The NHSCFA estimates that the NHS is vulnerable to £116.7m worth of General practice each year. Please see our latest strategic intelligence assessment for more details.
General Practice fraud relates to the manipulation of income streams or activities that violate contractual terms perpetrated by either practitioners or staff members.
The main fraud types in this category are:
- Claiming and receiving funding for services not provided - 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 diverted elsewhere to fund 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 - 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
- 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. As well as the redirection of patients to pharmacies and businesses in which they have an undeclared business interest.
For a full list of fraud types in this category, please check General Practitioners in the fraud definitions.
To assist you on how to spot the signs of General Practice fraud and how to put measures in place to stop this type of fraud, please see below
Think Prevention
- Are patient records being updated accordingly if they are no longer with the practice or are deceased?
- Is there enough separation of duties and adequate management of prescription forms throughout the practice?
- Are false claims being made in respect of patient demographics, allowances or, reimbursements.
Further information
Ghost patients (short animation)
This animation shows an example of claiming for NHS care that was never delivered through the creation of fake patients. It highlights the importance of reporting fraud and the consequences for those who commit it.
Case Study 1
A practice manager transferred a total of £596,000 over a three-year period to bank accounts she set up to pose as suppliers to the surgery.
The practice manager manipulated accounts at the Medical Practice to cover her tracks, transferring funds from one year’s records to the previous years to hide shortfalls created by the fraud. The fraud and missing funds were only discovered after she quit her role at the practice.
The practice manager was jailed for two years and the monies lost to this fraud were recovered in full.
Case Study 2
A doctor forged over 400 prescriptions in the names of three of his patients and obtained medicines to treat himself for depression using the name of his patients. In total, the doctor forged 243 prescriptions in the name of one of his male patients, 173 in the name of another, and 24 using a third patients’ identity.
The total value lost to the NHS was £10,047 and the patient details he used were all entitled to free prescriptions and did not have to pay.
The doctor was given a four months jail sentence suspended for 12 months and ordered to pay £10,047 compensation to the NHS within a year, after he pleaded guilty to three charges of fraud.
How to report fraud
Report any suspicions of fraud or attempted fraud to the NHS Counter Fraud Authority online at https://cfa.nhs.uk/report-fraud or through the NHS Fraud and Corruption Reporting Line 0800 028 4060 (powered by Crimestoppers). All reports are treated in confidence and you have the option to report anonymously. You can also report to your nominated Local Counter Fraud Specialist if you are an NHS employee or contractor.