A very Capita Christmas: How support services are letting GPs down

Earlier this year NHS England gave Capita the gift of extending the contract to manage GP support services for three years. But a Pulse investigation reveals problems remain.

‘I just want it to be over. Every month you are handing over thousands of pounds and you don’t know where it’s going; it’s just disappearing into this black hole,’ says a GP in Wolverhampton, talking about problems with his pensions statements. ‘You don’t know how hard you’ll have to fight or how long you’ll have to wait for the money.

‘It’s already been hundreds of hours of time finding all the forms, compiling spreadsheets, trying to make it easy to understand so they can see what’s missing. And often doing this in the middle of the night because I wasn’t able to sleep.’

It’s been seven years since NHS England awarded Capita the contract to run a number of services that would affect the personal and professional lives of GPs and patient care, including the administration of pensions, transfer of medical records and payments to practices. Earlier this year, Capita’s contract was extended for another three years.

The contract extension was met with disbelief by the profession. The BMA called it ‘astonishing’, saying Capita had presided over ‘a litany of failures’. A damning 2018 National Audit Office report found the service ‘potentially compromised patient safety’.¹

Capita and NHS England now present a much more positive assessment of the progress of Primary Care Support England (PCSE), Capita’s service delivery arm. Performance data suggest it is meeting its targets. And NHS England continues to insist the move has saved millions of pounds. 

But a Pulse investigation has found the situation described by the GP in Wolverhampton is not an isolated incident. Other GPs have told us about having to delay retirement, 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.

We have scrutinised the company’s performance, how it has affected GPs and patients, and the justification for the contract extension.  

Read all our case studies in our dedicated section

Management of pension administrations
What PCSE is supposed to do
PCSE is responsible for the administration of the NHS Pension Scheme for GPs. This involves, among other things, maintaining GP pension records, processing pension estimates and retirement applications, ensuring pension records are accurate and up to date and processing information provided by GP practices. For GPs, this is essential – being unable to access accurate records could delay retirement, leave GPs unable to pay tax bills and even affect divorce proceedings. 

What Capita and NHS England say 
Information on Capita’s performance is not readily available. However, data released to Pulse via a freedom of information (FOI) request reveal that Capita seems to be hitting targets for processing information. It also says it has improved many of the processes that GPs and the NAO raised concerns over, following a review of GP pensions data in 2018 by accounting firm PwC. An online portal for GP pensions and payments was launched last year. Capita said this has led to GPs becoming more engaged, while NHS England said the service provided by Capita makes it ‘easier than ever before for GPs to access and update pension information’.

What GPs tell us
Pulse has collected accounts from GPs across the country that paint a very different picture. Although targets have been met, these metrics appear to mask issues being faced by GPs – especially data missing from pension records. 

A common problem is difficulty 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. NHSBSA sets deadlines each year for PCSE to process pension certificates to make the statement available for GPs in August and December, which PCSE tends to meet.  

However, the statement cannot be produced if data are missing from previous years – and this is where the issues arise. GPs have told us they have contacted PCSE after noting their TRS is appearing as blank, and are asked to resubmit information they have sent on multiple occasions. But there are no performance measures on this. Neither Capita nor NHS England explained why this was the case. 

The impact of this is significant, as our cases studies confirm.

Dr Nick Grundy, a GP in Richmond, south-west London, who has undertaken significant campaigning work to try to resolve some of the issues with PCSE, tells Pulse that, after the PwC review, NHS England promised that people with terminal illness wouldn’t be ‘sent to dig out their pension records from five years ago’ or people going through divorce ‘wouldn’t be fobbed off for 18 months because it was a bit difficult’. 

However, he adds: ‘We’ve found over the last five years that [these problems are still occurring]. Even people who had accountants deep-dive their pension records have had the same data go missing as in 2017/18.’ He says he is approached ‘at least once a month’ by a GP who is going through a divorce but can’t proceed because of delays in getting their cash equivalent transfer value (CETV) statements – required as part of proceedings.  

All 10 GPs we spoke to had made at least one formal complaint to PCSE. Furthermore, figures obtained by Pulse from the Pensions Ombudsman show there have been 31 complaints where PCSE is the respondent since April 2019, including 13 since April 2022, two months before the contract extension was announced by Capita. The GP in Wolverhampton told Pulse they had been through the ombudsman process, only to have the same issues resurface, prompting a second complaint.

This is affecting practices’ finances too. Pulse was contacted by a practice that recently had £46,000 in pension contributions taken in error by PCSE, and was told the refund would not be made for three weeks. In a separate case in September 2019, a Cumbria practice saw £30,000 of pension contributions taken in error, just days before payday. It should have been taken from a neighbouring practice in the same building. 

