Request

Question 1. The number of claims made by those indicating they were exempt adults patients for:

i) free NHS prescriptions and

ii) NHS dental treatment, by month from Jan 2017 to present.

Question 2.The number of Penalty Charge Notices issued to patients suspected of misclaiming:

i) free NHS prescriptions and

ii) NHS dental treatment, by month from Jan 2017 to present.

Question 3. The cash value of Penalty Charge Notices issued to patients suspected of misclaiming:

i) free NHS prescriptions and

ii) NHS dental treatment, by month from Jan 2017 to present.

Question 4. The number of Penalty Charge Notices challenged by fine recipients for misclaiming:

i) free NHS prescriptions and

ii) NHS dental treatment, by month from Jan 2017 to present.

Question 5. The number of challenges that resulted in PCNs being overturned for misclaiming:

i) free NHS prescriptions and

ii) NHS dental treatment, by month from Jan 2017 to present.

Question 6. The cash value of PCNs overturned for misclaiming:

i) free NHS prescriptions and

ii) NHS dental treatment, by month from Jan 2017 to present.

On 8 November 2023 you clarified the following:

Question 1

When you say “adult” what specific age range do you require? please include anyone over 16 or 16-18 and not in full time education.

When you say “free NHS prescriptions” do you mean NHS Dental prescriptions or all NHS prescriptions? All NHS prescriptions.

Question 5 and 6

Could you please define what you mean by ‘misclaimed’? We can supply information on how many cases had been closed due to mismatch of information if this is the information you require. Patients issued with fines following a claim for an exemption they were subsequently considered ineligible for

Response

Question 1 Part i

Please see a copy of the information attached.

NHS Prescription Services process prescriptions for Pharmacy Contractors, Appliance Contractors, Dispensing Doctors, and Personal Administration with information then used to make payments to pharmacists and appliance contractors in England for prescriptions dispensed in primary care settings (other arrangements are in place for making payments to Dispensing Doctors and Personal Administration). This involves processing over 1 billion prescription items and payments totalling over £9 billion each year. The information gathered from this process is then used to provide information on costs and trends in prescribing in England and Wales to over 25,000 registered NHS and Department of Health and Social Care users.

Data Source: ePACT2 - Data in ePACT2 is sourced from the NHSBSA Data Warehouse and is derived from products prescribed on prescriptions and dispensed in the Community. The data captured from prescription processing is used to calculate reimbursement and remuneration. It includes items prescribed in England, Wales, Scotland, Northern Ireland, Guernsey / Alderney, Jersey, and Isle of Man which have been dispensed in the community in England. English prescribing that has been dispensed in Wales, Scotland, Guernsey / Alderney, Jersey, and Isle of Man is also included.

The Data excludes:

• Items not dispensed, disallowed and those returned to the contractor for further clarification.

• Prescriptions prescribed and dispensed in prisons, hospitals, and private prescriptions.

• Items prescribed but not presented for dispensing or not submitted to NHS Prescription Services by the dispenser.

Dataset – The data covers all prescriptions which have been declared as exempt from payment from the recipient, aggregated monthly.

Time Period – January 2017-September 2023 (figures are presented on an aggregated monthly basis)

Please note that, at present, September 2023 is the most recent month for which data is available.

Organisation Data - The data is for prescription items dispensed in the community in England.

Items - Items shows the number of times a product appears on a prescription form not the quantity prescribed.

Exemption Categories- The overall high level exemption rate is as robust as it can be in terms of the data we hold.

However, the data in relation to the standalone exemption categories does have significant limitations in terms of its quality.

This is due to how information has been captured during our scanning process and even for prescriptions received via the Electronic Prescribing System, normally higher quality data, there is considerable uncertainty due to the increasing use of the Real Time Exemption Checking service (RTEC). Exemptions determined using RTEC are classified as “No Declaration/Declaration Not Specific” and this is likely to include a large but unknown number of prescriptions for those standalone exemption categories.

Exemption Categories included within the data are as follows:

• Under 16 / Aged 60 Or Over
• Aged 16-18 And In Full Time Education
• Aged 60 Or Over
• HC2 Charges
• HRT Pre-payment Certificate
• Income Based Job-seekers Allowance
• Income Support
• Maternity Exemption
• Medical Exemption
• NHS Tax Credit Exemption Certificate
• No Declaration/Declaration Not Specific
• Non-Chargeable Contraceptive
• Pension Guarantee Credit
• Pre-Payment Certificate
• Sexual Health
• Unassigned
• Universal Credit
• War/MOD pensioner exemption

Question 1 part ii

Please see a copy of the information attached.

This report contains the details from General FP17s processed in England for Exempt Adults for the Months 201701 - 202310 and includes activity by Foundation Dentists. The information within the report includes the data items and descriptions listed below.

Country Name: The country name where the contract is located based on the contract postcode

Year Month: Used throughout the system to identify the specific year and month that the data relates to, i.e. for forms, it would be the month that the activity was scheduled. This is in the format 'YYYYMM' e.g. 201804 for April 2018.

Adult/Child: Adult/Child Patients are defined based on the patients’ age at the date of acceptance. An adult is defined as a patient aged 18 or over at the date of acceptance, a child aged under 18.

Exempt Adult Charge Payers: FP17s where the Patient is an Adult and Patient Charge Status is Exempt

Question 2,3,5 and 6

Please see a copy of the information attached.

Question 4

I am writing to advise you that following a search of our paper and electronic records, I have established that the information you requested is not held by the NHS Business Services Authority. This is because this is not recorded on our systems.

Data Queries

If you have any queries regarding the data provided, or if you plan on publishing the data please contact foirequests@nhsbsa.nhs.uk ensuring you quote the above reference. This is important to ensure that the figures are not misunderstood or misrepresented.

If you plan on producing a press or broadcast story based upon the data please contact communicationsteam@nhsbsa.nhs.uk This is important to ensure that the figures are not misunderstood or misrepresented.

The information supplied to you continues to be protected by the Copyright, Designs and Patents Act 1988 and is subject to NHSBSA copyright. This information is licenced under the terms of the Open Government Licence detailed at: http://www.nationalarchives.gov.uk/doc/open-government-licence/version/3/

Should you wish to re-use the information you must include the following statement: “NHSBSA Copyright 2023” This information is licenced under the terms of the Open Government Licence:

http://www.nationalarchives.gov.uk/doc/open-government-licence/version/3/

Failure to do so is a breach of the terms of the licence.

Information you receive which is not subject to NHSBSA Copyright continues to be protected by the copyright of the person, or organisation, from which the information originated. Please obtain their permission before reproducing any third party (non NHSBSA Copyright) information.