£101m
vulnerable from an expenditure of £10.1 billion
Fraud in this area is generally considered to be the manipulation of NHS income streams by practitioners or staff members. It could also be considered activities that violate NHS contractual terms for practitioners and services provided.
This is approximately the same expenditure as in 2020 – 2021; however, last year included extra funding in the form of COVID-19 support payments and payments relating to COVID-19 immunisation. The 2021 – 2022 expenditure does not include these payments, so in effect, becomes an actual increase from pre-pandemic levels. As such, financial vulnerability also remains the same. This expenditure is now distributed across fewer providers so the NHS pays on average more per registered patient (£159.61 increasing to £163.65).
The contract could be manipulated due to the reliance upon GPs to provide accurate information relating to patient lists and treatments. This may allow a minority to gain from increased Global Sum Payments. It is also a realistic possibility that some GP partners and practice employees may be enabling contract manipulation by covering up for one another.
It is assessed that some staff members may abuse their position to commit fraud, with those in senior positions and other influential roles potentially having a greater opportunity to divert significant funds without detection or scrutiny. This includes unauthorised salary increases, diversion of funds, and salary overpayments.
NHSCFA assess the COVID-19 related additional support payments were vulnerable to fraud by manipulation, thus potentially increasing GP practice income. This may mean fraudulent practices are diverted elsewhere in the budget moving forward.
Information reports received for General Practice contractor fraud
During this reporting period, NHSCFA received a total of 190 reports, an increase of 12% from 2021 – 2022. Many reports relate to high-value fraud and irregularities committed by practice managers which include unauthorised salary increases and diversion of funds from practice accounts to personal accounts. Furthermore, GPs and practice employees claiming overtime not worked and staff listed on payroll receiving a full salary but not actually working. The increase in reporting is a return to pre-pandemic levels, suggesting there was an impactfelt by the restrictions seen in 2020 and 2021, such as fewer patients seeing GPs, reduced oversight of suspicious behaviour, and as such, fewer opportunities to report.
The change in the number of fraud reports received in relation to GP contractors from 2018 – 2019 to 2022 – 2023 is illustrated in the chart below:
| 2018 to 2019 | 2019 to 2020 | 2020 to 2021 | 2021 to 2022 | 2022 to 2023 |
|---|---|---|---|---|
| 2018 to 2019 164 | 2019 to 2020 190 | 2020 to 2021 160 | 2021 to 2022 170 | 2022 to 2023 190 |