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NHS outsourcing 'put patients at risk'

17 May 2018

The National Audit Office's (NAO) report looks in detail at the process by which Capita procured Primary Care Support England (PCSE) services in September 2015, the problems that have arisen since and the impact that these have on patients and practitioners. In 2016, delays in processing new applications for the lists resulted in around 1,000 Global Positioning System, dentists and opticians being unable to work.

But as well as attempting to modernise the service, Capita closed 35 of the 38 support offices and cut staff numbers from 1,300 to 660 in around a year.

It's clear that Capita prioritised money over service and were incentivised by the contract awarded by NHS England to close support offices and cut staff as quickly as possible regardless of the problems that were quickly developing.

Although no actual harm was identified, the NAO said administrative issues including 87 women being notified incorrectly that they were no longer part of the cervical screening programme had occurred.

"Neither NHS England nor Capita properly understood the scale of the challenge before agreeing the contract and are still in dispute over future payments".

So far NHS England has deducted £5.3m from payments to Capita as penalties for poor performance but expects it may have to pay up to £3m in compensation to primary care providers. But the service has suffered a number of set backs including doctors reporting problems with the transfer of medical documents, and problems caused by shortages of stock in the NHS supply chain.

Dr Richard Vautrey, of the British Medical Association, said Capita's service was 'poorly thought-out and woefully-run'.

The NAO acknowledged that Capita's self-reported performance had improved.

Earlier this year, the NAO criticised NHS England and Capita over the backlog of 162,000 undelivered items of clinical correspondence.

Both Capita and NHS England underestimated the scale and nature of the task of transforming services. But they questioned whether some of the services should be taken "in-house".

He added that value for money was about more than just cost reduction. "Hundreds of NHS dentists have been unable to provide care for patients, or support their families, because officials were fixated on quick savings".

Public Accounts Committee chair Meg Hillier said: "Trying to slash costs by more than a third at the same time as implementing a raft of modernisation measures was over-ambitious, disruptive for thousands of doctors, dentists and pharmacists and potentially put patients at risk of serious harm".

"It is deeply unsatisfactory that, two and a half years into the contract, NHS England and Capita have not yet reached the level of partnership working required to make a contract like this work effectively".

A Capita spokeswoman added: "The report notes that several organisations and legacy issues all contributed to underperformance".

The report said Capita "acknowledges that it made performance issues worse" when it continued to close support offices in the summer of 2016 "even though it was aware" its customer service centre "was struggling to meet demand".

"PSNC wrote to NHS England in July 2016 expressing its dismay at Capita's services and seeking remedial action; at that point we had many reports of services operating at well below acceptable standards, and this is echoed by the NAO report".

NHS outsourcing 'put patients at risk'