General Practitioners Committee General practitioner Patient and public Practice manager England Junior doctor

Last updated:

Primary Care Support England (PCSE) service failures

healthcare

Primary Care Support England (PCSE), also known as Capita, have been responsible for the delivery of NHS England's primary care support services since September 2015.

GPs and LMCs identified serious issues with the service from the outset, with patient safety, GP workload and GP finances being affected.

Talks between the BMA, NHS England and PCSE began in a bid to raise these issues, to act quickly to resolve them and to give GPs and their practices confidence in the services PCSE provide. However, services are still falling short of what is acceptable.

Download the full briefing (PDF)

 

Find out more about...

  • National Audit Office report

    The National Audit Office has produced a report on NHS England’s management of the primary care support services contract provided by Capita. Key findings include:

    • NHS England imposed a £5.3 million in contract penalties on Capita between January 2016 and April 2017;
    • Failure to deliver key aspects of the service put primary care services and, potentially, patients at risk of serious harm, but no actual harm has been identified;
    • NHS England served default notices, placing five of Capita’s nine services in a formal rectification process in September 2016;
    • NHS England’s decision to contract with Capita both to run existing services and also simultaneously to transform those services, was high risk.

    Find the full report

    The General practitioners committee was one of a range of stakeholders which contributed to the report, providing evidence collated via surveys of its membership and feedback from LMCs, practice staff and GPs.

    Following the publication of the report, Dr Richard Vautrey, Chair of the General practitioners committee England, has written to NHS England to express his disappointment that after over two years of operation the service continues to fall short of an acceptable standard. The letter has also been shared with senior governmental figures such as Sarah Wollaston, Chair of the Health Select Committee in the House of Commons and Meg Hillier, Chair of the Public Accounts Committee.

    Letter sent to Simon Stevens on 17 May regarding NAO report 

    Capita's 'scandalous' risks unravel (BMA news)

    Read the press release

     

    Further media coverage

    BBC Online: Patients ‘could have been harmed’ after Capita outsourcing
    Guardian: Capita put NHS England patients at risk, says watchdog
    Independent: NHS cost-cutting Capita contract put ‘patients at serious risk of harm’, find auditors
    iNews: Capita deal with NHS ‘potentially put patient safety at risk’
    Financial Times: NHS doctors bemoan pain of working with outsourcer Capita
    Daily Mail: Cervical cancer patients were put at risk after being wrongly told they no longer needed checks in latest NHS screening blunder
    The Times: NHS outsourcing ‘put patients at risk’
    Telegraph: Cervical screening bungled and patients put at risk of ‘serious harm’, report on Capita NHS contract finds
    Huffington Post: Capita condemned for ‘widespread failures’ in delivering NHS backup services
    GP Online: High-risk £330m Capita deal threatened ‘serious harm’ to patients, NAO warns
    Pulse i: Capita GP support contract ‘potentially compromised patient safety’, find auditors
    Pulse ii: NHS England ‘asked Capita to halt primary care support offices closures’

  • Latest developments

    Compensation claims related to Capita Performers List delays update - May 2018

    We have received a reply from an FOI we sent to NHS England with regard to delays in National Performers List applications. In its response, NHS England said that GPs would only be eligible to be considered for compensation if the delay was longer than 16 weeks.

    Read our response here.

     

    Subject Access Request (SAR) template letter - March 2018

    We have received an increasing number of reports from practices and practitioners that there are issues with the processing of pension contributions, which is the responsibility of PCSE (contracted by NHS England). This is leading to cases of incorrect or incomplete pension records. We have also received feedback that it is proving difficult for practitioners to access their pension records.

    We have produced a template subject access request letter, that practitioners can complete and send to NHS England, to access this important information. This puts a duty on NHS England to respond to your request within 40 days.

    If you have any difficulty with this process or have any feedback, then please email [email protected]

    Download the SAR template letter

     

    Freedom of Information requests - March 2018

    GPC continues to put pressure on NHS England to resolve the outstanding issues effecting practices caused by the failings of PCSE, by submitting the following Freedom of Information requests:

  • What the BMA is doing

    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.

    GPC has been meeting with NHS England and Capita to highlight the ongoing issues since its inception, and does acknowledge that 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.

    Therefore, a deadline of the end of December 2017 was given to resolve all the pending issues. In addition to this, we have also undertook a survey to understand the full extent of problems. The results show that there is little improvement, if any, across all service lines, when compared to our previous survey in October 2016; in fact, there appears to be a significant deterioration in some services.

    This has led GPC to make the decision that due to the severity of the issues and impact which it is having on primary care services across, that we are now left with no option but to support practices and individual doctors in taking legal routes to seek resolution.

    We have written to Simon Stevens to this extent and also asked that NHS England conducts a review of all policy, procedures and processes used by PCSE across each service line. See the Record of correspondance for more details. 

     

    Surveys

    In July 2016, the GPC undertook an informal exercise to monitor PCSE performance, asking practices to provide a list of ongoing issues throughout that month. This provided GPC with the evidence to provide to NHS England, showing the widespread issues across England.

