A National Audit Office (NAO) report has criticised NHS England (NHSE) and outsourcing company Capita for jeopardising the safety of patients following serious failures in the provision of services.

The report claimed neither NHSE or Capita fully understood the level of service and performance standards needed to ensure patients were not put at risk of harm. Three years ago Capita was contracted by NHSE to provide primary care support services, a £330 million seven-year deal that covered payments to pharmacies, GP practices and opticians, the administration of pensions of GPs and changes to the lists of health practitioners to ensure they are suitably qualified and have passed the relevant checks.

The NAO found that NHSE attempted to reduce its costs by 35% from the first year of the contract to modernise the service but did not know enough about the services it inherited to set achievable service levels and performance standards.

NHSE’s decision to contract Capita to run the existing services and at the same time try to transform those services was also described by the report as “high risk.”

Its findings were damning. Capita’s failure to update the list of 37,000 qualified practitioners may have harmed patients “in cases where practitioners should have been removed” while 87 women were incorrectly told they were no longer part of the cervical screening programme.

Delays in processing new applications for the list of qualified practitioners resulted in about 1,000 GPs, dentists and opticians being unable to work, with 200 applicants so far seeking to recover loss of earnings from NHSE.

The PSNC, who raised concerns about pharmacy services being provided by Capita in a letter to NHSE in 2016, said: “Investigators found that only 41% of pharmacy market entry applications were processed within 70 days in November 2017 which, in one case, meant a pharmacist was unable to retire.”

The report produced five reasons for the failures;

• Capita underestimated the scale and nature of the task.
• NHSE’s performance measures did not cover all the service areas Capita was required to deliver.
• NHSE’s assessment of the contract focused on the financial savings target and failed to adequately assess the risk of Capita failing to provide the service to a good standard.
• NHSE did not have the contractual mechanisms to intervene in some of Capita’s service changes.
• NHSE’s ability to hold Capita to account was limited because the basic principles about the contract were not agreed.

NHSE said the arrangement had saved £60 million over the last two years despite the difficulties. A Capita spokeswomen told the BBC: “The report notes that several organisations and legacy issues all contributed to underperformance.

“It has been acknowledged that performance has improved and Capita will continue to work with all parties to address the small number of remaining service issues.”

The report offered seven recommendations;

• Determine whether all current services within the Primary Care Support England (PCSE) contract are best delivered through that contract or whether some should be taken in-house by NHS England.
• Agree with Capita performance indicators and targets, and also the data sources and assurance mechanisms which need to underlie these indicators.
• Prioritise the stabilisation of existing services when rescheduling transformation programmes.
• Secure user engagement in advance of service changes.
• Pilot significant transformation changes effectively.
• Create a joint risk register which would more thoroughly set out dependencies, mitigations, responsibilities and required actions.
• Improve its management of the factors which influence the overall performance of PCSE, which are outside Capita’s control.

Gordon Hockey, director of operations and support at the PSNC, who contributed to the NAO investigation using evidence gathered from contractors and LPCs, said: “The conclusions of the NAO will come as no surprise to the many community pharmacies and LPCs who have reported problems with PCSE services provided through Capita.

“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.

“We are pleased our work to raise the matter and push for improvements has had some impact, with services generally improving since 2016, but we will continue to work closely with pharmacies, LPCs and Capita to ensure this continues. We must have confidence that PCSE is offering a consistently good service to pharmacies across the country.”

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