of NHS England’s primary care support team that there was a problem with an unquantified accumulation of “clinical notes” (a term which can refer to a range of material, including clinical correspondence). In October 2016, Capita flagged the issue again in a report to NHS England. However, NHS England told us that the incident was not escalated to its senior management team and Chief Executive until August 2017.21

13.NHS England told 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”.22 NHS England had already established a separate National Incident Team (NIT) in March 2016 to process the backlog of correspondence that had been identified in NHS SBS, but the new items of correspondence were not transferred to the NIT until September 2017.23 NHS England told us that the reason for the delay was because most of the correspondence related to current material and NHS England’s response was to try to fix the process that was in place for dealing with such correspondence.24 NHS England recognises that the issue was escalated “rather belatedly internally” and is carrying out an internal review of what went wrong.25

14.During the period before the issue was escalated, 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 estimates that it will cost £2.4 million to review the new backlog of clinical correspondence for evidence of harm caused to patients.26


15 C&AG’s Report, paras 2, 11; Q44

16 Qq 41–45

17 Qq 45–48, 51; C&AG’s Report, para 9

18 Q 51

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

20 Qq 54–60

21 C&AG’s Report, paras 4–5; Q 66

22 Q 67

23 C&AG’s Report, para 3.5

24 Q 69

25 Q 74

26 C&AG’s Report, para 6, 3.8, 3.12




Published: 6 June 2018