Concerns with Primary Care Support Services – letter from NHS England

Please see letter below sent on behalf of Karen Wheeler, National Director: Transformation and Corporate Operations at NHS England in relation to concerns with Primary Care Support Services provided by Capita.

The letter is to brief stakeholders and contractors on the steps that NHS England are taking to hold Capita to account contractually and to drive them to improve service delivery. It also includes contact details for Capita, which may be useful for when issues require onward escalation by yourselves or your contractors.


Concerns with Primary Care Support Services

We know many of you 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).  This letter is to explain how NHS England is responding to those issues and holding Capita to account to drive improvements in services as swiftly as possible.

The contract with Capita started on the 1st 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 out-dated 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.

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.

When Capita took over the service, NHS England established a dedicated Service Management Team and regular monthly oversight and management processes to oversee the operational performance and transformational changes to the service. These include monthly Boards, chaired by a National Director, to review and hold Capita to account for operational performance and their transformation plans, and regular meetings with Capita’s Executive Team.  We also have continued the Stakeholder Forum we set up last year, to ensure that the views of stakeholders with respect to the operational service and transformational changes are heard.

Our management scrutiny and processes are underpinned by a number of robust contractual mechanisms designed to ensure that PCS services are delivered in line with our expectations.  These include applying Service credits where agreed performance targets across service lines have been missed.  We are already applying such regimes to Capita. There are also mechanisms to monitor and ensure compliance with information governance requirements and a 6-monthly user satisfaction survey which is part of the performance indicators.

Since April, when issues started to emerge, the national team have scaled up the operational management scrutiny such that there are now daily performance meetings. This is working to drive improvement, albeit not as fast as we would all wish. In May, Capita developed an Operational Improvement plan for the issues then experienced in the Customer Support Centre, medical records, supplies and ophthalmic payments. As a result we have seen significant improvements in the Customer Support Centre and supplies which are now largely recovered.  We have also seen improvements in medical records and ophthalmic payments though there remains more to do to.

More recently, issues have emerged in other areas, including managing the applications to the National Performers List, especially for trainees, the timely completion of patient registration transactions and the responsiveness of PCSE to emails.  These services are included in the daily performance meetings.  We have also been examining the escalations from practices and representative bodies to understand the areas of concern and priorities for action.

Local stakeholders have expressed frustration that they have been unable to get some issues addressed in a proactive and timely way.  We have, therefore, also commissioned an assurance review to look at the interfaces between PCSE and local stakeholders to ensure that robust mechanisms exist for the feedback and resolution of local issues and promote more proactive communications.  If you do have any issues with PCSE services the National Engagement team regional managers are there to assist.  A list of those people can be found here.  If a satisfactory resolution is not achieved, then you can escalate your concerns to NHS England’s Service Management Team.

We know that given recent experiences you may be concerned about further changes to the services. We are taking stock of the remaining planned changes, with Capita, to ensure their plans reflect learning from recent experience.  As a result, more time is being built into plans for testing and managing local transition.  We have also ensured there is greater stakeholder representation within the Project Boards which will oversee changes to each service line, to ensure that stakeholders have a strong voice to influence the design and implementation of future changes. We continue to speak to representative bodies to ensure the most appropriate involvement.  Additionally, service users can sign up to a User Panel to input to the design and testing of new services.

NHS England apologise, on behalf of Capita, for the service they have provided. We can assure you that addressing these issues quickly is a significant and urgent priority for our national team and Capita.  We are confident that our scrutiny and oversight is helping to drive Capita’s recovery across all service lines.  We do expect you to continue to see improvement and a recovered service over the next few weeks.

Letter to HoPC regarding PCSE 22 August 2016 – printable version