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Looking for fraud using community pharmacy data

23 May 2024
  • The potential scale of public sector fraud and error is eye watering.

    We previously estimated that fraud and error cost between £100 million and £1 billion each year to Welsh public services.

    Audit Wales’s work in this field includes facilitating the National Fraud Initiative (the NFI) in Wales, part of a UK-wide data sharing and matching exercise. Each year, the work identifies millions of pounds of avoidable fraud and loss.

    And we’re keen to do more, to explore new areas of ‘fraud analytics’ work, to use data at scale to highlight potential fraud, error and possible savings.

    Where do you start looking?

    Looking for fraud can be like looking for a needle in a haystack. Fraud analytics will hopefully provide us with a magnet.

    Working with NHS Counter Fraud Service Wales and other stakeholders, we have been learning from past fraud cases in community pharmacy to carry out a data matching pilot project.

    We explored millions of rows of data, looking mostly for outliers where medicines were particularly expensive.

    Our work was deliberately limited in focus, and while we didn’t find any specific examples of fraud, we were able to flag potential dispensing cost savings of around £700,000.

    You can read more in the letter we published on our website.

    We learnt valuable lessons from the project, such as the benefit of bringing together expertise across organisations to review fraud risks. And we learnt that data governance is time-consuming to navigate.

    The NHS in Wales can learn lessons from our work too. We’ve challenged the NHS to do more thinking on how to manage risks around fraud and error in community pharmacy. And we are pleased that it is building on our work to create its own data tool and adapt its approaches to reviewing community pharmacy dispensing data.

    Our next steps are to take stock and decide where to go next. We’re already working with NHS stakeholders to progress another pilot exercise on issues relating to patient registrations with general practitioners. Watch this space.


    About the author

    Picture of David the author

    Dave Winstone is a Data Analyst at Audit Wales, working on a range of data analytic projects including the Community Pharmacy Data Matching Pilot, and has worked in Audit Wales since 2020. He is interested in how data can be used to improve processes and has experience in the public sector before joining Audit Wales.


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