General Practitioners Committee General practitioner Patient and public Practice manager England

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PCSE (Primary Care Support England) service failures

This guidance covers the issues GP practices have raised about PCSE, guidance on how you can raise concerns and what the BMA is doing to help.

 

The background

PCSE (Primary Care Support England), 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. 

The BMA general practitioners committee has been engaging with NHS England and PCSE and on several occasions had been promised improvements. 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. 

 

Guidance for practices

We are aware of a number of issues that practices have experienced with PCSE and we are pushing NHS England and PCSE to resolve them.

Download our guidance for GP practices on how to resolve these issues and get compensation, how to raise a concern with PCSE and make a claim for any unpaid money.

Download PCSE guidance for practices

 

Issues reported

Medical records

  • Delays to the movement of medical records for various reasons including labels not being received or incorrect labels being received
  • Missing and incomplete medical records which compromises patient treatment
  • Lack of timely delivery of urgent requests for patient records
  • Practices reporting large backlog of records waiting to be collected
  • Wrong patient records delivered to practices
  • Unable to systematically collect medical records from branch practice surgeries resulting in practice staff having to transport them to the main surgery
  • Reported delays in receiving records for cross-border practices

 

Patient registrations

Faulty processes causing delays and problems with delayed registrations, incorrect removals and issues with removals of violent patients. 

 

Performers list 

Mistakes in updating and maintaining the performers list due to:  

  • delays in processing performer status changes which could impact on practice finances
  • duplicate entries
  • newly qualified GPs not being amended on the performers list in a timely manner (issues related to signing partnership agreements, leases etc)
  • adding doctors who have not completed their CCT
  • GPs not being visible on the performers list resulting in GPs being unable to work and a significant loss of earnings. 

There has also been instances of LMCs not receiving the data about entrants to performers list in their area. 

 

Medical supplies

  • Failure in the provision of medical supplies (such as syringes, needles) and prescriptions stationery so that patient services were disrupted
  • Supplies are not delivered in a timely manner
  • Some supplies that were previously provided are no longer

 

Payments 

  • GP training practices not receiving their training grants and trainee pay reimbursements
  • Practices not being paid correctly/reimbursed for other elements of the service they provide
  • Uncertainty over what they are being paid as there is not clear breakdown of payments
  • Problems with LMC levy collections and payments

 

Pensions 

  • Significant issues with the processing of pension contributions leading to cases of incorrect allocations and records of pension contributions
  • Locum GP pension payments are not acknowledged or processed in a timely manner and in some instances have gone missing
  • Superannuation payments being taken from practices for doctors that have left the practice
  • GP trainees not being added to the scheme in a timely manner
  • Tax implications because of incorrect records

 

Cervical screening 

A significant number of women not receiving important correspondence relating to cervical screening.

 

General communications 

  • Customer service centre underprepared
  • Inappropriate responses from customer service centre
  • LMCs, practices and individuals that are not being dealt with in a timely manner
  • Complaints process not fit for purpose
  • Unacceptable delays in resolving problems

 

Key developments and the BMA's reaction

Latest statement

Practices may be aware of a recent PCSE incident in which 160,000 patient medical records were erroneously archived instead of being sent to the subsequent GP practices (following further investigation, the number is closer to 148,000). These records will have been sent to the practices that currently have the patients registered, and NHS England expects those practices to undertake an assessment of harm for each patient affected.

Over the past few weeks, GPC England has been in discussions with NHS England to highlight the impact this will have on practices and their patients. We have been clear that practices should receive the necessary support to cover the additional costs of dealing with a problem, for which they are not to blame, to ensure that GPs and other practice staff are not taken away from direct patient facing provision.

Unfortunately, NHS England is not prepared to provide the amount of funding that we believe is necessary to cover GP and practice staff the time required to do this assessment properly. GPC England was not prepared to agree to a settlement which, we believed, would not fully compensate practices for the problems created by Capita.

If you would like to ask NHS England what compensation they are able to offer to your practice, please contact [email protected]. Practices should carefully consider whether any offer made reflects the work that will need to be undertaken and whether it will adequately compensate them.

If a practice believes the offer is sufficient and accepts it, they will not be able to claim additional monies via any legal route. If, however, a practice considers the offer does not reflect the work that will be required and decides to reject it (with the hope of claiming compensation via a legal route for the additional work), we would recommend that the practice contacts the BMA ([email protected]) with the attached pro forma so that we can start to collate the necessary information to take forward legal action*.

*Please note, the provision of legal support to you is at the discretion of the BMA. The BMA may withdraw legal support if you do not follow legal advice given to you or if you fail to co-operate with the BMA, including but not limited to offers of settlement. If you accept an offer of settlement, you must immediately inform the BMA and it will no longer be possible for you to bring a legal claim.

Download the pro forma

 

National Audit Office 

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

  • NHS England imposed £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. 

Read the full report

The BMA 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, BMA GPs committee England chair Richard Vautrey wrote a letter to NHS England that was also shared with senior governmental figures.

 

Surveys 

The BMA general practitioners committee have undertook a number of surveys on members' views and experiences with PCSE. This enabled us to evidence the widespread issues to NHS England.

 

Cervical screening correspondence

Following the BMA GPC writing to NHS England expressing its extreme concern after being made aware that a significant number of women had not received information regarding cervical cancer screening after a system error, it was agreed that Capita will no longer be responsible for this service. A review is now being undertaken by Professor Mike Richards.  

 

Archived medical records

Capita mistakenly archived 160,000 patient records, which means practices will have to clinically review these records. GPC England is in discussions with NHS England regarding this to find an urgent resolution. 

Our advice to practices would be to undertake the work of processing patient information received to the extent they are able with the resources they have. You should also inform your CCG and NHS England locally if you do not have resources to undertake the work quickly enough to mitigate against any risk to patient safety. 

Read the full statement