General Practitioners Committee General practitioner Patient and public Practice manager England

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Practice support services England

Capita has been responsible for the delivery of NHS England's primary care support services since 1 September 2015, under the name PCSE (Primary Care Support Services England). GPs and LMCs identified serious issues with the service from the outset, with patient safety, GP workload and GP finances being affected.

GPC has been meeting with NHS England and Capita to highlight the ongoing issues, and some progress has been made following our lobbying. However, services still fall short of what is acceptable and there is still an urgent need to resolve these issues to give practices and GPs confidence in the service.

The latest actions that GPC has taken to resolve this include writing to Simon Stevens, Chief Executive of NHS England, to highlight ongoing issues with PCSE. We have also undertaken a survey so that we understand the full extent of problems which will be used to inform our regular discussions with NHS England and GPC, has set a deadline of the end of December 2017 for the below pending issues to be resolved. For more detail on how things have progressed, please see the below section ‘What GPC are doing’.

 

Ongoing Capita issues

The main ongoing issues which we are pushing NHS England and PCSE to resolve are as follows:

  • Patient registrations - delays and faulty processes in both registration and patient removals is affecting patient care and practice cash flow.
  • Medical records - significant delays to the movement of medical records for various reasons including labels not being provided and patients’ records going missing delaying patient treatment in some cases.
  • Management of the performers list - mistakes in updating the local Performers list resulting in some GPs being temporarily unable to work with increasing delays for patients.
  • Performers List Data and LMC Payments - LMCs are still not receiving data about new entrants to the performers list in their area, which is making it difficult for them to discharge their statutory representative functions to their constituents. Similarly, ongoing problems with LMC levy collections and payments is destabilising for LMCs.
  • Pensions - significant issues with the processing of pension contributions leading to cases of incorrect records of pension contributions. Practices have also reported a series of issues with the processing of pension payments, such as no receipts received, pension contributions being taken for doctors that have long since left the practice, GP trainees not being added to the scheme in a timely manner and superannuation certificates not being shared.
  • GP payments - some GP training practices have not yet received their training grants and trainee pay reimbursements, and are having to fund the shortfall from elsewhere. Practices are also not being properly paid/reimbursed for other elements of the services provided, for example enhanced services. Or when they are, there is often uncertainty over what they have been paid for as there is no clear breakdown of payments.
  • General communications - we are aware from LMCs, practices and individuals that queries are not being dealt with in a timely manner, if at all, and the complaints process is not fit for purpose.

 

PCSE claims guidance

We are aware that practices and individual GPs continue to experience unacceptable incidents relating to PCSE (primary care support services in England), commissioned by NHS England and provided by Capita.

The issues have been ongoing for some time and we are aware of cases where practices have not received payments, or have received incorrect payments. It is never acceptable for payments to be delayed and we advise practices to follow the below process to ensure incorrect payments are corrected.

Similarly, we are aware that practices or individual doctors may have suffered losses due to the failing of these services and again we advise to follow the below process.

 

Process

1. If a practice or individual has any issue due to the service provided by PCSE, such as delays or errors in payment, they should contact PCSE in the first instance to resolve the issues [email protected], or you can make a complaint to PCSE by emailing [email protected].

2. If the issue is not resolved by PCSE in a timely manner you should contact NHS England to make a claim at their designated email address [email protected].

Every case is different, and the BMA cannot advise on individual cases, however we suggest that you include the following details in your email:

  • Your name and address (or the name of the practice and its address)
  • The reason for your claim
  • A clear explanation of the facts
  • What losses are you are claiming (these may be direct losses such as your contractual payments, or indirect losses such as costs incurred as a result of having to take out a loan to pay for practice expenses)
  • Attach any supporting documents which verify the facts in the letter and the amount claimed
  • A date by which you want a full response - we recommend 28 days
  • Any other relevant information

NHS England should then be in contact about your claim. You should note that by accepting an offer of compensation it could mean you forego the right to seek any further redress, so please consider fully all losses that you suffered as a result of failings by PCSE.

If you cannot reach agreement with NHS England over your claim, please contact GPC England ([email protected]) and we can escalate the issue on your behalf. Please include the previous correspondence and a clear outline of the issue and the desired outcome.

You may also wish to consider taking up your claim via the small claims court, however not all claims are suitable for this route.

See guidance on bringing a small claim to the court

If you are unsure about the terms of any offer or your legal rights you may wish to seek independent legal advice, however, depending on the financial loss you have suffered, this may not be financially prudent.

BMA Law offers expert legal advice at preferential rates for BMA members. They can be contacted on [email protected] or 0300 123 2014.

