Capita

Capita and the Primary Care Support Services contract

Capita took over the coordination of primary care support services in September 2015.  However, since the PCSE contract began there has been an never-ending series of problems - ranging from things as mundane as surgeries running out of prescription pads and syringes to far more serious problems with the secure transfer of patient notes around the country, with notes going missing or delivered to the wrong surgery, and women being dropped from the cervical cancer screening programme. The problems encompassed GPs, dentists, opticians and pharmacists.

Recent issues

In December 2022, after seven years of Capita being in charge of the Primary Care Support Services (PCSE) contract, Pulse published a series of articles on the continued problems. Capita and NHS England have said that performance data suggests the company is meeting its targets, however the Pulse articles suggest otherwise.  NHS England continues to insist the move has saved millions of pounds.

The Pulse investigation was told of GPs having to delay retirement due to pension issues, facing complications with divorces, spending tens of thousands of pounds on legal and accountancy fees, and having to devote a session a week to deal with PCSE’s poor administration.

The Pulse articles focuses on administration of the NHS Pension Scheme for GPs. Capita and NHS England were positive about the administration of the scheme in information sent to Pulse, however Pulse reports that it has collected accounts from GPs across the country that "paint a very different picture." Although targets have been met, there are many issues being faced by GPs – especially data missing from pension records. In particular there are difficulties accessing the ‘total rewards statement’ (TRS), which can be obtained online via the Government Gateway or an employer, or requested from NHS Business Services Authority (NHSBSA). Without an up-to-date TRS, GPs cannot make decisions about their retirement. They also can’t get an accurate assessment of their annual allowance tax charges. 

The problems are affecting the finances of GP practices. Pulse reported on a practice that recently had £46,000 in pension contributions taken in error by PCSE, and another in Cumbria saw £30,000 of pension contributions taken in error, just days before payday.

There are still issues with the PCSE customer support centre, with GPs telling Pulse of struggling to get help on the phone, waiting months for a response to an email, and being given multiple case reference numbers leaving them unsure which to use. Data supplied to Pulse also show the customer support centre receives thousands of complaints each year.

Problems from earlier years

A campaign by the GPC (General Practice Council) has been ongoing since early 2016; in May 2016 chair of the GPC Dr Chaand Nagpaul wrote to NHS England demanding practices be compensated for extra workload due to the ‘systematic failure’ of PCSE, and indemnified against any claims as a result of support service issues.

In September 2016, NHS England had to intervene, serving default notices on Capita and increasing the numbers of staff. However, in November 2016 the GPC reported that the support services remain a 'chaotic mess' despite nearly a year since the services were outsourced to Capita.

Finally, in May 2018 the National Audit Office (NAO)  produced a report on the contract noting that patients had been “put at serious risk of harm” due to Capita's failures. The report  noted how both parties grossly underestimated the size and complexity of the task and the risks involved. The NAO report was particularly critical of NHS England and its inability to control Capita’s “aggressive” programme of office closures and redundancies, even when it became clear “it was having a harmful impact on service delivery”. In response NHS England highlighted the £60 million the contract had saved; the NAO report noted that the extent of harm to patients will not be known for some time to come.

In an excellent analysis of the contract by Richard Vize in The Guardian, he notes that the contract was "a textbook example of how to set up an outsourcing contract to fail. Pretty much everything that could have gone wrong went wrong."

Under the contract Capita was expected to make massive losses in the first two years in return for later riches. Vize notes that "With a big upfront loss, Capita had a massive incentive to cut costs quickly, so by the end of 2016 it had shut virtually all the local offices it had inherited and halved the staff. Vital local knowledge was lost."

Furthermore, as things went wrong, Vize notes how everyone argued rather than focusing on fixing the problem. Capita is reported to have lost £125m in the first two years – double the target and Capita and NHS England are still arguing over the contract. The NAO notes: "two and a half years into the contract basic principles are still not agreed, which limits NHS England’s ability to hold Capita to account. NHS England and Capita have still not agreed how to calculate 11 performance measures, and how these data should be used to calculate payments owed to Capita for delivering the services."

