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Majority of NHS fraud allegations relate to primary care, claims report

By Beth Gault and Rebecca Gilroy
17 September 2019

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The NHS could be losing £1.29bn every year due to economic crime, with over half of the losses down to primary care, according to an NHS England strategy document.

In a new fraud, bribery and corruption strategy report, NHS England said ‘Primary care features heavily in the NHS Counter Fraud Authority’s (NHSCFA) estimate of the cost of fraud.’

It reported that fraud in general practice included list inflation, claiming for services not provided, quality payments manipulation, conflicts of interest and self-prescribing.

The document revealed 2016/17 figures from the NHSCFA, which found that primary care services as a whole, including pharmacy and dentistry, contributed to 58% of the estimated £1.29bn losses.

General practice is said to account for £88m of the losses, and for community pharmacy £111m of them. A further £2.2m is estimated to be lost from NHS pensions each year.

However, the British Medical Association (BMA) said it was wrong to extrapolate figures that ‘don’t have a firm basis’ and send the wrong message to GPs and practice staff.

‘Considerable scope for manipulation’

The document blamed the ‘high trust environments’ in primary care, which it said allow ‘considerable scope for manipulation’.

The strategy reported: ‘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 that] 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.’

‘High priority’

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

The strategy 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.

Errors, not 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 extrapolating 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.’


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