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General practice responsible for £88m of fraudulent behaviour, claims NHS report

The NHS could be losing £1.29bn every year due to economic crime, with £88m of that from general practice, according to an NHS England strategy document. 

In a new fraud, bribery and corruption strategy report, NHS England said fraud within general practice included list inflation, claiming for services not provided, quality payments manipulation, conflicts of interest and self-prescribing.

The document revealed figures from the NHS Counter Fraud Authority which found that primary care services as a whole, including pharmacy and dentistry, contributed to 58% of the estimated £1.29bn losses.

A further £2.2m is estimated to be lost from NHS pensions each year.

However, the BMA said it was wrong to extrapolate figures which ‘don’t have a firm basis’ and send the wrong message to GPs and practice staff. 

The document blamed the ‘high trust environments’ within general practice, which allow ‘considerable scope for manipulation’.

The strategy said: ‘Primary care services are provided on the whole by independent contractors, who operate as businesses in their own right. They are commissioned by NHS England and CCGs via a variety of contractual arrangements.

‘These high trust environments present considerable scope for manipulation and sharp practice. There is the potential for differing interpretations in relation to clinical opinion and some areas operate historic paper-based claims systems.’

The strategy laid out NHS England’s response to fraud until 2021, which was to make a culture where fraud is ‘neither ignored nor tolerated’.

It said: ‘[The vision is to ensure] Everyone is aware of the risk to patient care presented by economic crime and the impact it has on the ability of NHS England to carry out its business objectives. A culture is embedded where fraud is neither ignored nor tolerated.’

The document said general practice had a ‘high’ priority for future action, however, that it was difficult to measure the cost of fraud.

It said: ‘There are considerable gaps in intelligence with reference to fraud risks in primary care areas, a significant proportion of current work and future priorities therefore relate to primary care.

‘This is due in part to the lack of available intelligence and the historical data which shows that fraud does occur in these areas. Due to the nature of primary care information and the way it is held, there are a number of barriers which need to be overcome to effectively apply proactive analytics within primary care.’

It added that a key consideration for the strategy was the need to establish a collaborative approach to fraud.

BMA GP Committee chair Dr Richard Vautrey, said: ‘The vast majority of staff in the NHS go to work to do a good job for patients. In a complex, large industry, errors will be made – but it is often that, rather than deliberate fraud.

‘Where there are exceptional cases, which often impact on GPs and partners in the practices as much as anyone else, they need to be dealt with appropriately.

‘We will never defend those who defraud the NHS, but to extrapolate to create figures that don’t have a firm basis should not be done. It sends the completely wrong message to dedicated GPs and practice staff, who are working hard to deliver as good a service as possible, at a time when the Government and NHS bosses should be telling them how valued they are.

‘It’s doubly insulting to the profession when NHS England has singularly failed to resolve the problems created by Capita in its handling of GP backroom services, meaning practices themselves are often left out of pocket through no fault of their own.’

RCGP chair Professor Helen Stokes-Lampard said: ‘Hardworking GPs and their teams – who today alone will deliver care to over a million people under intense resource and workforce pressures – will be shocked and hurt to hear that insinuations they are complicit in somehow defrauding our national health service are still being propagated.

‘NHS England has a responsibility to review patient lists and ensure that resources are used where they are most needed, and our administrative staff spend a lot of time trying to ensure our patient records are as up to date as possible. But records can never be perfect as our patients’ circumstances change all the time – it is an inevitable consequence of having a patient list, it is certainly not a case of surgeries deliberately and systematically profiting by keeping patients on their lists when they shouldn’t be there.’

She added: ‘Where fraudulent activity occurs it needs to be taken seriously, but to single out general practice when what is needed is a wide-ranging programme to tackle any deliberate fraud in the NHS, is profoundly demoralising for GPs and a distraction from the wider issues of improving value for money from our scant NHS resources.’

It follows the news that complaints about GPs in England dropped by 5% in a year.

This article has been updated to clarify that the figures come from NHS Counter Fraud Authority.