    Read the feedback from LMCs on PCSE performance - Jul 2016 (PDF)

    As PCSE entered its second year, GPC undertook a more robust exercise to assess whether the issues previously reported were still prevalent and if they had seen any improvement over the month of October. It is worth noting that although individual GPs (particularly GP locums and GP trainees) and LMCs have been affected by the services provided by PCSE, this exercise concentrated on GP practices.

    Read the report - Oct 2016 (PDF)

    In December, a survey of practices and individual practitioners was conducted. The results show that there has been little improvement, if any, across all service lines, when compared to the previous survey in October 2016.

    See the full survey results - Jan 2018 (PDF)

     

  • Statutory demands

    PCSE is responsible for processing NHS England’s payments to practices for the services they have provided.

    We know that these are not being processed properly and therefore, practices are often owed money and the process to recoup money owed is burdensome.

    As NHS England is the commissioner of services by Capita, and the funding originates with NHS England, it is NHS England who is responsible for ensuring practices and doctors receive the money they are owed.

    We have provided the following resources to assist practices in making a legal written request to have an undisputed debt paid within 40 days, including: a template covering letter which you can amend, the template form you should complete and enclose along with your letter to NHS England.

     

  • Key issues with PCSE services

    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. Read the statement and follow the steps to make a claim.

    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.

     

  • Record of correspondence

    February 2018

    The joint GP IT committee wrote to NHS England to express reservations about the proposed National Cervical Screening Transformation project.

    Read the letter (PDF)

    May 2016

    GPC wrote to NHS England to highlight significant concerns with the systemic failure of the services provided by PCSE under contract to Capita.

    Read the letter (PDF)

    Aug – Sep 2016

    Further discussions and correspondence with NHS England and PCSE persisted during August and September, to highlight the issues which continued to be outstanding.

    Read the letter from GPC to NHS England – Aug 2016 (PDF)

    Read the letter from NHS England to GPC – Sep 2016 (PDF)

    Oct 2016

    GPC received reports from GP trainees to say they had not received either correct payment or no payment at all for work done. Chairs of the GPC and the GP trainee subcommittee wrote to NHS England to ask for an immediate solution and for assurances that no trainee would be left unpaid and that no practice would have to make up the shortfall in funding.

    Read the letter from GPC and GP trainee subcommittee to NHS England (PDF)

    Oct 2017

    GPC wrote to Simon Stevens to highlight disappointment at the lack of progress to resolve the ongoing issues with PCSE during the past two years.

    Read the letter (PDF)

    Dec 2017

    GPC wrote to LMCs across England to provide an update on the outcomes of a meeting with Jill Matthews from NHS England. It states that while some improvements had been made, PCSE were still operating at an unacceptable level and a resolution deadline was set. 

    Read the letter (PDF) 

    Jan 2018

    Following a meeting with NHS England on 11 January 2018, GPC England chair Richard Vautrey wrote to NHS England chief executive Simon Stevens to express disappointment over the lack of significant improvement in the service delivery of PCSE.

    Read the letter (PDF)

     

  • Case escalation for practice payments or losses

    Due to the services failures of PCSE, we are aware of cases where practices have not received payments, or have received incorrect payments. Similarly, we are aware that practices or individual doctors may have suffered losses due to the failing of these services.

    It is never acceptable for payments to be delayed and we advise practices to follow the below process to ensure incorrect payments are corrected and losses are compensated. 

     

    Steps to follow for practices and GPs:

    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. For enquiries email [email protected], or if you wish to make a complaint to PCSE, email [email protected]
    2. If the issue is not resolved by PCSE in a timely manner you should contact NHS England to make a claim, contact [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 on [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.

     

    Small claims court

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

    Read 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 services

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

  • Sessional GPs guidance on NHS pensions and Capita

    Since Capita took over the pensions contract in November 2015, it had been supported by a team from NHSE (NHS England) to help deliver the contract. NHSE made the decision to withdraw that support in January. This has brought unease as to how the service will continue and whether Capita will be able to deliver.

    This guidance aims to address the main questions that sessional GPs have raised.

    It was updated by the BMA sessional GPs subcommittee in February 2018 following meetings with Capita (PCSE) and NHS England.

    Read the guidance

  • GP trainees pay issues

    We are aware a number of practices have not been provided with accurate information by PSCE, in order to pay GP trainees at their practice or have not received reimbursement for GP trainee pay. Again, this is unacceptable and whatever the cause of 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.

     

    Steps to follow for practices:

    • Practices who have not been provided with accurate information to pay their trainees
      If this is your situation, you 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.
    • Practices who have not been provided with the funding to pay their trainees
      If this is your situation, 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 or PCSE), they have not received the required information or the required reimbursement which leads to financial discrepancies or hardship, that legal proceedings will be issued in the County Courts.

    Steps to follow for GP trainees:

    • GP trainees who have not been paid or paid incorrectly
      If you are a GP trainee who has not been paid or who has been paid significantly less than you should have been paid (causing financial hardship), please contact the BMA as soon as possible on 0300 123 1233 or [email protected]

     

    Small claims court

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

    Read 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 services

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