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Support services include anything from transfers of patients note to cleaning and maintenance services. Large private companies such as Capita and Interserve have become involved in these contracts over the last couple of years, but not without issues.
Capita took over the coordination of priamry care support services in September 2015. The contract from NHS England was designed to save £40 million per year by bringing together a previously fragmented service to a single national provider for Primary Care Support England (PCSE).
Capita's bid hinged on making a £21 million per year saving. The contract which could run from seven to ten years is worth up to £400 million.
However, since April 2016 when Capita closed local centres to leave just three national hubs and implemented a single online 'portal' for practices, there has been a growing number of reports of problems affecting GPs, community pharmacists and optometrists.
These include major problems with the secure transfer of patient notes around the country, with notes going missing or delivered to the wrong surgery.
GPC (General Practice Council) chair Dr Chaand Nahpaul wrote to NHS England demanding practices be compensation for extra workload due to the 'systematic failure' of PCSE, and indemnified against any claims as a result of support service issues.
In 2013 Interserve signed a contract with Leicestershire Partnership NHS Trust, University Hospitals of Leicester NHS Trust and the Leicester City, Leicestershire Country and Rutland Primary Care Trust Cluster to improve estates and facilities management services across the cities and counties.
The contract was seven years long, worth around £300 million and was expected to save the NHS a significant amount of money. Interserve were to be in charge of catering, cleaning, maintenance and security across more than 550 NHS buildings and properties.
However, in April 2016 this contract was scrapped four years early due to major problems and poor standards. These included patients in one hospital receiving meals up to three hours late and the merging of cleaning and catering services meaning around 100 people lost their jobs.
It later came to light that ex-Interserve staff were getting paid half what the NHS contracted staff were being paid.
The Health Service Journal reported in February 2017 that Carillion, which won a £200 million, five-year estates and facility contract in 2014 with Nottingham University Hospitals Trust, would be stripped of the contract by April 2017. The contract would be transferred back to the NHS.
The company was warned in 2016 about its poor standards after reports that nurses at the trust were having to clean wards as the cleaners were failing to maintain standards. By early 2017, however, Carillion had failed to make sufficient improvements, hence the loss of the contract.