Primary Care Support Services provided by Capita
1. Introduction Official We know that many stakeholders have been experiencing significant issues over recent months with the primary care support (PCS) services provided on our behalf by Capita, under the name Primary Care Support England (PCSE). We are sorry that practices and primary care contractors have experienced problems with these services. We can assure you that NHS England takes these performance matters very seriously. We recognise that Capita has not been providing the standard of service that both we and you should expect, and my team has been working with Capita to affect improvements to address the underlying problems causing the issues. We assure you that this does not reflect the standard of service that Capita were commissioned to provide. This briefing has been prepared for the meetings of the delegated Primary Care Commissioning Committees held in public to explain how NHS England is responding to those issues and holding Capita to account to drive improvements in services as swiftly as possible. 2. Background The contract with Capita started on 1 September 2015 and involves Capita transforming PCS services over the early years of the contract. These services were previously delivered through local offices with significant variation across the country, and under-pinned by outdated technology at the end of its useful service life. The service has badly needed modernisation and improvement to provide users with much more consistent and effective services, which are also financially sustainable. The contract is saving the NHS and taxpayers tens of millions of pounds a year for reinvestment in frontline NHS care. Since the contract started there have been a range of changes towards achieving a national service including: standardising work in national PCSE delivery centres; creation of a new Customer Support Centre to handle telephone and email enquiries; a PCSE website has been launched; a portal for primary care contractors to order supplies has been implemented; a new approach to the movement of medical records is being piloted. While some of these changes have been delivered effectively, we recognise that some have resulted in significant operational issues which have impacted your services. NHS England has been challenging and working closely with Capita over recent months to address concerns and improve the performance of the service. Progress in many areas has been made but we know that these improvements are not yet being consistently experienced. 3. Supporting Improvement NHS England is committed to supporting Capita in resolving all the issues with current service delivery. Capita are taking significant steps to bolster their operational capacity and capability within PCSE, and reviewing their processes. A new chief operating officer is now in post to oversee implementation of the operational improvement plans and ensure root causes are addressed to restore the on-going stability of the services. Capita have accepted the service is unacceptable and reconfirmed their commitment to make every effort to recover services with urgency. To assist them in this recovery, a team of NHS England experts has been embedded and are working alongside the Capita team to help advise, provide necessary business knowledge and more quickly identify and resolve issues. This team of senior staff is led by myself, Jill Matthews, who previously managed the primary care support service for NHS England.
We now have regular detailed reviews of the services with Capita to hold them to account and ensure that every possible effort is being made to deliver the improvements that are needed. We have recently met with representatives of the BMA GPC to keep them apprised of developments and the steps NHS England are taking to hold Capita to account and improve performance. We are also communicating, on a regular basis, with other membership bodies, NHS England Heads of Primary Care and Communications Leads about progress. Whilst we appreciate and regret the disruption these issues have caused for practices, we are confident that the recent short-term difficulties caused by the changes should be more than offset over the medium-term by the efficiencies and improvements which will be delivered through this new contract. 4. Service Line updates 4.1 Movement of medical records Capita have introduced a weekly records collection and delivery service for all GP practices in England with a new national courier provider, City Sprint. This new national process has had difficulties bedding in and is currently taking longer to move records through the system than it should or will in the future. NHS England has been ensuring Capita takes actions to recover service performance. Capita have brought in extra resources to improve processing speeds and worked with CitySprint to improve their service. This has included providing larger vehicles on routes to enable more records to be moved and putting on additional routes so that all practices receive regular collections and deliveries. We are now seeing much improved processing and delivery times so practices should be seeing smoother movements for records transferring between GP practices. This should avoid practices receiving large volumes of records at one time. The retrieval of records from suspense is being slowly increased, so again this should avoid large volumes arriving at one time for any individual practice. In addition, Capita has started to make changes to some of the CitySprint collection / delivery routes. These route changes, which will affect the day on which around 30% of practices are visited, will help address the issues that some practices have experienced due to them being closed when the CitySprint collection/deliveries take place. Capita will also considerably reduce the number of practices visited on some routes to ensure that all practices receive a regular weekly records collections / delivery and supplies delivery service. Where there is a change to a practice collection / delivery day, or move from a morning to an afternoon slot or vice versa, Capita have already contacted each practice main contact this week to advise them of this. The distribution of MREs for patients registering with a GP practice for the first time (i.e. babies and new entrants to the NHS) will recommence shortly. PCSE will also send a confirmation letter of registration directly to the patient s home address. Practices will receive new MREs for patients registered since March 2016 in a separate drop off to their normal records collection and delivery. Practices will then start receiving new MREs on a regular basis, as part of their usual CitySprint records collection and delivery. Further information will be provided in PCSE s November GP Update and on the website.
