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MPs slam ‘heavy-handed’ prescription fine system

Public Accounts Committee: The PCN system neglects clear evidence of abuse by repeat offenders
Public Accounts Committee: The PCN system neglects clear evidence of abuse by repeat offenders

MPs have called for a “fundamental overhaul” of the “heavy-handed, inefficient” system for fining patients for incorrectly claiming prescription exemptions.

The process of issuing penalty charge notices (PCNs) – fines sent to patients who have incorrectly claimed exemption from prescription charges or dental treatment – is a “heavy-handed, rush to judgement, which penalises those who fail to navigate the overly-complex exemption criteria”,  the Public Accounts Committee concluded in a report today (September 20).

While it is supposed to discourage people from claiming free prescriptions, too many incorrect penalty notices are issued – 30% of all PCNs issued since 2014 having been withdrawn – which particularly affects vulnerable patients, added the committee, made up of MPs.

It also “neglects clear evidence of abuse by repeat offenders”, the committee said. It pointed out that nearly 115,000 people who have received five or more PCNS, with more than 1,600 receiving 20 or more, despite only five cases have been referred to court.

It called for a “fundamental overhaul” of the system, which it deemed “not fit for purpose”.

“Shockingly complacent”

The committee’s report follows its meeting on the subject in July, where MPs heard evidence from the Department of Health and Social Care (DH), NHS England and NHS Business Services Authority (NHS BSA) on penalty charge notices in healthcare.

The NHS BSA is “over-zealous in pursuing people who have made mistakes once” and the DH and NHS England have been “shockingly complacent about fundamental problems with the PCN process”, the committee concluded.

While the bodies argue that most exemptions are claimed correctly and the system generates additional revenue for the NHS, “they seem to have lost sight of the fundamental importance of helping people claim what they are entitled to”, the committee stressed.

Giving evidence at the committee hearing, NHS England’s chief pharmaceutical officer Keith Ridge suggested pharmacists have a duty to provide “patient-centred care”, which includes guiding patients “through the system” to help them determine if they are eligible for free prescriptions.

The committee said it “fully supports efforts to deter fraud”.

“However, we simply do not believe that the current system achieves this efficiently, and the DH and NHS England need a fundamental reappraisal of how they can more effectively and humanely pursue these goals,” it stressed.

The committee issued six recommendations for the DH and NHS England to meet.

RPS: Stop criminalising patients

Royal Pharmaceutical Society (RPS) director for England Ravi Sharma welcomed the committee’s conclusions, which he said “rightly condemns a system of fines which is not fit for purpose”.

“The system needs to be simplified before we start to criminalise those [who] make a mistake navigating it,” he said.

“Pharmacists want to spend their time helping people with their medicines, rather than checking their exemption status,” he added.

“We don’t want to be the prescription police. Nor do we want to be in the position of potentially having to refuse to supply a medicine to a patient simply because they haven’t brought the right paperwork with them.”

The RPS reiterated its call for prescription charges in England to be scrapped, so patients “always have the medicines they need without having to make payment decisions”.

What are the Public Accounts Committee’s recommendations?

  1. The DH should set out how it will make exemptions more readily intelligible
  2. The DH should work with the Department for Work and Pensions to determine the feasibility of indicating whether claimants are entitled to free prescriptions in letters sent about benefits eligibility
  3. In six months’ time, the DH should inform the committee when it plans to add an additional stage to the PCN process, where an individual will be alerted to a possibly unjustified exemption claim before a fine is issued. It should also set out how this will reduce the number of PCNs that are later overturned
  4. The DH should actively seek information about the consequences of prescription charges and the PCN process, and present their findings to the committee
  5. NHS England and the NHS BSA should prioritise the rollout of the real-time exemption checking (RTEC) system, which allows pharmacists to digitally check whether a patient is exempt from prescription charges, before medication is dispensed
  6. The NHS BSA should evaluate the cost-effectiveness of pursuing repeat offenders and present its findings to the committee.

Source: Public Accounts Committee, September 2019

20 Comments
Question: 
Do you think the prescription fine system should be overhauled?

H Saw, Community pharmacist

Hahah a what a "patient-centred care", hilarious especially when community funding is being cut. I guess we should be reminding and feeding the patients next, for free of course.

Leon The Apothecary, Student

Universal Prescription Charges. 80p an item and the NHS gains more income, based on the latest HSCIC data. No need to have a complicated exemption system. No need to "police".

Simplification is the way forward.

A B, Community pharmacist

This has been suggested before and is great in theory. Problem would be when dealing with vulnerable patients e.g. those with learning difficulties or in care homes. Would the charge have to be taken directly out of their benefits or paid for by carers?

May not be the simplification you are hoping for. Maybe other countries have a process we could copy? Matt Hancock would like that

Caroline Jones, Community pharmacist

I think it’s would be quite straightforward. These vulnerable people will likely already be in receipt of benefits of some sort; so whoever helps them claim these then have to pay the ‘pre-payment’ charge.

