Working with NHS Counter Fraud Service Wales, we analysed community pharmacy dispensing data at scale, to provide insights on areas of high cost and potential fraud. We focused on community pharmacy because it involves considerable expenditure, it is an area of known fraud risks, and it did not appear to be scrutinised for fraud as much as some other NHS services.

While we did not find any evidence of specific fraud, we pointed to savings opportunities of £700,000 (subject to various caveats). And we found errors in the form of overpayments totalling £22,000 that have since been recovered by the NHS. 

The findings also pointed to a clear opportunity: while existing processes offer some safeguards, more centrally supported work to detect and prevent fraud in dispensing activity, as well as to ensure value for money, could be beneficial.

Improvements include a new dashboard 

Responding to our report [opens in new window], the Chief Pharmaceutical Officer for Wales acknowledged our findings and committed to a series of actions. Central to these was the development of an interactive dashboard to provide NHS bodies with analysis of items dispensed across Wales, covering expensive items (items with a net ingredient cost of £100 or more) and expensive specials (items requiring special preparation by a registered manufacturer). 

The All Wales Therapeutics and Toxicology Centre [opens in new window] developed the dashboard, which is now available to all health boards. This represents a positive step. It allows users to view data about prescribing as well as dispensing in community pharmacy, helping to identify outliers and patterns in high-cost dispensing. 

Despite being one of the original aims, the dashboard does not allow users to drill down to individual prescriptions. Certain NHS staff can access individual prescriptions but only through a separate system operated by the NHS Wales Shared Services Partnership. Without the ability to drill down directly within the dashboard, opportunities to gain additional insight and save time are not being fully realised. 

All health boards have controls in place but is there scope for better sharing? 

Another response to our work was for the Chief Pharmaceutical Officer to write to all health boards, asking them to describe the arrangements they have to minimise avoidable expenditure and the risk of fraud and error from prescribing and dispensing expensive items.

All health boards responded with most saying they use the dashboard as part of various efforts to investigate outliers and manage risks around fraud, error and high cost. Some health boards said the dashboard’s consolidation of information at the level of individual community pharmacies was giving them added assurance. However, data on the number of users of the dashboard suggests scope to increase usage within health boards. 

Other actions from health boards include routine surveillance of data about high-cost prescriptions and specials, separate to the data presented in the dashboard, as well as maintenance of spreadsheets highlighting possible outliers, and targeted GP practice visits.

It was unclear from the responses whether health boards are doing enough to share intelligence and good practice. 

Technology is opening up new opportunities 

We still believe that community pharmacy dispensing is an area where further scrutiny could be beneficial. Some health boards’ responses to the Chief Pharmaceutical Officer highlighted specific ideas for additional controls and checks.

And advances in technology—such as the possibility of using artificial intelligence to identify anomalies in prescribing and dispensing —alongside better integration of electronic systems (including the rollout of electronic prescribing [opens in new window]) offer promising avenues for progress. 

These innovations could enable more sophisticated analysis, greater transparency, and time savings in identifying fraud risks and potential savings. 

A recent report [opens in new window] from the National Audit Office provides further food for thought and useful case studies on how public services can use technology to identify fraud.

Conclusion

Some of the steps taken since our 2024 report are encouraging, but hopefully they represent the beginning rather than the end of the journey. In our opinion, Wales can do much more in addressing risks of fraud and error in community pharmacy dispensing by committing to further centralised analysis (and resource to enable this analysis), stronger collaboration across NHS Wales, continued investment in technology, and better linking of data sources.

Next steps for Audit Wales

Our next steps on fraud analytics include creating a data tool to help our auditors gain better insights from the National Fraud Initiative [opens in new window] (NFI), to enable better-informed discussions with participating bodies about the NFI and hopefully better financial outcomes.

We have also undertaken a pilot exercise on NHS GP registrations, matching non-medical record details of patients permanently registered on GP practice lists with other data sets with the objective of identifying anomalies. We plan to report separately on this exercise in the near future. 

Fraud analytics work remains high on our priority list. To help us select our future projects, we will reach out to various organisations with expertise and experience in fraud detection and prevention. This will help us deliver a pipeline of fraud analytics projects over the long term.