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Penalty system for free prescription claims must be “more humane,” say MPs

BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l5660 (Published 20 September 2019) Cite this as: BMJ 2019;366:l5660
  1. Elisabeth Mahase
  1. The BMJ

The current system of penalty charge notices, which is supposed to discourage people from claiming free prescriptions they are not entitled to, is “heavy handed” and needs to be “substantially overhauled,” MPs have said.1

After reviewing the system the House of Commons Public Account Committee found that it “penalises those who fail to navigate the overly complex exemption criteria and neglects clear evidence of abuse by repeat offenders.”

It also said that the Department of Health and Social Care for England and NHS England have been “shockingly complacent about the fundamental problems with the PCN [penalty charge notice] process” and “seem to have lost sight of the fundamental importance of helping people claim what they are entitled to.”

The criticisms came after the National Audit Office said earlier this year that the rules on prescription exemptions set by the department were too complex and led patients to make genuine mistakes.2

The new report from the public spending watchdog said that the rules on entitlement to free prescriptions and dental treatment were “unnecessarily convoluted” and that the “presumption of guilt” when errors were made meant that penalty charge notices were “issued too readily, particularly where vulnerable people are concerned.”

The NHS Business Services Authority, which runs the system, had also implemented the policy without evaluating the effect of penalties on claimants seeking treatment, the review said. And although the authority had argued that 97% of non-age related exemption claims were correct, it had not tried to identify people who were entitled to an exemption but paid for treatment.

Meanwhile, the authority had done “very little to pursue those who repeatedly claim free treatment without an exemption,” the report found. It said that nearly 115 000 people had received five or more penalty charge notices for prescriptions, and more than 1600 had received 20 or more, yet just five cases had been referred to the Crown Prosecution Service.

The committee has now called on NHS England and the Business Services Authority to recognise the problems in the system and to respond to it in one year to “explain how they have made the process more humane and cost effective.”

The committee’s chair, the Labour MP Meg Hillier, said, “Patients find it very confusing to understand whether or not they can claim free prescriptions or dental treatment because of a convoluted system that causes patients, in some cases, distress.”

She continued, “The [committee] fully support efforts to deter fraud and pursue those who claim exemptions to which they are not entitled to, but the current penalty notice system is cumbersome, inefficient, and not fit for purpose.

“The DHSC should substantially overhaul the system, so that those who are rightfully entitled to free prescriptions and dental treatment get the exemption they deserve.”

Earlier this year The BMJ found that the number of penalty charge notices issued to patients in England had risen by 60% in the past three years, from 864 366 in 2016 to 1 379 957 in 2018.3

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