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Primary care

NHS England’s outsourcing of primary care support 'a long way below acceptable standard'

A National Audit Office report reveals shortfalls of the seven-year, £330m contract between NHS England and Capita to deliver primary care support services.

A report from the National Audit Office (NAO) says that support services provided to pharmacists, GPs, dentists and opticians are “a long way below an acceptable standard” after NHS England and Capita misunderstood the risks in outsourcing primary care support services. 

The report, ‘NHS England’s management of the primary care support services contract with Capita’, published on 17 May 2018, revealed that problems with the support services left one pharmacist claiming that they were unable to retire because applications for changes in pharmacy business ownership were being processed so slowly. 

In August 2015, NHS England began a seven-year, £330m contract with Capita to deliver primary care support services to GPs, pharmacies, dentists and opticians, under a programme called Primary Care Support England (PCSE). In doing so, NHS England aimed to reduce its costs by 35% across all primary care support services.

But in May 2016, primary care providers began raising concerns with NHS England about failures of the PCSE contract, such as delays in transferring medical records. In December 2015, NHS England put out a formal statement to say that Capita had failed to deliver key aspects of the service, putting primary care services and patients at risk.

PCSE provides supplies for pharmacies, such as NHS stationary, pre-printed forms and needles and syringes. It also validates and processes market entry applications on behalf of NHS England, including change of ownership applications.

As part of the NHS contract, PCSE was also responsible for administering monthly contracts and reimbursements to pharmacies, but the report says that NHS England removed this workstream from Capita’s transformation programme. Capita’s estimated service volume of payments to pharmacies in the third year of the contract was shown to be 62% lower than NHS England’s predicted volume from bid.

The report highlighted that failures to deliver key aspects of the end-to-end service resulted in NHS stationery and medical supplies not being delivered, leading to shortages of prescription pads, needles and syringes.

As part of the market entry service, Capita is required to provide NHS England with a file to enable a decision on applications for new pharmacies within 70 days of receipt of the initial application. But NAO’s report showed that there had been long delays in new pharmacies being approved and changes in ownership of existing businesses being processed. In November 2017, only 41% of applications were processed within 70 days.

Gordon Hockey, director of operations and support at the Pharmaceutical Services Negotiating Committee (PSNC), which was interviewed for the report, said that the conclusions of the NAO would come as no surprise to the many community pharmacies and local pharmaceutical committees who had reported problems with PCSE services.

“The PSNC wrote to NHS England in July 2016 expressing its dismay at Capita’s services and seeking remedial action; at that point we had many reports of services operating at well below acceptable standards, and this is echoed by the NAO report,” said Hockey.

“We are pleased our work to raise the matter and push for improvements has had some impact, with services generally improving since 2016, but we will continue to work closely with pharmacies, LPCs and Capita to ensure this continues – we must have confidence that PCSE is offering a consistently good service to pharmacies across the country.”

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2018.20204867

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