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Last week news broke out about Capita’s contract with NHS England with regard to list cleansing exercises. One proposal was that practices would be annually required to provide Capita with a list of patients who have had no contact with the surgery in five years, and who would then be contacted to confirm their registration. Failure of a patient to respond would remove them from the practice list.
Such a measure is utterly misguided and damaging. It penalises patients who are healthy and have no need to unnecessarily see a GP – especially given the move towards self-care and accessing other health services such as pharmacists.
It raises information governance concerns in requiring GPs to provide confidential details of patients who have not seen their GP – and, worse, it could drive patents to waste their own and their GP’s time by attending their surgery simply for fear of being deregistered. Practices could unfairly find themselves in situations of conflict between understandably angry patients who blame the practice for deregistering them, when the fault lies with wider NHS systems.
I immediately contacted NHS England calling for these proposals to be halted. In addition to the serious implications to patients, this will add unacceptable bureaucratic demands on practices, and is at odds with the pronouncements in the GP Forward View to reduce our workload burden. I have since been assured by NHS England that any new proposals for list cleansing will not go ahead without formal discussion with GPC, and I will keep you updated.
This issue was also vigorously debated at the GPC meeting last week, as were the broader problems that have plagued practices under Capita’s contract with NHS England. These range from delays of up to several weeks for records being transferred between practices, to failures in the provision of medical supplies (such as syringes and needles) and prescriptions stationery. This has led to the disruption of services, and clearly presents a significant risk to patient care.
In May I wrote a letter to NHS England detailing these concerns. In view of the fact there has not been any tangible improvement, and with continued risk to patients and serious disruption for practices, GPC passed a motion of no confidence in Capita’s delivery of primary care support services.
Members of GPC featured heavily in publicising these issues in the media. BMA GP committee deputy chair Richard Vautrey conducted a range of broadcast interviews – he was interviewed live on the Today Programme as well as with BBC Radio Five Live, BBC Radio West Midlands, Sky News, BBC Radio Manchester, the BBC’s Victoria Derbyshire programme and BBC News.
Dr Robert Morley, chair of the GPC contracts and regulations subcommittee, had his comments featured in a series of national online articles including Daily Express, The Daily Telegraph, Mail Online, The Sun, The Guardian, Mirror Online and 185 regional and local titles.
Shared Business Services
As a corollary to the above problems, we now also know that GPs have been missing out on patient correspondence dating back to 2011, due to errors made by NHS Shared Business Services (SBS) in redirecting and forwarding correspondence sent to the wrong practice by hospitals.
This is being dealt with by NHS England as a significant event. It includes temporary resident forms, duplicate documents and communications about treatment steps. NHS England have undertaken a clinical review to assess any high-risk correspondence which might need action, such as those that have involved an oncology history or child protection issues. Dealing with any high-risk case is likely to involve additional work, and this must be remunerated. GPs are being notified so that in the cases where it may be needed, they can take steps to follow up with their patients.
We are in contact with NHS England on this issue and are discussing a remuneration and support package for practices involved in this process, and to work to understand the full extent of this failing by SBS.
The dangers of outsourcing NHS services
The above examples highlight the dangers in outsourcing NHS services to external providers, and have been a direct consequence of political ideology in England in the past decade from successive governments. The NHS is wholly different to providing commercial services; it is based on serving patients’ needs, not transactions. Loyalty and the goodwill of staff have been central to its remarkable cost-effectiveness.
The debacles with both Capita and SBS demonstrate that promises to provide a better service at less cost have in reality turned out to be the total opposite. This is why the BMA continues to oppose competition law in England via the Health and Social Care Act, that forces NHS services to be put out to tender, and why we are calling for legislative change to reverse this.
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