A pattern of fraud has been identified involving the misuse of prescribing systems and paper FP10 prescriptions to obtain high-value weight loss medications, including Mounjaro (tirzepatide) and similar drugs.

These medications now carry significant illicit market value, driven by demand for weight loss treatment. Access via NHS prescribing routes is restricted, whilst private purchase can be costly, increasing the incentive for fraudulent activity. Robust auditing, reduced reliance on paper prescribing, and vigilance across staff access are critical to fraud prevention.

Modus Operandi

Investigations have identified the following consistent methods:

  • Unauthorised access to patient records
    Clinical or administrative staff access records of patients already receiving relevant medications which are commonly for diabetes.
  • Creation of false prescription entries
    A medication entry (e.g. Mounjaro or similar GLP‑1 therapies) is temporarily added to the patient record.
  • Generation of paper FP10 prescription
    The prescription is printed on a FP10 form, allowing for manual handling and a potential forged GP signature.
  • Concealment of activity
    The medication entry is subsequently deleted or cancelled from the patient record to reduce audit visibility.

Why FP10 paper prescription forms are targeted

  • The majority of legitimate prescriptions are now issued via EPS (Electronic Prescription Service). EPS prescriptions require additional authentication and system interaction
  • Paper FP10 prescription forms enable:
  • Reduced oversight
  • Ease of forgery (e.g. GP signatures)
  • Avoidance of secondary checks

Scale of Risk

  • Confirmed cases have resulted in significant financial loss to the NHS
  • One investigation identified:
  • Approximately 70 fraudulent FP10 prescriptions
  • Estimated value: circa £30,000
  • Involvement of a GP practice employee

Key Risk Indicators

Practices should be alert to:

  • Unusual or unexplained access to patient records
  • Medication entries created and quickly deleted
  • Discrepancies between prescribing system records and issued prescriptions
  • Increased or unexplained use of paper FP10 forms
  • Prescriptions issued outside normal clinical pathways
  • Signatures that appear inconsistent or forged

Recommended Actions

Immediate Controls

  • Reinforce strict controls around FP10 prescription pads
  • Limit access to prescription stationery
  • Ensure secure storage and regular stock checks

Audit & Monitoring

  • Conduct targeted audits of:
  • Prescribing activity for Mounjaro and similar medications
  • Recently cancelled or deleted medication entries
  • Frequency and justification for FP10 usage vs EPS
  • Compare FP10 usage against expected norms (given EPS predominance)

Access & Governance

  • Review staff access permissions to patient records and prescribing systems
  • Monitor for inappropriate or excessive access patterns
  • Reinforce audit trail reviews

Awareness

  • Brief clinical and administrative staff on this fraud risk and emphasise professional and legal consequences

Reporting Concerns

Any suspicions or irregularities should be reported immediately to your Anti-Crime Specialist or to Andrew Ede, Head of Investigations  andrew.ede1@nhs.net or 07814 285177