Layer 1

Legal view: ‘Why the £111m pharmacy contractor fraud figure is bogus’

“The figure doesn’t come from cases in which pharmacists have been found guilty of fraud”

NHS England estimates that pharmacy contractor fraud costs the NHS £111m annually, but legal expert David Reissner says this number is bogus

NHS England published its economic crime strategy for 2018-21, dealing with tackling fraud, bribery and corruption, on September 13.

The document says there is a “realistic probability” that pharmacy contractors are responsible for defrauding the NHS in England of £111 million per year through claims for services that haven’t been provided. NHS England’s source for this figure is a report by the NHS Counter Fraud Authority (NHSCFA), using figures from 2016-17, which I have previously commented on. Here are some of the reasons the £111m figure is bogus:

  • The figure doesn’t come from cases in which pharmacists have been found guilty of fraud. They haven’t detected fraud totalling £111m. If they haven’t detected it, how can they know?
  • The estimate was arrived at by looking at total NHS spending in a given year, saying fraud cost the NHS £1.29 billion that year and referring to “historical fraud rates” in England of 1-3.5%. It isn’t clear what any of these figures are based on, but fraud investigators have to justify their existence, so they say it’s based on “intelligence”. Intelligence? As Frankie Howerd might have said: “No, don’t mock.”
  • To arrive at £111m, NHSCFA took an arbitrary 1% of pharmacy funding for the year in question.
  • NHSCFA banded its estimates – you and I might call them ‘guesses’ – under the headings:
  • “almost certain”
  • “highly likely”
  • “probable”
  • “realistic probability”.

The estimate of pharmacy fraud falls under the label “realistic probability”, but this label is disingenuous. We are talking about something that, by definition, is not probable. The label might be accurate if it was changed to “possible”.

Even when NHS England included the NHSCFA estimate in the 2018-21 strategy document, it said that NHSCFA had “the lowest level of confidence” in the figure. NHS England could at least have put the figure in context by quoting NHSCFA’s own strategic intelligence assessment that, with my emphasis, says:

“Intelligence is not fact; it is based upon the processing of information and the inferences drawn from that.”

I’m sure there is some fraud in the NHS, and we all support efforts by NHS England and NHSCFA to eradicate it. However, presenting unreliable figures to smear the professionals working hard to deliver services to patients is not the right way to go about it.

David Reissner is chair of the Pharmacy Law and Ethics Association

Read C+D's exclusive revelation that only one pharmacy owner has been sanctioned for committing fraud in two years, further undermining government claims about the scale of the issue.

3 Comments

Uma Patel, Community pharmacist

We all know about government intelligence like Saddam Hussein's WMD

Snake Plissken, Student

“Intelligence is not fact; it is based upon the processing of information and the inferences drawn from that.”

How many a time a government hath decieved the masses based on "intelligece" and innocence is first to pay for it. 

SydBashford Sold&Retired&DeRegistered, Community pharmacist

I don't have any real statistics or proof, but I reckon there is a 1-3.5% probability that this fraud estimate is NOT B*** S***. 

Job of the week

Pre-registration Pharmacists 2021
London (South), London (Greater)
Competitive package