Intended for healthcare professionals


Prescription exemption rules are “overly complex” and cause genuine mistakes, says watchdog

BMJ 2019; 365 doi: (Published 14 May 2019) Cite this as: BMJ 2019;365:l2200
  1. Elisabeth Mahase
  1. The BMJ

Rules on prescription exemptions set by the Department of Health and Social Care are too complicated, causing patients to make genuine mistakes, the National Audit Office has said.1

The spending watchdog investigated penalty charge notices (PCNs) issued to patients who claim free prescriptions or dental treatment fraudulently or in error, and it found a significant increase in exemption checks and the fines issued.

In February The BMJ reported that the number of PCNs issued to patients in England had risen by a third last year and by 60% in the past three years.2 The NHS estimates that this type of fraud costs £256m (€295m; $332m) a year and has set a target to halve the losses by 2020.

However, the National Audit Office report said that many factors may be causing the confusion and erroneous claims, including universal credit—where claimants are eligible for exemptions only if their monthly earnings are below a specified level—and prescription forms that do not yet include universal credit as an option.

Mistakes may also be a result of people not understanding differences between benefits. For example, a claimant who receives income based jobseeker’s allowance is automatically eligible for free prescriptions and dental treatment, whereas a claimant who receives the new-style or contribution based jobseeker’s allowance is not.

Additionally, some exemptions may vary between prescriptions and dental treatments, and in specific circumstances, such as pregnancy, the patient may need to apply for an exemption certificate to obtain a free prescription. The length of time the exemptions apply may vary.

Valid exemptions

Nearly a third (30%; 1.7 million) of PCNs issued since 2014, worth £188m, were withdrawn because of a valid exemption. This means that many patients are incorrectly receiving “distressing, threatening letters or fines” that could affect their mental wellbeing, said Richard Vautrey, chair of the BMA’s GP committee.

“We must not create a culture where patients, particularly those in vulnerable circumstances, face barriers to them gaining access to prescriptions they can legitimately claim,” he added.

The National Audit Office concluded, “Since 2014, the NHS Business Services Authority has significantly increased the number of checks it carries out and the number of PCNs it issues but has only recently started taking commensurate steps to improve public awareness of the rules. A simpler system or better real-time checking will be important going forward in deterring fraud but not disadvantaging vulnerable people.”

Meg Hillier, chair of the Committee of Public Accounts, said, “Almost one third of prescription and dental penalty charges issued to patients were later revoked, because they had a valid exemption. This is not a system that is working as it should. The NHS must take urgent steps if it is to avoid causing unnecessary distress to patients, tripped up by an overly complex system, who end up facing large penalty charges.”


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