4.2 National Performers List Primary Care Support England (PCSE) is responsible for administering entry and status changes to the National Performer Lists on behalf of NHS England. For new trainees, they apply to join the Performers List at the commencement of their training at which point there is a three month grace period for them to join the Performers List. The process is necessarily detailed and involves a number of parties and a face to face interview. Trainees are able to practice during this grace period. GP Trainees legally cease to be trainees when the GP registrar achieves their Certificate of Competed Training and the GMC register is updated. NHS England policy requires GP Trainees to provide evidence that they have completed their training and complete a change in status form, enabling PCSE to update their status on the National Performers List. The administrative change in status is a relatively simple process, and whilst this is taking place, assurance that a trainee has completed their training can be obtained by checking the GMC register or liaising with Health Education England. This mitigates the potential for any delays in completing the administrative change from impacting on a registrar s ability to start work. We have recently been made aware of some delays in processing applications to join the National Performers Lists, such as for new trainees. The decision to admit or decline an applicant to the National Performers List is the responsibility of NHS England, and at the discretion of the local Responsible Office to consider the information and circumstances presented in reaching the decision and any conditions attached. We are working closely with Capita to identify all cases which may be affected by delays in processing applications. Those identified are being investigated and any urgent cases will be prioritised. PCSE will be directly contacting any applicant who is affected and will advise the relevant Responsible Officer with all the supporting information to allow them to determine the most appropriate next steps. The current cohort of GPRs (August 2016) have now been accepted onto the performers list. This has been confirmed to them by email. The performers list website is being updated and the GPRs will receive a formal notification of inclusion letter when this is completed. PCSE have also reviewed processes and increased capacity to speed up the processing of applications so that they are progressed in a timely manner. Addressing the outstanding issues around the National Performers List process remains a key focus. A weekly National Performers List panel has been established to address the most urgent applications. NHS England and Health Education England are also accelerating a change to legislation which requires GP registrars (trainees) to be admitted to the National Performers List. Once in place, this will further lift the administrative burden on applicants and it will support PCSE, NHS England Medical Directors and HEE to ensure that all applications are processed in a robust and timely way. We are working with the British Dental Association to establish the complete list of who should be on the National Performers List and should be joining now as they are newly qualified. We will be using this to rapidly assess who is already on the List, and will progress applications through specially convened local or national panels to ensure that all applicants are reviewed before the end of November.
In addition, we are also working with the College of Optometrists and the General Optometry Council, to establish the complete list of who should be on the National Performers List and should be joining now as they are newly qualified. We will be using this to rapidly assess who is already on the List and to urgently progress applications through specially convened national panels for those that are yet to join. We are being supported in this endeavour by local optometry advisors and LOCSU. We are more confident this service is now being managed, but continue to work with Capita to ensure all aspects of the Performers List process are given appropriate attention. 4.3 Payment to registrars There are delays in reimbursement of salaries and / or training grants in certain areas. This is as a result of gaps in the data PCSE have received and due to the high volume of individual queries. Capita are working with all parties involved to clarify the payment process for registrars and resolve the issues that have arisen as a result of some delays in reimbursement of salaries and/or training grants in certain areas. I appreciate the inconvenience these delays have caused individual registrars and apologise on behalf of Capita. PCSE is making urgent payments to practices who may be awaiting salary reimbursements. Additional checks are also being made to ensure all GP registrars who started in general practice in August 2016 have been set up on the payment system. 4.4 Supplies Capita introduced a new online portal for ordering supplies, such as prescription pads, needles and syringes, at the end of March. They experienced a much greater volume of orders than expected which led to difficulties with meeting orders on time. Capita put in place a recovery plan to address capacity and optimise the supply chain, so we return the service to one where contractors can receive supplies when expected, and realise the intended benefits of the new system. We are now seeing much better performance across the country: 96% of orders placed in August were delivered within 12 days. Primary care contractors are made aware if there are any issues with stock availability. We continue to press Capita to ensure the system and processes continue to be refined and improved. 5. Additional concerns If practices continue to have concerns, we suggest they telephone the contact centre in the first instance on 0333 014 2884. Improvements have been made to the contact centre and it is now operating a triage of all calls. If an escalation is required then practices and CCGs can raise these with the PCSE National Engagement Team local managers. A list of these people can be found at http://pcse.england.nhs.uk/net/. Jill Matthews, Managing Director Intensive Expert Management Team, Primary Care Support Services NHS England November 2016 End of briefing.