Free prescription penalty charge system is ‘not fit for purpose’, say MPs

A committee of MPs has accused the Department of Health and Social Care and NHS England of being “shockingly complacent” over the penalty charge notice system for prescription exemption in England.

Meg Hillier, MP for Hackney South and Shoreditch

The penalty charge notice (PCN) system in England, which fines people up to £100 for wrongly claiming a free prescription, is not fit for purpose and needs to be overhauled, MPs have said.

The House of Commons Public Accounts Committee has also called for plans to introduce real-time checking for prescription charge exemptions in community pharmacies — which are currently in the pilot trial stage — to be prioritised.

In its report, published on 20 September 2019, the committee condemned the present PCN system as “heavy handed” and punitive. They found that it was quick to penalise people who fail to navigate the “overly complex” exemption criteria, but ignored those who are deliberate offenders.

“The current system is not fit for purpose,” they concluded.

The committee also accused the Department of Health and Social Care (DHSC) and NHS England of being “shockingly complacent” about the problems of the current PCNs, adding that the two bodies have “lost sight” of the fundamental importance of helping people claim what they are entitled to, and they need to fundamentally reappraise “how they can more effectively and humanely pursue these goals”.

The MPs had little confidence in the current real-time prescription exemption checking pilot because it is limited to just four pharmacies and, they said, it fails to consider benefit-related exemptions. “We are highly sceptical that real-time exemption will be rolled out soon,” they noted.

They have called on NHS England and the NHS Business Services Authority to pursue the plans as a “priority”, expand the existing pilot scheme, evaluate the results and present the committee with a timetable for its widespread introduction.

Meg Hillier MP, who chairs the committee, said: “A presumption of guilt means penalty charge notices are issued too readily — particularly where vulnerable people are concerned. Yet where there is clear evidence that people are persistently committing fraud by making false claims, there has been a failure to take effective action.”

In evidence taken to prepare the report, the committee found that around 30% of all PCNs issued since 2014 were withdrawn after being successfully challenged by patients.

They gave the DHSC six months to present them with a timetable for introducing an additional prescription exemption checking stage which, the MPs believe, should prevent people who are legally exempt from automatically being issued with a PCN.

The committee also wants evidence from the NHS and government departments about how many patients fail to seek treatment for fear of being issued with a PCN fine, and those who fail to claim the exemption they are entitled to and end up in hospital.

Ravi Sharma, director for England at the Royal Pharmaceutical Society, said the “damning” report rightly “condemns a system of fines which is not fit for purpose”.

“The system needs to be simplified before we start to criminalise those that make a mistake navigating it,” he added.

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

“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.

“England should follow Scotland, Wales and Northern Ireland and offer free prescriptions to all patients, so they always have the medicines they need without having to make payment decisions.”

Last updated
The Pharmaceutical Journal, PJ, October 2019, Vol 303, No 7930;303(7930):DOI:10.1211/PJ.2019.20207092

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