One of the ways patients could potentially have been put at risk was the problems with the “performers list” of GPs, dentists and opticians practising in the NHS, including whether they are suitably qualified and have passed other relevant checks. According to the NAO report, problems with the list also led to around 1,000 GPs, dentists and opticians being unable to work, 200 of whom have sought money for lost earnings.

Another part of the contract was pensions administration for GPs. Delays have been reported to the payment of pensions as well as confusion surrounding many of the administration processes for the pensions. Despite Capita being in charge since 2015, in April 2018 there were still many ongoing issues.

Capita have had long standing issues with payroll and pensions nationally, in 2016 they were a year late submitting Barnet Council’s pension scheme to the Pensions Regulator, resulting in a fine.

Problems are still ongoing with the Primary Care Support contract, the NAO notes that "users continue to experience poor delivery with seven severe service failures in February 2018."

Dr Richard Vautrey, chair of the BMA’s GP committee, said his members want elements of the service to be taken back in-house. “With this as an option, we are now asking NHS England how it plans to resolve the shambles that is Capita’s running of Primary Care Support England,” he said. The NAO also recommends  that NHS England should determine whether all current services within the contract are best delivered through that contract or be should taken in-house by NHS England.

In November 2018, the BMA reported that Capita had failed to deliver correspondence relating to cervical cancer screening to 47,700 women. The BMA called Capita’s running of services ‘nothing short of shambolic’ and said it is ‘frankly appalling’ that the private company’s ‘gross error’ may have put patients at risk. The letters relate to appointment invitations or reminder letters, but does include some screening results. The BMA has demanded that the contract with Capita be stripped back and the contract taken back in-house.

In March 2019, Simon Stevens told the Public Accounts Committee that Capita would be stripped of its contract to run the cervical cancer screening programme. In July 2019, Capita admitted to further administration errors within their cervical cancer screening programme. This included not inviting 16 patients for cervical cancer screening, and failing to remove 99 patients from the programme when it was appropriate to do so. In response to this, BMA is pressing again for Capita to be stripped of its contract to provide GP support services. NHS England have said that the process of taking away the cervical screening contract is now underway.

There was further issues in May 2019, when Capita incorrectly archived 130,000 patient records, instead of sending them to the patients new GPs when they registered.

Issues with other contracts

In January 2013, it was revealed that Capita, under a UK Border Agency Contract, had been misinforming people that they had to leave the UK as they had no valid visa.

In June 2014 five of eight Liverpool NHS Trusts who had contracted their payroll and recruitment to Capita in 2012 withdrew from the contract because of concerns about the quality of the service provided.

Then in September 2014, West London Mental Health NHS Trust cancelled their contract for human resources services after Capita proved “unable to meet acceptable ‘time to hire’ targets”, particularly for nurses. At the same time Alder Hey Children's NHS Foundation Trust and Liverpool Heart and Chest Hospital NHS Foundation Trust terminated their contracts.

In 2014, a leak to The Guardian revealed that the Department of Work and Pensions had to send civil servants to help the company process personal independence payments for the seriously ill and disabled as "waiting times for assessment have been so long that in some cases people with terminal conditions have died before receiving a penny.”

In February 2015, it was reported that Capita was responsible for a breach of NHS employee’s personal data during the time the company had been in charge of payroll and human resources for trusts in Liverpool.

Financial concerns

In April 2018, Capita announced a massive rise in losses and £1.1 bn worth of debt. Capita announced a heavily discounted rights issue; 1bn new shares at 70p. Media commentators were quick to compare Capita to Carillion, the debt-laden outsourcing company that went into liquidation less than four months previously. These comparisons were dismissed by the company’s new chief executive, Jonathan Lewis, who took over in December.

In January 2018, Capita’s shares slumped when the company issued a profit warning, cancelled its dividend and said it would need seek more cash from investors. The news of the rights issue sent the shares 13% up, but they are still down by more than two-thirds over the past year.