Capita has been in the news for all the wrong reasons recently. Despite the extensive coverage, there has been little probing into the particular impact on optical practices.
Last month Optician was contacted by a practitioner who complained about the process by which NHS England (NHSE) and Capita were dealing with optical claims. While obviously not alone in their frustration, this individual had felt so aggrieved, and thought that the treatment was so unacceptable, he is now taking legal action against NHSE.
In 2015, Capita was awarded the primary care support services contract to administer payments to optical practices – as well as other healthcare sectors – to the tune of £330m over seven years. NHSE wanted a 35% reduction in cost across all primary care support services, affecting almost 40,000 primary care practitioners.
A Public Accounts Committee (PAC) report in July charged NHSE with not engaging with practitioners properly, resulting in ‘poor service performance’, and labelled the process ‘deplorable’.
‘NHS England wanted to reduce its costs by 35% from the first year of the contract at the same time as implementing a range of modernisation measures. This was a high-risk approach, particularly as the service was not well understood and was being outsourced for the first time,’ said the PAC report.
Given these demands from NHSE, the report said Capita expected to make losses of £64m in the first couple of years and thus had a ‘financial incentive’ to close support offices and reduce staff as fast as possible, leading to the ‘closure of 35 of the 38 support offices’ it inherited.
The same report stated: ‘Neither NHS England nor Capita did enough to gather the necessary information, assess the risks or test whether Capita would be able to deliver the service to a good standard.
‘Capita now acknowledges that it was a mistake to carry on closing offices and that in continuing to do so “we just made the problem worse as we went along … we should have stopped”.’
For opticians, the problems associated with the new contract focused on ophthalmic payments, CET claims and the national performers list – the list of recognised and qualified practitioners in England.
A National Audit Office (NAO) report in May said: ‘NHS England estimates that around 1,000 practitioners have been delayed from starting work and have experienced a loss of earnings due to the problems with the performers lists.’
It also concluded that ‘missed and inaccurate payments’ to practices had resulted in ‘some opticians having to take out loans’ to cover their costs. In July and August 2016, more than a quarter of payments ‘required correction’.
For the individual mentioned above, attempts to reclaim costs from Primary Care Support England (PCSE) – the administrative and support service for which Capita had been awarded a contract – had been unsuccessful. And, after robustly bringing up the issue in an LOC meeting, he said he was deemed ‘incapable’ of doing his work by the LOC ‘when they put a report into the GOC and NHS’.
‘I’ve been bullied, and I’ve been harassed,’ he said.
Instead of waiting for the situation to resolve itself, the practitioner is now taking it upon himself to ensure the payments are provided by taking NHSE to court. Part of the issue, and an identified cause of the debacle, is the inadequate communication between NHSE and Capita.
‘NHS England recognises that it has not always been having the right conversations with Capita,’ said the PAC report. The ‘conversations’ alluded to cover what factors are ‘outside of PCSE’s control’ and has been a major sticking point in the relationship of the two organisations.
When reporting on the performance against its contract, Capita said it was meeting 41 out of 45 of its performance indicators when ‘adjusted for factors it considered outside of its control’. When assessing the ‘raw performance’ indicators by outcome, Capita has met 32 out of 45 indicators.
The NAO said: ‘NHS England has not accepted Capita’s reported performance since May 2017 for 11 measures where there is a difference of view about how it should be calculated.
‘It is deeply unsatisfactory that, two-and-a-half years into the contract, NHS England and Capita have not yet reached the level of partnership working required to make a contract like this work effectively.’
The same practitioner had experienced this poor communication first hand. After informing NHSE they were taking legal measures against it, they were told to contact Capita. After doing so, Capita said to contact NHSE.
A separate optometrist based in Bath told Optician: ‘We had issues with Capita when they first took over the contract and payments were late for several months.
‘They were particularly difficult to deal with as no one seemed to know what was going on and it was difficult to get any answers or resolution. They seemed completely unprepared for the size of the contract they had undertaken, and their staff were ill informed. It was chaos for some months.’
However, they added: ‘Everything has been running smoothly for us this year.’
Meanwhile, another practitioner in the East of England had experienced a nightmare situation with Capita. According to him, it took 14 months to be put onto the national performers list, even after applying three months before ‘as suggested by Capita’.
He said this ‘resulted in the loss of at least £20,000 in GOS payments to the business’. In addition, the process resulted in an ‘under-performing business’, a loss of revenue from locum work as he was getting paid ‘half the rate’, and dismissal from the company in which he did his pre-registration as it ‘could not justify keeping me even on a part-time basis’.
‘Poor responses throughout with different advice given each time I rang’ made the situation far worse, he said.
He continued: ‘I was finally given my number in May 2017 and it then took six months to get a compensation form. I filled out the compensation form, but it kept getting sent back saying it’s the wrong form and I need to fill out another one. This happened three times. The process takes even longer because the board only have one meeting every month regarding compensation.
‘The issue is still not resolved, and I’ve partially given up because I don’t have time and energy to keep chasing it up when they are so uncooperative.’
‘I’m currently working six to seven days a week to make up the shortfall,’ he added.
A Capita spokesperson said: ‘Opticians affected by payment challenges at the beginning of the year received an apology at the time for any inconvenience caused.
‘A number of initiatives have since been introduced to deliver improvements to the ophthalmic payments service and help prevent reoccurrence, and payments are being made to schedule.
‘In the meantime, we are working with an independent expert and a representative from the optometry industry to improve the current paper-based service.’
The independent expert referred to is Katrina Venerus, who has been assisting as special advisor to PCSE’s ophthalmic payments service line since July. Venerus was seconded from her previous role as clinical director at Locsu with the support of its chief operating officer, Richard Whittington.
Whittington said: ‘Locsu and the Optical Confederation are pleased that Katrina is taking up this secondment to provide direct expertise to PCSE’s operational improvement work and the forthcoming transformation of the ophthalmic payments service.’
A Locsu spokesperson added: ‘The state of play currently is that all payment dates are being met and there are no significant delays or problems with payments.
‘Locsu is certainly not receiving any notable traffic from practices looking for escalation of payment issues.
‘In terms of CET, 2,000 CET claims have been received since the window opened and they have all been acknowledged and are processed within a few days of receipt.’
Regarding the performers list, Capita said it has ‘consistently delivered’ its part of the process to join the list ‘for more than a year’. This again indicated the lack of clarity between Capita and NHSE about who was responsible for which parts of the contract.
‘Some applicants continue to experience delays with their applications due to factors outside of PCSE’s control,’ said Capita.
Although some of the issues surrounding Capita’s contract have been improved or resolved, the PAC still noted concern regarding the short-sighted decisions made by it and NHSE.
Meg Hillier MP, chair of the PAC, said: ‘Trying to slash costs by more than a third at the same time as implementing a raft of modernisation measures was over-ambitious, disruptive for thousands of doctors, dentists, opticians and pharmacists and potentially put patients at risk of serious harm.
‘Neither NHS England nor Capita properly understood the scale of the challenge before agreeing the contract and are still in dispute over future payments.
‘Yet again this is poor contracting by government with one of its major suppliers and it must learn lessons.’