Intended for healthcare professionals


Fines for claiming free prescriptions rose by 30% last year

BMJ 2019; 364 doi: (Published 08 February 2019) Cite this as: BMJ 2019;364:l651
  1. Gareth Iacobucci
  1. The BMJ

The number of penalty prescription charges issued to patients in England rose by a third last year and has increased by 60% in the past three years, The BMJ has learnt.

Figures released under freedom of information legislation show that 1 379 957 penalty notices were issued in 2018. Previous numbers were 1 052 430 in 2017 and 864 366 in 2016.

The figures were disclosed by the NHS Business Services Authority, which issues the penalty charges if it believes that a patient has incorrectly claimed free NHS prescriptions or free or reduced cost dental treatment.

The disclosure comes amid a major government crackdown on prescription fraud.1 The NHS estimates that this type of fraud costs £256m (€290m; $330m) a year and has set a target to halve the losses by 2020. It launched a national campaign in September 2018, alerting patients that they needed to check before they claimed and warning that they faced a fine of up to £100 if they were not eligible.

The NHS is also due to pilot a new digital system in England this year to allow pharmacists to check instantly whether patients are entitled to a free NHS prescription and has created online tools to allow patients to check their eligibility.

But medical and pharmacy leaders warned that the crackdown risked having a disproportionate effect on people on low incomes, including those who qualify for free prescriptions but have failed to renew their exemption cards, and people on benefits who did not realise that their exemption status had changed when they switched to universal credit.

Figures released by the NHS Business Services Authority last year showed that around a third of penalty charges were later withdrawn because the patient was entitled to the free prescription.2

The authority told The BMJ that it had recovered “in excess of £80m” since September 2014, after factoring into account operating costs.

Richard Vautrey, chair of the BMA’s General Practitioners Committee, said, “It’s almost always the case that people have unwittingly not renewed their certificates of information that entitles them to free prescriptions. Real care needs to be taken in the messaging, as it can come across as very threatening to individuals. It’s not unusual for patients to be extremely distressed by the suggestion that they have committed fraud.”

Sandra Gidley, chair of the Royal Pharmaceutical Society’s English Pharmacy Board, told The BMJ that the new system of checks may put pharmacists in the firing line if they had to be “the bearers of bad news.”

“It’s not pharmacists’ job to police every single prescription,” she said. “The average pharmacy staff is not an expert in the benefit system.”

Gidley added, “Our view is quite simple. In Wales and Scotland patients get prescriptions for free—we think medicines should be free in England.”

“Dysfunctional” system

Rachel Power, chief executive of the Patients Association, said that the current system “appears to be dysfunctional.”

She said, “Far from a tougher system being needed, it’s essential that it stops slapping fines on patients who have done nothing wrong. We know that nearly one in three charges is later withdrawn because the patient was in fact entitled to a free prescription.

“The impact on people of receiving letters threatening court action, particularly those who are receiving treatment for mental illnesses, should not be underestimated.”

A spokesperson for the NHS Business Services Authority said, “Increasing the number of checks to verify entitlement to free prescriptions is important to protect NHS funds from loss through both error and deliberate fraud.

“While GP practice and pharmacy staff are encouraged to support their patients, it remains the patient’s own responsibility to check their entitlement before claiming free prescriptions.

“We are working to educate patients on the importance of keeping the details on both their GP records and their exemption or prescription prepayment certificate up to date.”

The authority said that it could cancel charges if they were incorrectly issued to people who were entitled to claim free prescriptions, such as people who have moved but not updated their address with their GP. It also said it could waive penalties if patients could show that they “did not act wrongfully or with lack of care, or if there is an exceptional reason why they should not pay the penalty charge.”


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