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Serco ordered to improve failing GP service
Serco has been given 14 days to present a plan to correct its failures at the out-of-hours GP service it runs for the NHS in Cornwall. Photograph: Jim Wileman
Serco has been given 14 days to present a plan to correct its failures at the out-of-hours GP service it runs for the NHS in Cornwall. Photograph: Jim Wileman

Serco ordered to improve failing GP service

This article is more than 11 years old
Firm criticised by health regulator as role of private contractors comes under scrutiny following G4S's Olympics problems

Serco, a leading private contractor of public services, is failing to meet legal requirements to provide enough staff, train them properly or monitor their performance in the out-of-hours GP service it runs for the NHS in Cornwall.

The company has been given 14 days by the health regulator, the Care Quality Commission, to come up with a plan to right the failures, which are highlighted in a damning report on Serco's operation in the south-west.

The CQC judgment comes as the role of private contractors is under renewed scrutiny following G4S's failure to recruit enough security staff for the Olympics, and as large numbers of NHS contracts are being put out to tender.

A Guardian investigation in May uncovered a string of serious allegations over Serco's service in Cornwall, made by whistleblowers who said the service was repeatedly so short-staffed as to compromise patient safety and who claimed Serco management manipulated data to suggest it met targets it had in fact failed to meet.

Serco acknowledged that it had not met legal standards at the time of the CQC inspection but said it had already made progress in correcting shortcomings. "We are confident that we will be able to fully satisfy the CQC that we are meeting all of the standards required when they next visit the service," it said.

CQC inspectors, who made a series of unannounced visits to the service in April after persistent complaints from staff and local MPs, found Serco was failing to meet four of the mandatory standards for quality and safety. Their final report says the company has not provided enough qualified, skilled staff to meet patients' needs, although it stops short of finding the service unsafe. A quarter of staff had not completed mandatory training. In addition, mandatory standards to protect vulnerable adults and children using the service from abuse were not being met.

The regulator also found that Serco failed to meet the legal requirement to have an effective system of monitoring its performance. Inspectors confirmed whistleblowers' concerns over the accuracy of Serco's performance data. When they looked at a small sample of data, they found two examples of calls from patients where targets had not been met but which had been wrongly classified as achieving targets.

They also found that a manager routinely altered daily performance reports on targets, correcting individual records which suggested the service was failing if the entry was known to be incorrect. They did not however find evidence that the figures had been deliberately alterered to enhance performance. Inspectors instead found that there were unresolved problems with the computer system dating back four years, a situation they said was "puzzling".

The regulator's report concluded that one of the failures was minor while the three other had a moderate impact on patients.

Ian Biggs, CQC deputy director in the south, said: "At least half a million people depend n ths service, so it's vital it's proeprly staffed. At times Serco has not had enough doctors on duty. Quite clearly the system of monitoring performance is unreliable." He added that it was possible that Serco had overstated its performance in its results. The CQC said it was not policy to impose any fines on failing services at this stage. It will conduct further unannounced visits to see if Serco complies with the law in coming weeks.

Andrew George, the Liberal Democrat MP for St Ives, who reported the Serco service to the CQC, said he felt vindicated by the report, but remained concerned that the data manipulation issue had not been fully resolved. The integrity of data was vital to claims made by private companies to commissioners of services or to win other contracts. "It seems records were only manipulated in favour of Serco's interests. Although the CQC says that it did not find evidence of deliberate alteration of data, neither did it find evidence that it was not deliberately altered. The CQC simply does not have the forensic remit or capacity to prove or disprove such a point.

"This potentially raises serious questions about the future of the NHS reforms the Government is keen to roll out. In my view, commissioners can trust public sector providers to be less likely to undermine the integrity of data."

The commissioner of the privatised Cornwall service, the county's Primary Care NHS Trust, had given Serco a clean bill of health in its own audit carried out earlier this year in response to concerns. It confirmed that it was now conducting a more thorough review of the service, prompted by the Guardian revelations and the CQC report, which would look specifically at whether performance data had been manipulated. It told us however that it had not relied on Serco's adjusted management reports in monitoring the company's performance.

Dr Shelagh McCormick, medical director of the county's primary care trust, said: "Our primary concern is our patients and it is important they feel confident about local services. It is worrying for everyone when a provider fails to meet essential standards but we are already working with Serco to ensure they address everything that has been raised by the CQC."

Paul Forden, managing director of serco's clinical services, said: "Patient safety and wellbeing is our first priority. We have taken and will continue to take any criticisms extremely seriously and we have fully co-operated with the CQC in their investigation. We are confident that we will be able to fully satisfy the CQC that we are meeting all of the standards required when they next visit the service."

The failings in the privatised service come at a delicate time for the coalition government as it presses ahead with a policy that requires all 52 newly-formed PCT clusters in England to identify at least three of their community services to put out to competitive tender this year in a process that will lead to a rapid increase in private sector involvement in the NHS.

Serco, which generated revenue of £4.6bn in 2011, is likely to bid for many more of the NHS contracts.

The Department of Health said: "All providers of care must ensure they meet the highest standards. The local NHS has a legal responsibility to ensure a high quality out of hours service for their local population. Serco must now take action to ensure they comply with CQC standards."

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