We have undertaken a community pharmacy data pilot project working with NHS Counter Fraud Service Wales.

The aim of this project was to analyse community pharmacy dispensing data at scale, and to provide insight to NHS Wales on areas of high cost and potential fraud.

This work was also an opportunity to develop Audit Wales’s expertise in fraud analytics techniques.

Community pharmacy was chosen as the focus of the pilot because it is an area known for fraud risk and does not appear to be scrutinised for fraud as much as some other NHS services.

What did we find?

• Our work did not find any immediate evidence of fraud, although we focused on a small number of fraud risks.
• Our work has flagged a specific risk in relation to limited controls around the cost of Specials. No price restrictions are in place for certain Specials, presenting various opportunities for fraud or error. Although subject to various caveats, we estimate that during the three years covered by the pilot, approximately £700,000 could have been saved in Wales by reducing costs associated with Specials.
• Our work flagged numerous outliers to health boards. From these outliers, we identified overpayments totalling £22,000, which is now being recovered.
• Our work found scope for more analysis of community pharmacy dispensing on a national basis for the purposes of detecting or preventing fraud and ensuring value for money.

Although we have decided to end the pilot and not develop the tool further, we have learnt valuable lessons and are looking for other areas of work in the field of fraud analytics.