NHSCFA announces new loss measurement exercise

The exercise will focus on the GP contractor thematic area.

Published: 20 October 2021

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The NHS Counter Fraud Authority (NHSCFA) is an intelligence-led special health authority whose responsibilities include identifying, investigating, preventing and estimating the cost of fraud and other economic crime against the NHS. The NHSCFA is independent from other NHS bodies and is directly accountable to the Department of Health and Social Care (DHSC).

Each year the NHSCFA completes a strategic intelligence assessment in order to provide an estimate of financial losses, identify potential threats, vulnerabilities and enablers and measure the risk of loss to the NHS in thirteen key thematic areas. There are two main ways that NHSCFA achieves these objectives: loss measurement exercises and comparative loss assessments.

A loss measurement exercise is an in-depth analysis and measurement of a particular area of activity to provide a statistically robust percentage of how much of the funding/reimbursement for the relevant activities is vulnerable to loss caused by fraud or irregularity. Out of the two methods the NHSCFA has the highest confidence in this method.

A comparative loss assessment is used where the NHSCFA has not directly measured an area, and we are therefore reliant on vulnerability percentages derived from partners, stakeholders or loss measurement exercises in other similar areas. These may not be 100% comparable, so the NHSCFA has the least confidence in them.

The GP contractor thematic area has never been subject to a loss measurement exercise and relies on historic loss measurement reporting and comparative analysis referring to dental and optical contractor loss. Recent loss measurement exercises in the dental and optical contractor thematic areas have identified overall financial vulnerability percentages of between 1% and 3.5%, therefore the most conservative of these figures has been used to express possible financial vulnerability in the GP contractor thematic area.

This year, the NHSCFA has been tasked with carrying out a loss measurement exercise looking at financial vulnerability within the GP-administered NHS Seasonal Influenza Immunisation service, with a view to producing some benchmark loss estimate figures in the GP contractor thematic area. The exercise has been commissioned by the Health Sector Counter Fraud Board, comprising NHS Counter Fraud Authority, NHS England and Improvement, NHS Business Services Authority, Department of Health and Social Care and the Cabinet Office.

The primary aim of this exercise is to obtain a better understanding of the GP contractor thematic area, particularly within enhanced service claims, in order to estimate potential financial losses and identify possible vulnerabilities within the process. This is purely a strategic research exercise and no investigative action or redress will be taken. It is not the intention of NHSCFA to take action against any contractor whose enhanced service claims are thought to be incorrect as a result of this exercise. It is purely NHSCFA’s aim, through this exercise, to capture benchmark financial vulnerability figures and to improve the intelligence picture for this thematic area.

As part of this exercise, the NHSCFA will randomly select a number of GP practices in England that provided the NHS Seasonal Influenza Immunisation service and claimed item of service fees and/or reimbursement costs during the 2020-2021 flu season. Once the practices have been selected, the NHSCFA will be in contact with NHS Digital and/or the relevant CCGs in order to obtain flu vaccination data for the selected practices needed for the exercise. Much of the data needed may have already been collated for the purposes of flu vaccine uptake reports, so data collection should incur the minimum of inconvenience to selected parties’ administrative functions.

We are aiming to complete the exercise during the current financial year.

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