General practice accountable for £88m of fraudulent behaviour

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

Fraud within general practice included list inflation, claiming for services not provided, quality payments manipulation, conflicts of interest and self-prescribing. This has been uncovered in a new fraud, bribery and corruption strategy document which revealed that primary care services as a whole, including pharmacy and dentistry, contributed to 58 per cent of the estimated £1.29 billion losses.

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’, saying that general practice had a ‘high’ priority for future action, but that it was difficult to measure the cost of fraud.

The document blamed the ‘high trust environments’ within general practice, which allow ‘considerable scope for manipulation’, although the British Medical Association has said that the figures do not have a ‘firm basis' and could send the wrong message to GPs and practice staff.

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.”