Earlier this month (June 8), the Department of Health and Social Care (DH) released its latest counter-fraud strategy document, which will guide the NHS counter fraud authority (NHSCFA) from 2023 to 2026.
It proposed that one of three “particular risk areas'' that the NHSCFA should focus on in the next three years is primary care.
According to the document, the government will be “working with” pharmacy contractors to address “contractual fraud” as well as “inappropriate claims and reimbursements”.
Read more: NHS to investigate pharmacy owners’ fraudulent expenses claims
“We plan to further secure the gateway to NHS care from fraud by working with GPs, dental contractors and pharmaceutical contractors to tackle not only contractual fraud but fraud relating to inappropriate claims and reimbursements”, it said.
The NHSCFA is aiming to prevent, detect and recover fraud worth £500 million in this period across the NHS, it added.
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According to estimates in the document, the NHS in England as a whole is vulnerable to fraud worth £1.198 billion.
Lord Markham, parliamentary undersecretary of state at the DH, said in the document’s foreword that the NHSCFA had succeeded in “preventing, detecting and recovering” £400 million of fraud between 2020 and 2023, up from £151 million in the previous period.
A fair target?
National Pharmacy Association (NPA) director of corporate affairs Gareth Jones told C+D that the organisation recognises “the importance of efforts to prevent, deter and punish fraud” in pharmacy and across the sector.
But he added that the NHS should take a “targeted and proportionate approach”, as “the vast majority of pharmacy contractors are law abiding professionals who always put the needs of their patients first”.
Read more: Legal view: ‘Why the £111m pharmacy contractor fraud figure is bogus’
The NHSCFA’s work to counter NHS fraud in community pharmacy has also been subject to criticism in the past.
In a 2019 analysis legal expert David Reissner described the authority’s estimates of fraud in community pharmacy - £111 million annually - as 'bogus'.
And in November 2018, a C+D investigation based on an FOI found that despite NHSCFA claims that there was widespread fraud in community pharmacy, there was scant evidence of recent fraud.
Read more: REVEALED: Are DH claims of pharmacies 'scamming' the NHS accurate?
The NHSCFA’s strategic assessment for 2022 – published in July last year - claimed that £122 million was "vulnerable" to pharmacy contractor fraud from an expenditure of £12.2 billion, or 1% of all spending.
In 2021/2022, the NHSCFA reported 155 allegations of fraud received about pharmaceutical contractors, it said, although the assessment did not provide the value of the fraud or the number of cases prosecuted.
However, a 2022 FOI regarding NHSCFA fraud reports for community pharmacy between 2020 and 2022 revealed that of the 283 reports regarding potential fraud by community pharmacy contractors in the period requested, just 33 were converted into cases. Of these 33, just 25 remained open.
