Patient safety

Almost 2,000 ‘high priority’ clinical correspondences left unprocessed

Around 2,000 high priority letters such as urgent test results and screening documents were not processed due to a mishandling of the documents in transit, an investigation has revealed.

The report by the National Audit Office (NAO) reveals that a backlog of misdirected correspondence had accumulated with Capita, including almost 2,000 high priority items and 25,000 low priority items.

Back in June, the NAO described that a “colossal blunder” had been made by NHS Shared Business Services as its contractor, Capita, managed to leave a huge number of correspondences unprocessed in a warehouse. 

In October last year the Public Accounts committee was informed that NHS England had discovered a total backlog of 162,000 items of clinical correspondence that had not been redirected.

Before that, in May 2015, NHS England introduced new arrangements for handling misdirected correspondence, whereby recipients were to return the mail to the senders.

However, between June 2015 and March 2016 an unknown number of GP practices continued to send clinical correspondence to their previous Primary Care Services (PCS) centres for redirection.

During this period Capita operated from the procedures it had inherited from the 36 PCS centres it was managing.

When these sites were closed from March 2016, Capita made an inventory of all records at each site, which it shared with NHS England, making reference to “clinical notes,” but failing to identify the documents as unprocessed clinical correspondence.

Capita has acknowledged that, with hindsight, it could have reported the backlog sooner.

In November 2016 checks by Capita and NHS England identified an estimated 170,000 items of clinical correspondence, considered to be low risk by NHS England on review of a small sample.

NHS England advised that Capita should send the correspondence to the relevant GPs, but did not ask or contract Capita to return the correspondence.

By July 2017 the two organisations had identified and logged 277,000 items as part of an agreed process to return the correspondence to the correct GP.

In August last year an information governance incident occurred, which triggered wider knowledge within NHS England of the return of correspondence and let to a pause in the process.

Following the initial clinical review, by November 2017 NHS England had sent over 18,000 items of misdirected correspondence to relevant GPs in order to determine whether there had been any harm to patients.

NHS England expects to complete its review by the end of March 2018, at an estimated cost of £2.4m, including £0.3m that it will pay to GPs.

‘No actual harm’ identified

The NAO’s report states that to date, no actual harm has been identified.

GPs are still wrongly sending clinical correspondence to Capita, and NHS England told the NAO that it continues to receive clinical correspondence from Capita, at around 5,000 to 10,000 items a month.

To combat this NHS England is planning an information campaign to ensure that GPs understand the guidance for handling correspondence for patients not registered at their practice.

The process has not yet been finalised between NHS England and Capita for handling any correspondence that Capita receives in error.

A Capita spokesperson told NHE: “As the NAO report states, Capita has no contractual responsibility for redirecting clinical correspondence.

“Capita informed NHS England in May 2016 that there was a problem with an unquantified accumulation of clinical notes.

“In October 2016, Capita then formally reported the incident to NHS England and has continued to report on the issue.

“NHS England has not yet finalised its process with Capita for handling any correspondence that Capita receives in error.”

NHE has approached NHS England for comment.

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