A backlog of 374,000 clinical documents which included more than 1,800 high priority items were not redirected as they should have been, a report has revealed.

The National Audit Office (NAO) investigation, published on 2 February, looked into a small proportion of GPs who had not been complying with guidance to return to sender if they were wrongly sent correspondence.

This included clinical papers, child protection notes, treatment plans and changes to patients’ medication regimes – such as when a patient has moved to another practice.

Instead the doctors had been sending the mail on to outsourcing firm Capita, the provider of primary care support services for NHS England, which is not contracted to forward it on.

The incident was reported to the NAO in October 2016, 18 months after new arrangements for handling misdirected correspondence were introduced in May 2015.

Initial backlog checks by Capita estimated there were 580,000 ‘clinical notes’ involved, but later checks by NHS England revealed there was an estimated 170,000 items of clinical correspondence.

The report reveals NHS England did not ask or contract Capita to return the correspondence.

By July 2017, Capita and NHS England had identified that there were in fact 277,000 items of clinical correspondence which were under an agreed process to return to the correct GP.

NHS England paused the review and return of clinical correspondence in August 2017 following an information governance incident, which highlighted a wider problem. In October 2017, it was thought there was a backlog of 162,000 items of clinical correspondence.

However, the NAO said NHS England’s National Incident Team had now identified and clinically reviewed 374,000 items of unprocessed correspondence.

The vast majority required no GP action to be taken, although NHS England identified 1,811 high priority items  – such as documents deemed to be related to screening or urgent test results – as well as 25,361 low priority items.

By 20 November 2017, NHS England sent 18,829 items of misdirected clinical correspondence to relevant GPs, so that they could assess whether there had been any actual harm to patients.

It is estimated that it will cost NHS England £2.4 million to review clinical correspondence for evidence of harm, although until now there has been no evidence to suggest this.

The review is expected to be completed by the end of this month.

The report states NHS England is unable to stop GPs from sending clinical correspondence to Capita in error. This means NHS England has continued to receive between 5,000 and 10,000 items of clinical correspondence from Capita per month.

The NAO said it expected NHS England to carry out an information campaign to ensure that GPs understood the guidance for handling correspondence for patients who are not registered at their practice.

Dr Richard Vautrey, GP committee chair at the British Medical Association (BMA), said the misdirected correspondence was “no surprise”.

He added: “What is clear from this investigation is the inability of both NHS England and Capita to get to grips with a problem they have now known about for years.

“Capita itself admitted it failed to officially disclose the scale of the backlog to NHS England in good time, and both are yet to decide whose responsibility it is to return records to the right practice.

“Further, NHS England has still not launched an effective information campaign aimed at GPs, despite continuing to receive misdirected correspondence almost two years after it became aware of the problem.

“This is a further indictment of Capita’s shambolic running of GP backroom services and the real effect its failings are having on the safe care of patients.”

Back in November, the House of Commons Public Accounts Committee slammed the NHS for its ‘shoddy handling’ of the problem.