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Withdrawn penalty notices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Of the 5.6m fines issued during this time, 1.7m – amounting to £188m – were issued then withdrawn, because a valid exemption was confirmed after patients challenged the fine, according to the report published today (May 14).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