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NHS England outsourced primary care Capita deal a ‘complete mess,' PAC says

NHS England’s outsourcing of primary care support services was short-sighted, disruptive to thousands of medical professionals, and had the potential to put patients at “risk of serious harm,” MPs have said today.

A report released by the Public Accounts Committee (PAC) – just a few months after a similarly critical investigation by the National Audit Office – found that neither NHS England nor Capita understood the service that was being outsourced and both “misjudged the scale and nature of the risks.” Once issues arose, not enough was done to mitigate the impacts.

Capita was granted the seven-year £330m primary support contract in 2015. It was expected to run administrative care providers with the aim to cut costs by a third and improve the efficiency of services.

But the scathing PAC report found that savings targets were a “high-risk” approach, with neither side understanding how it would work and with no considerable data on the volume, cost, and performance of services for the outsourcing plan to achieve desired results.

“NHS England nor Capita did enough to gather the necessary information, assess the risks or test whether Capita would be able to deliver the service to a good standard,” it said.

“The short transition period between Capita signing the contract and making changes to the service meant there was no time to identify the many unknowns.”

The damning document went on to argue that NHS England focused on maximising financial savings quickly, at the expense of service quality, and Capita’s performance indicators were focused on speed and efficiency rather than quality.

The private giant’s failure to deliver back-office functions— including poorly implemented primary care ordering systems, which left GPs without notepads and syringes— resulted in around 1,000 GPs, dentists and opticians being delayed from working with patients, some losing earnings as a result. The committee also noted that stakeholders raised concerns about missed and inaccurate payments to practitioners, and a backlog of half a million patient registration letters.

Further back-office issues included delays in moving medical records which impacted patients’ ability to access necessary care, leaving 87 women incorrectly notified that they were no longer part of the cervical screening programme – yet the report found that “no actual harm” had been identified.

Committee chair Meg Hillier said: “NHS England made a complete mess of what could have been a responsible measure to save taxpayers’ money. It is clearly unacceptable that poor procurement should put patients at risk of harm and undermine the ability of GPs, dentists, opticians and pharmacists to do their jobs.

“As we have seen time and again, take away the pillars of best practice and there is every chance a contract will collapse—at the expense of taxpayers and service users. Central government must show leadership and ensure government departments and agencies do the job properly.”

A Capita spokesperson said: "Capita has apologised for unacceptable failings in relation to the initial delivery of this contract. We are now meeting the vast majority of key performance targets, and have put in place a new governance arrangement with NHS England to ensure improvement continues.

"Capita is committed to delivering this contract and its vital purpose: digital transformation for NHS support services that were previously paper-based, fragmented and without national standards. We are focussed on delivering a 21^st century digital service that works for NHS practitioners."

An NHS England spokesperson said: “We will continue to work with medical professionals and Capita to resolve the historic issues which this look-back report reviews, but by making this change over the past two years, the NHS has successfully saved taxpayers £60 million, which has been successfully reinvested in frontline NHS patient care, funding the equivalent of an extra 30,000 operations.”

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