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RPS: Not pharmacists’ job to police 5.6m prescription exemption fines

NHS estimates it lost £212m in 2017-18 from people incorrectly claiming exemption
NHS estimates it lost £212m in 2017-18 from people incorrectly claiming exemption

Pharmacists are at risk of becoming “prescription police”, the RPS has warned, following the news that 5.6 million penalty charges were issued to patients in five years.

The number of prescription checks has “significantly increased” over the past five years – from 750,000 in 2014-15 to 24 million by 2018-19 – resulting in 5.6m penalty charge notices issued to patients for wrongly claiming free prescriptions and dental work, an investigation by the National Audit Office (NAO) has found.

Last October, health secretary Matt Hancock said exemptions would be digitised so pharmacists can help crack down on prescription fraud.

However, Royal Pharmaceutical Society (RPS) English board chair Sandra Gidley said it is not pharmacists’ role to check the validity of a patient’s exemption claim.

“Pharmacists should not be the prescription police – they want to spend their time helping people with their medicines, rather than checking their exemption status,” she said in response to the NAO report.

“The NAO identifies there’s plenty of room for improvement and the current system is too complicated and bureaucratic,” she added. “The system needs to be simplified before we start to criminalise those that make a genuine mistake navigating it.”

Withdrawn penalty notices

Since 2014, the NHS Business Services Authority (NHS BSA) has been charging patients who have incorrectly claimed exemption from the cost of the prescription item or dental treatment and a penalty charge of five times the amount, capped at £100. A surcharge of 50% is added if the fine is not paid within 28 days.

Of the 5.6m fines issued during this time, 1.7m – amounting to £188m – were issued then withdrawn, because a valid exemption was confirmed after patients challenged the fine, according to the report published today (May 14).

The NHS BSA admitted the system is “complicated” and “genuine mistakes and confusion happen”.

However, a government spokesperson told C+D “it is absolutely right” to recoup the estimated £212m lost to prescription fraud in 2017-18.

“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,” they added.

Digital checks may reduce fines

The Pharmaceutical Services Negotiating Committee (PSNC) said while community pharmacy teams are required to ask for evidence of exemption, “they are not responsible for the accuracy of a patient’s declaration”.

The rollout of ‘real time exemption checking’ – which the NAO reports has been piloted in four pharmacies in England since February – and the planned changes to universal credit exemption should lead to fewer penalty charge notices being issued.

However, the NAO report indicates that “the existence of a prescription charge and penalty system runs the risk of the most in need not getting their medicines”, PSNC said. 

The RPS’s Ms Gidley said England should follow Scotland, Wales and Northern Ireland’s lead and offer free prescriptions to all patients, so they “always have the medicines required, without having to make payment decisions”.

Do you think digitised prescription exemptions will help reduce fraud?

Shilla Shah, Superintendent Pharmacist

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

PARESH shah, Community pharmacist

I do not want this role being pushen ont pharmacy. They will initially pay us as part of the settlement and eventually reduce its value so we do it for free like a lot of previous things. FIXED INDEX -PROOFED PAYMENT AT AN ACCEPTABLE RATE OR NO DEAL.


C A, Community pharmacist

Perhaps the PSNC and RPS should take a leaf from the BMA -

"It is not GPs’ job to “police” online pharmacies prescribing high-risk medication, the BMA has said"

Kevin Western, Community pharmacist

absolutely agree... its time psnc grew a set and started telling DoH to proceed and multiply... unless they are going to pay for the priveledge in a meaningful way

A B, Community pharmacist

I agree with How High! Would be a lot easier to do away with the charges.

I think the script charge system has several problems in it's current form.

1. It is unfair - some patients get 1 month of medication, others get 2 or 3.

2. The income brought in is offset somewhat by the cost of implementing the charging system.

3. Medical exemptions are not given to people who clearly should be exempt e.g. patients with cystic fibrosis.

The other option of charging a fee for every item for everyone is also a good idea but would be hard to implement for some patient groups e.g. patients in care homes or patients with learning difficulties.

C A, Community pharmacist

3. I would say the corollary is also true - people with hyperthyroidism and other disases have been getting medical exemptions, even though they don't qualify*


*Based on anecdotal evidence

Paul Dishman, Pharmaceutical Adviser

The only chance that the Government have of getting pharmacy to police prescription charges is to pay, and pay well. 

Benie I, Locum pharmacist

Someone will break ranks and lobby to do it for free. They'll be led by B***s.

How High?, Community pharmacist

Why can't we just do away with the beaurocracy of presciption charges altogether and follow our welsh and scottish counterparts?

Save employing a bundle of penpushers who are just issuing fines and make the system more streamlined by nhaving no exemeptions to complete, no charges to take etc.

Also save a lot of grief at the counter from ill informed customers who think that the script charge actually goes to us.....

Lucky Ex-Boots Slave, Primary care pharmacist

Mind you if everything is given out for free then I can only see endless abuse of the whole system because everything will just be taken for granted. This will be unsustainable and will eventually lead to total collapse. People need to realise there is a cost to everything and their meds don't just grow on the trees. The current med wastage is already high enough and I just can't imagine how even higher it will get to if everything becomes free of charge. If the country is rich enough to do this then it's fine, but it isn't and the NHS financial crisis is just getting worse and worse day after day!

And I do agree with Andrew here re charging everyone for every item for 50p or £1. It's just like the plastic bag 5p charge and people will think twice before ordering rather just everything on the list as they are all free!

Leon The Apothecary, Student

90% reduction on bag usage after that charge was introduced; does show your point well!

Andrew Martin, Primary care pharmacist

Or charge for every item, say 50p or £1, as people attach no value to anything that is free.

Leon The Apothecary, Student

£1 ends up earning the NHS more money per year if you go by the statistics. Remember reading about it on here.

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