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Government launches counter-fraud strategy targeting primary care

Government launches counter-fraud strategy targeting primary care

The Department of Health and Social Care has launched a counter-fraud strategy which identifies primary care as a key risk area to focus on in the next three years.

The new strategy will focus on exposing fraudulent claims in general practice as well as dentistry and pharmacy, the DHSC said.

It is estimated that the NHS in England is vulnerable to £1.198bn of fraud, bribery and corruption each year and preventing and detecting fraud, as well as recovery of funds, will help meet a savings target of £500m for the NHS between now and 2026, according to the Government.

Between 2021 and 2022 the financial amount vulnerable to general practice fraud was estimated at £101m, according to the latest NHS Counter Fraud Authority (NHSCFA) Strategic Intelligence Assessment report, used to develop the strategy.

In the same period, the estimated financial vulnerability to fraud for community pharmacists was £122m and for dental contractors was £61m.

During 2021/22, there were 160 allegations of general practice-related fraud made to the NHSCFA.

A DHSC spokesperson said a key part of the 2023-2026 counter-fraud strategy is ‘ensuring that, wherever possible, fraud is prevented from occurring in the first place by working with stakeholders, such as GPs, to identify any weaknesses in the system that can be closed’.

A policy paper says DHSC will take a data-driven approach and make counter-fraud a ‘part of day-to-day activity’.

One objective will be to ensure staff ‘understand fraud and how it could impact their work, and their roles and responsibilities to prevent it’ as well as make sure they feel confident to report suspected fraud early.

It also says it will ‘continue to use a range of options to deal with those who commit fraud, allowing proportionate and cost-effective action to be taken’.

Health minister Lord Markham said: ‘Every pound lost to fraudsters is a pound lost from patient care.’

He added: ‘The methods and means of attack from fraudsters are constantly changing and I am determined that we not only keep pace but anticipate their actions.

‘No level of fraud is acceptable, and DHSC and its partners will do even more in response to this threat, with an ambitious new three-year strategy target of £500m.’

Primary care is one of three targets in the DHSC’s anti-fraud strategy, also including procurement and commissioning and prevention policies.

Two GPs were suspended for 12 months in May after an MPTS tribunal found that their falsification of QOF records amounted to serious misconduct. However the tribunal accepted that their motivation was not financial gain but a bid to save their practice from being closed down by the CQC.

What does fraud in general practice look like?

The NHSCFA Strategic Intelligence Assessment 2022 report said: ‘Fraud in this area is generally considered to be the manipulation of NHS income streams by practitioners or staff members. It could also be considered activities that violate NHS contractual terms for practitioners and services provided.’

It highlights the threat of organised crime groups (OCGs) potentially colluding with GPs to obtain prescription medication for selling.

The report says: ‘Intelligence suggests non-existent or deceased patient details have been used by GPs when prescribing medication for onward trade. OCGs may fraudulently obtain prescriptions, or even collude directly with GPs themselves.’

It also said ‘it’s likely a small minority of GPs could manipulate contracts to increase profit’ by using false records or declarations to secure funding or ‘deliberately fail to remove former patients from their lists, resulting in increased Global Sum payments’.

Finally, it added there is a ‘realistic possibility that practice employees may knowingly or unknowingly be complicit in supporting contract manipulations. The staff member may not directly benefit, but could potentially register ghost patients, or intentionally fail to remove patients from surgery lists.’

A version of this article was first published by Pulse’s sister title Management in Practice



Please note, only GPs are permitted to add comments to articles

Michael Green 20 June, 2023 5:38 pm


Darren Tymens 20 June, 2023 6:45 pm

Nothing new here: from 2019…
Fraud in hospitals in a typical year is estimated by the same people to be 3-4 times that in GP, pharmacy and dentistry combined – but strangely no headlines bashing them.
Meanwhile… PPE?

paul cundy 20 June, 2023 7:46 pm

Dear All,
And to what extent do they include in their definition of fraud “NHS side mal administration”? CCGs, ICBs, SLAs not being honoured or their terms being retrospectively changed or “unless you re-submit in 6 weeks” deadlines being imposed by the mindless morons who inhabit that world?
My suspicion is that we’ve lost more through their incompetence and inefficiency and utter opacity of claims processes.
Paul C

Northern Trainer 20 June, 2023 8:15 pm

Paul you are spot on. If only a real journalist had the time and inclination to truly investigate self-awarded pay-rises, expanding teams of “managers” and sheer incompetence. I remain baffled at the lack of accountability….. It’s probably just easier to re-hash an NHSE press release as clickbait. So sad.

Dr No 20 June, 2023 9:32 pm

Perhaps they can look at PCSE first. It’s a year since I applied for my pension and I still don’t have it. I wonder if they are fraudulently going to pocket the interest on my lump sum? And then perhaps they can look at the millions trousered by Tory connected shysters fraudulently selling useless PPE to the nhs. I doubt we’ll ever see that money again. Then maybe look to Jeremy Hunt, fraudulently promising 6000 new GPs in return for my income tax. Can I have my money back mate? Oh yes 😉 ha ha ha. Bunch of tossers….

Douglas Callow 21 June, 2023 8:20 pm

HMG DH NHSE Gaslighting as usual
Meanwhile another month where day to day Gov borrowing is > GDP and tax receipts at record levels

David Church 1 July, 2023 9:00 am

Do they not even realise we can see through their false accusations? We are NOT that gullible (although general population seems to be) – we are better educated.
Registering ghost patients and failing to delete deceased patients from our lists?
Primary Care GPs cannot register ghost patients, because all attempts at registration are checked by NHS-side against national databases within 2 working days, by computer, and a number of genuine patients are refused if we have made a mistake in spelling htier names or dates of birth. All deaths are registered by District Registrars, who report those details to NHS database, and they are centrally deleted, and then removed from GP lists within days afterwards. There may be a slight delay, since GPs can only delete patients once somone has told us they died – and there may be occasional failures in our process when the IT connections are not up to scratch, but that is taken account of in the contract, and GPs are funded per quarter, not per patient-day.
Temporary registrants are no longer paid by IOS – they are, if you are lucky, funded to historical levels, but they are counted, and funding reduced (but I don’t think ever increased) if there is a change in numbers seen. Most GPs are suffering from effects of lockdown funding losses even now. Any any non-existent patients attempting to register are declined by NHS-side IT.
But in any case, any IOS claims do not result in extra funding to GPs, they only result in changes in relative distribution of funding between GPs from a limited pot, and claw-backs are made from the pot the following year (or quarter).
Patients committing fraud by false registration is more likely. There are a number of overseas students taking unfair advantage of our system by getting very reduced rate or free healthcare over here for expensive conditions and prescriptions initiated by overseas doctors, but NHS is not interested in that – nor in the fact they jump the queue over local students with same problems!
Quite possibly more is lost in cost of prescriptions sought and issued in good faith but not used, due to change in condition or death of patient, or over-ordering due to mental health issues or dementia.
Prison services seem to prescribe a lot more drugs of addiction than do other GPs, so perhaps conditions in prisons could be looked into. Most inmates apparently start off on illegal sources of drugs, even in prison.
And then there is PPE, PFI, blatant fraudulent building development contracts for hospitals and GP services, (and less obviously, but still inappropriately awarded and poorly completed ones), and NHS bodies do not seem to be interested when something is reported to them. Possibly conflicts of interest at work? Historically even the MPTS has let people off on strange and irrational excuses. And a fraud reported to HMRC, there has been no feedback on.
Plank in eye syndrome appears to be at work here.