But most of all, this confusion piles more workload on GPs, with one spending ‘a session a week dedicated to ensuring my pension was all up to date’. Others speak of being ‘in tears’ and being ‘stonewalled and gaslit’. 

The BMA told Pulse there had been improvement in Capita’s delivery of services but pensions committee chair Dr Vishal Sharma says: ‘We know thousands of GPs have been unable to access accurate information about their pensions records, so they are unable to make informed decisions, and are open to exorbitant taxation charges. This can take a toll on their wellbeing and personal lives.’

Customer support centre
What it is supposed to do
The front door to PCSE is the customer support centre, which a 2015 NHS England document on the contract said should ‘acknowledge and respond to queries from a range of stakeholders, including GPs, practice managers and their accountants’.² Performance targets include answering phone calls within 30 seconds, acknowledging complaints within three days, and resolving them in 40 days. 

What Capita and NHS England say 
The performance data released to Pulse suggest PCSE is meeting some of its targets on customer support, such as 100% user satisfaction. But it consistently achieved 90% against a target of 95% for ‘key customer support processes’. 

What GPs tell us 
The 100% user satisfaction rate seems optimistic. GPs told Pulse communication with PCSE was a major frustration. They spoke 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. In 2021/22 alone, there were 3,028 complaints. GPs told Pulse that making complaints to PCSE was routine – and often the only way to get action. Dr Richard Johnson, who now practises in Australia, says: ‘I escalate to complaints within two weeks – because I know what will happen.’ 

Earlier this year, PCSE launched an ‘escalation process’ trial with four LMCs to address GPs’ unresolved queries, including those where a GP had been waiting more than 40 days since first raising an issue. Capita has confirmed that the escalation process is now being rolled out nationally, although this will no longer be based on the 40-day wait but when the lack of resolution is causing severe financial hardship, is a risk to an individual’s safety, or the agreed steps to resolve the issue have not been met by PCSE.

But the need for the trial suggests customer service is lagging. A statement published in March on Wessex LMCs’ website – an LMC in the trial – said: ‘We are still receiving numerous queries from practices… We completely understand your frustration and your concerns and are currently trialling a new escalation process with PCSE.’ 

Other historical issues 
Under the contract, PCSE is responsible for medical records management and movement. Pulse’s analysis of NHS England’s annual reports found that in the first three full years of the contract – 2016/17 to 2018/19 – there were 32 serious incidents relating to the loss of personal sensitive data because medical records had been delivered incorrectly by PCSE. Examples included bags of medical records being left outside practices, or being sent to the wrong practice or the wrong person. No further incidents were mentioned in more recent reports.

The performance data show PCSE is meeting its target on medical records movement now. 

In 2019, Capita was also found to have wrongly archived 160,000 patient records in a processing error. At the time, the BMA’s legal team was exploring ‘all avenues’ following talks over who should pay for the work created by the mistake. It told Pulse it ultimately decided not to pursue legal action but did report Capita to the Information Commissioner’s Office for the breach.

Also in 2019, Capita was stripped of responsibility for the cervical screening programme, after a series of failings. This included cervical screening letters being sent to an old NHS office for three years, affecting 2,000 patients, and 47,000 women not receiving correspondence about appointments in 2018. More errors were also revealed after July 2019, with Capita admitting a delay in inviting 16 women to screening because of admin errors, and failure to remove a further 99 women from the programme. 

Former NHS England chief executive Simon Stevens told the Public Accounts Committee at the time that he was not ‘satisfied’ with how the private company had run the programme. 

There have also been historical issues with the performers list, such as delays in processing performer status changes and GPs not being visible on the list, resulting in loss of earnings. The BMA told Pulse these issues had improved since the launch of a new performers list portal in 2019, but that it continues to ‘keep this under review’.

Capita set to stay
The NAO report concluded that NHS England had secured its ‘financial objective’ from outsourcing primary care support services to Capita, but said the two organisations needed to secure ‘stable and sustainable’ service delivery while supporting the transformation of services. Capita’s latest annual report (2020/21) suggests it considers the issues with the contract largely resolved. 

NHS England’s response to Pulse’s investigation has been to advise GPs with concerns to ‘contact the PCSE customer support centre’. As this analysis shows, that is an ongoing source of difficulty and distress for the profession. For GPs who have suffered as a direct result of PCSE’s delivery of services, the advice is unlikely to offer any comfort. 

This appears in the December 2022 issue of Pulse. Visit our dedicated page to read our case studies in full

References

1. National Audit Office. NHS England’s management of the primary care support services contract with Capita. May, 2018. Link
2.  NHS England. Primary Care Support England – Description of Services. November, 2015. Link