Concern over complex prescription charge rules

In a report issued today, the NAO said the NHS estimates it lost £212m in 2017/18 due to people incorrectly claiming they were exempt from prescription or dental charges. Around 89% of prescriptions and 47% of dental treatments are claimed as exempt each year. The NHS dispenses around 1.1 billion prescription items and provides 39 million courses of dental treatment annually.

The report said confusion over the benefits system can lead to incorrect exemption claims. For example, those receiving income-based jobseeker’s allowance are eligible for free prescriptions. However, claimants are not exempt from charges if they receive new-style jobseeker’s allowance or contribution-based jobseeker’s allowance. And eligibility could vary between different prescriptions and dental treatment.

The number of prescription checks have been stepped up significantly in recent years – from 750,000 in 2014/15 to 24 million in 2018/19. This has led to a rise in prescription penalty charge notices – from a value of £12m to £126m for prescriptions and from £38m to £72m for dental treatments.

The NHS Business Services Authority, which administers the distribution of penalty charges, has issued notices worth £676m since 2014, but recovered £133m (just under 20%). Notices worth £297m (44%) were settled without a penalty charge being paid and 246m (36%) is owed to the government. The authority spent 31p on managing the process for every pound recovered.

The NAO said that the authority and NHS England are trialling a tougher approach on potential fraud, focusing on people who have been issued five or more penalty notices in 12 months but had made no attempt to pay.

Amyas Morse (pictured), the head of the NAO, said: ‘Free prescriptions and dental treatment are a significant cost to the NHS, so it is reasonable to reclaim funds from people who are not exempt from charges and deter fraud. However, the NHS also needs to have due regard to people who simply fall foul of the confusing eligibility rules. It is not a good sign that so many penalty charge notices are successfully challenged.’

Meg Hillier, chair of the Commons Public Accounts Committee, said that while it was right to tackle fraud, she was concerned about the complexity of the rules around eligibility for free prescriptions and dental treatment.

‘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,’ she added.

‘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.’