Fraud relating to the manipulation of income streams or activities that violate contractual terms perpetrated by either GPs or practice staff.
The diversion of practice funds involving the manipulation of salaries and payroll is a realistic possibility. Senior members of staff at practices have significant authority within their workplace enabling them to siphon funds from practice accounts directly into their own personal accounts - funds that have been provided by the NHS to offer GP services in the community. This can include staff members or practice partners colluding to increase their own salaries by purporting to work overtime shifts or offer additional services.
£110.1m
vulnerable from an expenditure of £11 billion
Some staff members could be capable of abusing their position by exploiting their access to prescription or other controlled medication. There is intelligence to suggest some instances of false or self-prescribing for personal misuse of these controlled drugs, as well as to stockpile and trade with criminal groups in more lucrative markets. This can include using the details of ex-patients to conceal a falsified prescription and obtain controlled medication, for example those who have moved from the area or who are deceased.
Some GPs and practice staff may collude to boost revenue for the practice. It is a realistic possibility for contracts to be manipulated to achieve higher levels of funding from the NHS through practices claiming for services and treatments which were not provided, known as manipulation of Quality of Outcome Framework (QOF). Also, potentially achieved through the manipulation of Global Sum Payments via the deliberate inaccurate supply of patient lists and treatments, known as ‘ghost patients’.
Information reports received for General Practice contractor fraud
The change in the number of fraud reports received in relation to GP contractor fraud from 2019 - 2020 to 2023 - 2024 is illustrated in the chart below:
| 2019 - 2020 | 2020 - 2021 | 2021 - 2022 | 2022 - 2023 | 2023 - 2024 |
|---|---|---|---|---|
| 2019 - 2020177 | 2020 - 2021149 | 2021 - 2022160 | 2022 - 2023173 | 2023 - 2024183 |
Horizon scanning
NHS England (NHSE) released arrangements for the 2024 - 2025 GP contract in February 2024 including an overall pay growth assumption of 2%, which could result in an increase of GPs taking opportunities to increase cash flow through fraudulent means to make up for funding perceived as insufficient.
A ‘taskforce’ is to be launched by the Department of Health and Social Care (DHSC) to hear from stakeholders within the general practice remit around priorities for change and the future of general practice.