 

  • What GPC are doing

    We are in the process of developing template letters which practices and doctors can use to send to PCSE to speed up the process for getting a resolution. These will be available in due course.

    GPC are also having regular meetings with NHS England to discuss ongoing issues with Capita. A deadline of the end of December 2017 has been given to resolve all the pending issues. In addition to this, we have met with the legal department to progress alternative options if the issues are not resolved by the deadline.

    In October 2017, GPC undertook an exercise to understand the extent of the outstanding issues which led the GPC England chair Richard Vautrey to write to Simon Stevens, Chief Executive of NHS England, to highlight ongoing issues with PCSE.

    As well as developing three short surveys (one for LMCs, practitioners and practices respectively), to gauge the severity of the problems to continue efforts to push NHS England and PCSE to resolve these issues. We will be sending these directly to LMCs. The deadline to complete the surveys is 8 December.

    Letter to Simon Stevens re outstanding issues – Oct 2017

    Survey of practices

    Survey of practitioners

    Survey of LMCs

     

  • Previous activity

    In May 2016, we wrote to NHS England to highlight the significant concerns of the BMA’s GP committee and the wider GP population with the systemic failure of the services provided by primary care support England under contract to Capita, having received a multitude of serious complaints from practices and LMCs. While these have been discussed with Capita, the scale of the problem means we need to highlight this at the most senior level as NHS England is ultimately responsible.

    Failure of PCSE letter to NHS England

    In July 2016, GPC used a robust exercise to identify the extent of the issues and assessed whether there had been any marked improvement in the service being delivered by Capita. GPC then provided the results of the exercise to NHS England which we then set improvement deadlines for the various service lines that were causing concerns. In addition to this we had further discussions and correspondence during August and September, with NHS England and PCSE, to highlight that issues continued to be outstanding.

    Feedback from LMC's on PCSE performance (since July 2016)

    BMA GPC letter to NHS England re Capita - Aug 2016

    Letter of response from NHS England to BMA GPC - Sept 2016

    The then GPC England Chair, Chaand Nagpaul and GP Trainees Subcommittee Chair, Samira Anane, had to write to NHS England in October 2016, to seek an immediate solution to reports from GP trainees that they had not received correct payment and some had not received payment at all. We asked for assurances that no trainee was left unpaid, and to ensure that no practice had to dip into their overstretched budgets to make up the shortfall in funding. While it is the responsibility of the practice as the employer to pay their trainees, if the employer has not been provided with the required information and/or the required funding, they may be unable to do so.

    Letter to NHS England re GP Trainee Pay – October 2016

    In recognition of the additional administrative burden on practices, a goodwill payment of £250 payment per practice was then made by NHS England and this was paid to practices by 30 April 2017. However we would like practices to note that this payment should not prohibit those who have suffered a demonstrable loss from being recompensed. Please see above for the process in which practice/individual doctors can undertake for compensation.

    Over the next few months, GPC productively engaged with NHS England and PCSE regularly to resolve the significant issues that were causing much distress to practices and putting patients at risk. However, there was a constant requirement for GPC to escalate cases on behalf of LMCs, practices and individuals who are experiencing issues with PCSE and are unable to reach resolution through communicating directly with them. We also heard cases of GPs suffering large financial losses due to systematic failings of the services provided by Capita.

  • GP trainee pay guidance

    GPC England is aware that under arrangements for the provision of primary care support services provided by Capita, a number of practices have not been provided with accurate information in order to pay GP trainees at their practice or have not received reimbursement for GP trainee pay.

    No matter the reason for the issues, GP trainees should not be left without pay.

    It remains the responsibility of the practice (as the employer) to ensure they pay their trainees, however, we recognise that it may not be possible to do so without the required information or the necessary funds.

    Where practices have not been provided with accurate information to pay their trainees, they should contact NHS England regional teams for immediate advice on appropriate payments and should pay their trainees without delay. This does not remove the contractual responsibility for the practice as the employer to ensure their trainees are paid.

    Where practices have not been provided with the funding to pay their trainees, practices should pay their trainees and subsequently contact NHS England regional teams to ensure they receive immediate reimbursement.

    Practices should also write to NHS England regional teams and to PCSE to advise them that, if within 7 calendar days (from the date of their letter to NHS England/PCSE), they have not received the required information or the required reimbursement which leads to financial discrepancies/hardship, that legal proceedings will be issued in the County Courts.

    Any trainee who has not been paid, or who has been paid significantly less than they should have been paid (causing financial hardship) should contact the BMA as soon as possible (0300 123 1233 or [email protected]).