Fraud relating to the manipulation of income streams or activities that violate contractual terms perpetrated by either GPs or practice staff.
Financial vulnerability in this area has increased compared to the previous financial year. However, it is assessed that this increase is not necessarily indicative of an increase in fraud and is more in-line with the increase in expenditure paid by the NHS to general practitioners this financial year. Due to data anomalies, a different methodology was used to calculate financial vulnerability compared to previous assessments.
£116.7m
vulnerable from an expenditure of £11.6 billion
Strategic intelligence picture
Claiming and receiving funding for services not provided is likely in this area. This is where GPs or Primary Care Networks (PCNs) intentionally claim for funding to provide additional services, which are then not provided to the public as agreed contractually. Funding is provided by Integrated Care Boards (ICBs) from the NHS, direct to PCNs based on weighted population, where it can be used to reimburse the cost of hiring some additional roles to support the day-to-day workload of GPs, such as paramedics covering GP appointments. In some instances, this funding was diverted elsewhere to fund other ineligible services, top up core-staff wages, or siphoned for personal profit by senior partners in GP practices.
Diversion of practice funds, involving the manipulation of salaries and payroll is also prevalent in this area. This can involve the incorrect allocation of core ‘Global Sum’ funding provided by the NHS as well as senior members of staff at practices diverting or siphoning funding allocated for salaries, staff pensions and other payroll requirements for personal gain. The overall seniority and authority these GPs, partners or staff members, have in the General Practice model creates vulnerability as this enables them to move these funds away from the practice with little scrutiny or challenge, preventing whistleblowing and encouraging collusion through complicity to remain in employment.
Another prevalent MO identified in this thematic area is the abuse of position by GPs and other senior practice staff to enable their own personal or professional gain at the expense of the NHS. This includes abusing access to controlled medications in order to self-prescribe for personal misuse, or onward trade for personal gain. This can include the use of the information of deceased or ex-patients who have moved area. Again, this activity is vulnerable due to the seniority and authority held by GPs and high-ranking staff members within the GP model.
Further to this, an emerging MO identified as part of this category is the redirection of patients to pharmacies in which they have an undeclared business interest, to increase activity and claim the maximum amount possible from the NHS. This professional gain for the pharmacy in-turn allows for personal gain through increased turnover which may constitute a conflict of interest.
Information reports received for General Practice contractor fraud
The change in the number of fraud reports received in relation to GP practice fraud from 2020 - 2021 to 2024 - 2025 is illustrated in the below chart:
| 2020 - 2021 | 2021 - 2022 | 2022 - 2023 | 2023 - 2024 | 2024 - 2025 |
|---|---|---|---|---|
| 2020 - 2021149 | 2021 - 2022160 | 2022 - 2023173 | 2023 - 2024183 | 2024 - 2025233 |
Horizon scanning
The British Medical Association (BMA) has backed a UK-wide extension of salaried GP maternity leave benefits, whereby funding would be made available for all GP surgeries based on their patient size list for these salaries to be drawn out of. There is potential for fraud if outgoings on salaries were to increase.
A new NHS neighbourhood model could drive an overhaul of GP contract funding, which could create emerging threats and enablers of GP fraud for the NHS.