"There’s nothing at all that reassures me this isn’t going to be an absolute bloody disaster." That was the response of GPC contracts lead Dr Robert Morley in July 2014 when it was announced that NHS England was outsourcing primary care support services to save cash.
Two years later, stories of delays and missing patient records are continuing after the private company Capita won a £330m contract to provide primary care support services in April 2016 – with the budget cut by 40%.
Now, a Pulse survey of more than 500 GPs and practice managers can reveal the full administrative challenge practices are facing. GPs report missed referrals, delayed care and having to cancel clinics due to patient records not being available or delayed supplies.
In one case a practice was reported to the Information Commissioner’s Office for being unable to provide records, while another could not fulfil a court order because two patients’ records were missing. Another had to wait 15 days for a violent patient to be removed from its list.
Capita says it is improving its systems, now moving records within three to six weeks, and fulfilling "more than 90%" of clinical supplies orders placed in August.
But many of the problems that began four months ago remain. There is a major backlog of unprocessed records, new NHS numbers not being issued quickly enough and practice payments are delayed.
Patients at risk
The GPC passed a vote of no confidence in Capita in July, with chair Dr Chaand Nagpaul stating the problems are "putting patients at risk"and causing "serious disruption" to practices. Even NHS England says it is "disappointed" in the service, and is "vigorously holding Capita to account".
Pulse can reveal the number of patient records that needed to be processed every week was substantially underestimated. An internal graph, obtained by Pulse and verified as correct by Capita, shows NHS England had estimated around 800,000 patient records would have needed processing by June.
The actual number was closer to a million. But even at NHS England’s low estimate, Capita would not have been able to cope by June, as it was only able to handle 500,000 records.
Capita claims it has made improvements, such as using larger vans and additional routes and testing a new system to track the notes. It says it is now moving records from A to B in three to six weeks – which complies with the previous standard for non-urgent transfers.
But the backlog at distribution centres is taking time to clear. Around 85% of GPs and practice managers Pulse surveyed say they are still waiting on an average of 90 patient records, while 40% say they continue to hold a backlog of uncollected notes. And all of this is occurring as we approach the time when students traditionally register with new practices.
Capita has also taken on responsibility for processing registrations for new patients arriving from abroad, and who have no NHS number. But around 50% of GPs and practice managers in the Pulse survey say they are waiting for registrations to be confirmed.
The company says these processes are "improving daily" and all new registrations will be completed by the end of the summer, but this is proving a real headache for practices unable to refer patients for investigations for tests or for screening such as smear tests.
Problems with medical supplies have persisted; 33% of GPs and practice managers told Pulse their practice was experiencing delays, forcing them to "borrow, swap and be" supplies such as FP10s, needles and sterile cups. And 18% of all respondents said patient care had been affected .
Again, Capita claims improvements. "Over 90% of orders placed this month have been fulfilled", says a spokesperson, although they admitted the remaining orders are "awaiting stocks from suppliers".
Missing payments are also a big issue. Capita acknowledges "some delays in some payment processes, which we are working hard to address". But some 32% of respondents to Pulse’s survey said they had faced missed or delayed payments, such as rent and superannuation.
GPC sessional lead Dr Zoe Norris told Pulse missing contributions and seniority payments were "a huge issue" for locums in particular. She advised all GP locums to keep copies of superannuation payments and send them by recorded delivery.
GPC practice finance spokesperson Dr Ian Hume – who is leading on the issue – says there has been progress, but adds: "The feedback we’re getting from practices and LMCs is they don’t perceive it to be better. Some of the data from Capita shows things are moving, but still not as far as I would like."
NHS England has pledged to "hold Capita to account" for the disruption. A spokesperson says: "Cutting administrative back-office costs by 40% has freed up tens of millions of pounds for reinvestment in frontline NHS care, but Capita needs to deal with these issues so primary care is properly supported."
But an additional concern is that Capita is planning further overhauls in support services affecting GP practices.
In 2017, it is due to overhaul practice payments and pensions systems, and applications to the performers lists – with both systems accessed and managed online. Capita will also introduce a new service to administer breast and cervical cancer and other screening programmes next year.
And then there’s national list-cleansing drive, to root out "ghost patients". The GPC demanded the rollout of this be paused pending discussions after Pulse revealed NHS England had included this responsibility in the Capita contract.
Last month Pulse revealed claims from LMC representatives for West Sussex that individual practices had up to 15% of patients mistakenly flagged for removal via the FP69 process. Capita says the problem was "rectified quickly" and had "no impact to the delivery of patient care". But the precedent is concerning.
Capita may be starting to improve, but it appears to have a long way to go before it will have practices’ full confidence.
Changes to come
System for moving records
Autumn 2016. Capita’s "bag and barcode" system for moving records is due to roll out nationally later in the autumn, and is likely to increase practice workloads
Late September/October. A big spike in new registrations may affect the national record movement, and worsen the backlog in registering overseas patients
Overhaul of screening
April 2017 onwards. Next year, Capita is going to test automated systems for a national service for supporting NHS screening programmes
April 2017 onwards. Launch of online portal for managing practice payments, the performers list and pensions
GP list cleansing across England
Capita will target patients who haven’t contacted their GP for five years, overseas patients who first registered a year ago, or patients at an address where several are registered with the same practice