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Exclusive: Payment delays by Capita leave some trainees unable to cover mortgages and forced to ask for emergency funds
Hundreds of trainee GPs have not received their salaries from the outsourcing company responsible for paying them, forcing some to turn to charities for emergency funds.
Some GPs have been unable to cover their mortgages because of the delays by Capita, which holds a contract to administer training grants for GPs through a body called Primary Care Services England.
A letter sent to NHS England on 30 October by the British Medical Association and seen by the Guardian warns that some practices were “having to pay trainees out of already overstretched practice budgets, or trainees are going months without being paid if the practice cannot cover the shortfall”.
Capita confirmed it had outstanding payments to some trainee GPs but it was unable to say how many it is responsible for paying, or how many it has failed to pay.
The BMA estimates that hundreds of trainees have been affected, although NHS England was also unable to give a number. The Cameron Fund, a charity for the prevention of hardship among GPs and their dependents, said it had received three applications for emergency funding in the last week alone.
“This is actually probably the tip of the iceberg,” said the treasurer of the charity, Dr David Wrigley. “NHS England has commissioned out what was a very efficient service run within the NHS, and now Capita runs this contract in what I’d call another botched privatisation.”
One trainee GP, who asked not to be named, was not paid for two consecutive months by Capita. At the end of October she posted on a private message board for GPs asking: “Anyone know of how I access hardship funds (quickly) to feed children/pay nursery/mortgage (quickly)?”
She applied for charitable assistance immediately afterwards, she told the Guardian. The Cameron Fund gave her emergency funds so she could buy a present for her daughter’s seventh birthday.
“It’s pretty stressful. A constant drain. I’ve run out of energy to be able to fight it,” she said. Her surgery also provided her with a loan last month to tide her over, but did not hold enough surplus funds to do the same to help her again.
But in the last 24 hours, she says, “partners literally just stepped forward [and have] all taken a pay cut and provided me with a loan to get me through the month as they were worried about my family”.
Capita has faced issues with its primary care support services contract since it was awarded in June 2015, including missing records, administrative errors preventing GPs from working, and missing payments. Critics will see the latest revelations as evidence of the dangers of outsourcing NHS services.
An NHS England spokesperson said it was “holding Capita’s feet to the fire on needed improvements”. It added: “In the meantime, the lead employer for Health Education England or the GP practice are responsible for paying their GP trainee salaries and are subsequently reimbursed for this. Backlogs are being prioritised by Capita.”
But while it now says that it is piling on the pressure, six months ago NHS England appeared to be sanguine about Capita’s performance, with the GPs’ magazine Pulse reporting NHS England saying it was “encouraged” by the progress made by its much-criticised contractor in implementing a recovery plan.
Capita says that in some cases it has not received all the information it needs to pay salaries from the relevant employers. A spokesperson said the problems were an “inevitable” part of “a major transformation project to modernise a localised and unstandardised service”.
It added: “We have made significant investment to deliver improvements and these have been recognised by NHS England and demonstrated through improved service performance and improved customer satisfaction. We are continuing to transform locally managed operations into a modern and efficient national customer-focused service for NHS England and all primary care organisations.”
The BMA’s letter, to the NHS chief executive, Simon Stevens, details a range of problems with Capita.
“We are disappointed at the lack of progress that has been made,” it says. “These issues have been ongoing since NHS England commissioned Capita … and it is unacceptable that more progress has not been made to getting these resolved.” The BMA also claims there have been significant issues with processing both locum and trainee GPs’ pension contributions.
“The reality is that there are huge levels of funding that should be going to GP practices that are not going through,” said a BMA spokesperson, Dr Krishna Kasaraneni. “All the issues we’ve identified add up to this being a patient safety matter. Patients are at risk.”
One doctor in her third year of GP training who asked not to be named told the Guardian her salary had not been paid from April until August this year.
“My surgery gave me a loan initially, and then when it still wasn’t being paid, I had to dig into savings,” she said. “I was pretty frustrated. The people who were in charge of solving it clearly weren’t all that bothered, and it took a lot of very angry emails to get the fifth month paid. If it hadn’t been I was about to apply to a charity for help as I was running out of money.”
At the Cameron Fund, Wrigley says he believes Capita’s failings are so serious that the public accounts committee should be investigating the contract.
“NHS England have known about this for a while and the BMA has been putting constant pressure on, and it’s all promises that it’ll get better but it doesn’t. I heard [that in] Nigeria trainee doctors weren’t getting paid but you don’t expect it in the world’s fifth richest economy,’ he said. “It’s a complete failure and I’d like the contract taken back to be run by the NHS.”
New systems for cervical screening and GP payments and pensions that are also contracted out to Capita are due to go live next July. The BMA has told NHS England that it has “no confidence” in Capita’s ability to deliver these services.
“The consequences of failings will be very serious for practices, potentially affecting their viability,” its letter concludes. “All of us who work in general practice and who depend on this service, expect to see much more robust stance taken by NHS England to resolving these many problems.”
At the Cameron Fund, Wrigley is anticipating more requests for help. “I expect we’ll see more [applications],” he says. “There’s no sign of Capita sorting its act out.”
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