NHS : Prescription Charges Now Under The Spotlight : Too Complicated ?

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NHS prescription charges system is too complicated , says National Audit Office.

Patients are falling foul of an “overly complicated” system of prescription costs and dental charges which sees vulnerable people wrongly penalised for not paying while others fraudulently claim exemptions.

The warning has been made by the National Audit Office (NAO) in a report which suggests the system of enforcing NHS charges is not working properly.

The spending watchdog said that in 2017/18, an estimated £212m was lost due to patients incorrectly claiming exemptions.

Its report criticises the system under which the NHS issues patients with Penalty Charge Notices (PCNs) to patients.

Since 2014, some 5.6m PCNs have been issued, with a total value of £676m, but £246m worth of penalties, more than a third of the total, remain outstanding.

And hundreds of thousands of people have been given PCNs which were withdrawn on appeal, raising concerns of unnecessary distress being caused to patients. In the past five years around 1.7m PCNs – 30 per cent of those issued – had to be withdrawn because the patient had a valid exemption.

The report said: “This arrangement relies on the vulnerable person challenging the PCN, and not all vulnerable people may feel able to do so.”

Meg Hiller MP, who chairs the Public Accounts Committee, said: “It is right that the NHS tackles prescription and dental fraud but the NAO’s report makes for concerning reading. The rules around entitlement are complicated leading to confusion and genuine mistakes.

“Almost of a 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.”

Mistakes were caused by confusion over entitlements for people on benefits and prescription forms that do not yet include Universal Credit as an option.

Figures for September 2014-March 2019 also show that almost 115,000 people received five or more PCNs for prescriptions. NHS England and the NHS Business Services Authority (NHSBSA) are now taking a firmer approach to tackling fraud.

The report said: “Selected repeat offenders are now interviewed under caution at a police station and to date, NHSBSA has submitted five cases to the Crown Prosecution Service to consider for criminal proceedings.

“NHSBSA began a debt collection process for dental cases in January 2019 and is seeking approval for one for prescriptions.”

But it added: “NHSBSA accepts that the rules around entitlement, which are set by the Department of Health and Social Care, are complicated and recognises that genuine mistakes and confusion happen.”

A Government spokesperson said: “It is important our system for claiming free prescriptions is simple to understand for patients and clinicians, which is why we are currently piloting technology that allows pharmacies to check whether a patient is exempt from charges before prescription items are dispensed.

“Prescription and dental fraud cost the NHS an estimated £212 million in 2017/18 and it is absolutely right the Government takes steps to recoup this money so it can be reinvested into caring for patients.”


Am I entitled to free prescriptions ?

You can get free NHS prescriptions if, at the time the prescription is dispensed, you :

are 60 or over.
are under 16.
are 16 to 18 and in full-time education.
are pregnant or have had a baby in the previous 12 months and have a valid maternity exemption certificate (MatEx).
have a specified medical condition and have a valid medical exemption certificate (MedEx).
have a continuing physical disability that prevents you going out without help from another person and have a valid MedEx.
hold a valid war pension exemption certificate and the prescription is for your accepted disability.
are an NHS inpatient.

You're also entitled to free prescriptions if you or your partner (including civil partner) receive, or you're under the age of 20 and the dependant of someone receiving :

Income Support.
income-based Jobseeker's Allowance.
income-related Employment and Support Allowance.
Pension Credit Guarantee Credit.
Universal Credit and meet the criteria.

If you're entitled to or named on :

a valid NHS tax credit exemption certificate – if you do not have a certificate, you can show your award notice; you qualify if you get Child Tax Credits, Working Tax Credits with a disability element (or both), and have income for tax credit purposes of £15,276 or less.
a valid NHS certificate for full help with health costs (HC2).

People named on an NHS certificate for partial help with health costs (HC3) may also get help.

Find out more about the NHS Low Income Scheme (LIS)

People with certain medical conditions can get free NHS prescriptions if :

they have one of the conditions listed below, and
they hold a valid medical exemption certificate

Medical exemption certificates are issued on application to people who have:

a permanent fistula (for example, a caecostomy, colostomy, laryngostomy or ileostomy) requiring continuous surgical dressing or an appliance.
a form of hypoadrenalism (for example, Addison's disease) for which specific substitution therapy is essential.
diabetes insipidus or other forms of hypopituitarism.
diabetes mellitus, except where treatment is by diet alone.
myasthenia gravis.
myxoedema (hypothyroidism requiring thyroid hormone replacement).
epilepsy requiring continuous anticonvulsive therapy.
a continuing physical disability that means the person cannot go out without the help of another person (temporary disabilities do not count, even if they last for several months).

They're also issued for people undergoing treatment for cancer :

including the effects of cancer, or
the effects of current or previous cancer treatment.

Clear as ... mud ???
Yesterday we had to pay for the dentist but I haven't yet found out if we'll have to pay for the prescription from the dentist. It's on a yellow form which makes me think it might be subject to the rules for dental treatment rather than prescriptions?

What a complicated system.
Dental charges ?

Posted earlier this morning :

https://www.carersuk.org/forum/support- ... free-37092
No wonder no police officer is available to investigate break ins if prescription payment dodgers are being interviewed at the few remaining police stations.

Under this pilot program, I don't like the idea that the pharmacist should have access to information on if you're on job seekers allowance, etc. NHS sharing DWP databases?