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General practice responsible for £88m of fraud per year, claims NHS England

by Beth Gault
17 September 2019

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

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

The document revealed 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.

‘Considerable scope for manipulation’

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.’

‘Gaps in intelligence’

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.

In June, it was revealed that the NHS anti-fraud body would prioritise investigations of practice ‘fraud’ in retaining ghost patients.


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