NHS cracks down on script fraud with pharmacy exemption check pilot


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By Costanza Pearce
Reporter

15 May 2019

The NHS is piloting a system for community pharmacists and dentists to check peoples’ eligibility for benefit-related exemptions, according to the National Audit Office (NAO).

An estimated £212m was lost in 2017-18 to the NHS as a result of people incorrectly claiming exemption from prescription and dental charges, according to the NAO’s report on healthcare penalty charge notices (PCNs).

A pilot to check ‘health-related exemptions in real-time’ which aims to reduce fraud and error and therefore the number of PCNs issued was launched in four pharmacies in February 2019.

The NAO report added: ‘The Department for Health and Social Care (DHSC), NHS England and the NHS Business Services Authority (NHSBSA) will consider whether to extend this service after the pilot is complete.’

PCNs include the original cost of the prescription or dental treatment and a penalty charge of up to £100 and are issued by NHSBSA to those who are believed to have claimed a free prescription or dental treatment fraudulently or in error.

Around 89% of the 1.1 billion prescription items dispensed in the community each year are claimed as exempt from charges.

 

‘Prescription police’

 

Chair of the Royal Pharmaceutical Society (RPS) in England Sandra Gidley said: ‘Pharmacists should not be the prescription police – they want to spend their time helping people with their medicines rather than checking their exemption status.’

Ms Gidley acknowledged the importance of protecting NHS funding but called for the system to be ‘simplified’ rather than ‘criminalising’ genuine mistakes.

The NHSBSA ‘accepts’ that the rules around entitlement to exemptions set by the DHSC are ‘overly-complicated’ and lead to confusion and genuine mistakes, according to the NAO.

For example, eligibility varies for different types of Jobseeker’s Allowance and Universal Credit claimants are only eligible for exemptions if their monthly earnings are below a specified level.

In some circumstances, such as pregnancy, claimants must apply for an exemption certificate to obtain free prescriptions, while exemptions can differ for prescriptions and dental treatments and vary in length according to circumstances.

In 2017, the NHSBSA began to develop online support tools to help people determine their eligibility for free prescriptions and dental treatment.

 

‘Free prescriptions’ for all

Ms Gidley continued: ‘It would be much simpler to have free prescriptions for everyone, as is the case in Scotland, Wales and Northern Ireland, because then no-one would have to worry about filling out a form of declaration.’

She added that the money spent on collecting penalty charges, which totalled £11.2 billion in 2017-18, could be spent on patient care.

In February, Ms Gidley criticised the ‘relentless’ rise in prescription charges, suggesting they are harmful to patients.

The RPS is one of a group of 48 organisations calling on the Government to scrap prescription charges for people with long-term conditions in England.

 

‘Firmer approach’

 

The NAO report also revealed that 114,725 people received five or more PCNs for prescription charges between September 2014 and March 2019.

It said: ‘NHS England and NHSBSA are now starting to take a firmer approach to deterring fraud.

‘Under this new approach, selected repeat offenders are interviewed under caution at a police station and appropriate cases are shared with the Crown Prosecution Service (CPS) for a decision on whether to open criminal proceedings.’

Five cases have been submitted to the CPS so far and one was heard in court in January 2019, the report said.

In January 2019, the NHSBSA began a debt collection process for dental cases and is now seeking approval for one for prescriptions.

 

Successfully challenged

 

While the overall number of prescription eligibility checks has risen from 750,000 in 2014-15 to 24 million by 2018-19, the proportion of checks resulting in PCNs has been declining from one in four to one in 20 in the same time frame.

Since 2014, 30% of PCNs issued have been subsequently cancelled because ‘a valid exemption was confirmed to be in place following a challenge’, according to the report.

Head of the NAO Amyas Morse said it is ‘not a good sign’ that so many PCNs are successfully challenged.


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