 

Alexander The Great, Community pharmacist

Electronic scripts - my staff submit scripts every night after a long day, they have to tick a box declaring which exemption has been ticked. Say there is a 5% error rate, thats a massive amount of people who are going to get letters sent to them every month.

I really dont know why we have to do this. The NHSBSA have automated machines that could do this!!! Wastes our time, the fraud squad time and also anxiety from patients who are innocent.

Chris Locum, Locum pharmacist

Can we list the MPs who think we have received heavy-handed treatment in remuneration?

Shilla Shah, Superintendent Pharmacist

Keith Ridge - check prescription exemption with Pharmacist or Community Pharmacy Consultation Service to save money????

Paul Knapton, Community pharmacist

Given that the government's flagship benefit (Universal Credit) isn't listed in the back of an NHS prescription is it any surprise that there are problems with the system.

A B, Community pharmacist

I'd like to know the amount prescription charges generate in income for the government vs. the amount it costs to run and police the system (including the new RTEC system). If it only results in a relatively small amount (or loss even) would it not be easier to scrap the charges? 

I'm not in favour of people getting everything for nothing, but all this hassle seems pointless if the tax income is small. There is also the unfair situation where some patients have to pay £9 for 28 days medicine and others get 56, or even 84 depending on what surgery they use.

Caroline Jones, Community pharmacist

Only children should get ‘free’ prescriptions as you can’t rely on parents to put their children’s needs first. Everyone else should pay; although the item fee should be significantly less than £9!

Contraceptives would also have to be free!

Lucky Ex-Locum, Superintendent Pharmacist

But why should my taxes fund someones bad parenting? As I said in the other thread, those parents who won't pay for their childrens welfare will all have the latest phones.

And as I said elsewhere, are you including condoms in the free contraceptives?

C A, Community pharmacist

The last figures I recall seeing was about £450 million in income and allegedly less than £10 million in cost to run. 

SP Ph, Community pharmacist

£450 million -- income from either prepayment/ paid scripts. There is actually no fraud, but misunderstanding of which box you tick or a genuine mistake of forgetting that they have run out of their exemptions. 

Different scenarios of genuinity-

1. Patient on Universal Credit ticks H (what he/she used to always tick)

2. Patient knows they are exempt but don't know which category they belong at the moment.

Examples--

Patient who was F but lost job and waiting for the Authorities to confirm which category they belong now.

Patient who was always on M and still waiting for the letter to come through.

Patient recently told by the GP they are medically exempt but not filled and sent the form yet.

Most surprising -- Patient who is pregnant and confirmed by the midwife, yet not signed off by the GP, and has to collect a script for Folic Acid/ Laxido.

Many more.......... And surprisingly in all these scenarios the culprit ??? AUTHORITY who forgot to do their job promptly. What is the use of system (ONLINE) which will give falls +/- ??? If you cannot provide an online system which would confirm the exemption instantly then why penalise people??

This is the reason why most of the Notices are witdrawn.

£ 10 million -- Outrageos cost for issuing notices to be witdrawn later and then set aside against the income of £ 450 million. Disgrace.

We want the actual figures recovered by these £10 million wroth people to know if spending £ 10 millions is worth??

Or may be we can request Mr. Ridge to, add checking exemptions at the point of issue of Rxs through his brainchild CLINICAL PHARMACISTs in GP pracices/ CCGs/ wherever they are situated, as a most important duty??

 

 

A B, Community pharmacist

If it does cost that little to run then I guess it is not a surprise they are reluctant to abolish fees. Still an unfair system in my opinion though

Uma Patel, Community pharmacist

'Keith Ridge suggested pharmacists have a duty to provide “patient-centred care”, which includes guiding patients “through the system” to help them determine if they are eligible for free prescriptions'. He lives on a differnt planet. He hasn't worked in a busy dispensary for over 30 years. He has no idea of the work pressures we face

A.S. Singh, Community pharmacist

I slave in the dispenary until I drop and Rees Mogg gets to slouch in a commons chair and earn 15 x what I'm earning. Il challenge any MP who has an issue with the work we provide.

Caroline Jones, Community pharmacist

Not sure it is heavy handed? It’s a £100 (or thereabouts) fine for taking something that isn’t yours! Police on the spot fines are about the same (if not more)

People need to start assuming they pay; rather than thinking they must be exempt ‘because I’m ill’. It’s about time the general public started to understand the healthcare system in this country; rather than have the attitude ‘it’s free’

 

Seal Patel, Community pharmacist

To me it's simple.... Everyone who thinks they are exempt should have a letter or card from NHS indicating they are. People come in and know they don't pay but have no idea why, its a sense of entitlement.

Lucky Ex-Locum, Superintendent Pharmacist

Frankly I'm fed up of these 'MPs think...' headlines. I don't give a toss what MPs think because they don't give a toss what I think.

Angela Channing, Community pharmacist

Agreed!  Bloody remainers! 

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