Request

1. The number of prescriptions which were not paid for because the patient claimed they had a maternity exemption certificate in each of the following five financial years: 2019-20, 2020-21, 2021-22, 2022-23, 2023-24
2. The number of dentist appointments which were not paid for because the patient claimed they had a maternity exemption certificate in each of the following five financial years: 2019-20, 2020-21, 2021-22, 2022-23, 2023-24
3. The number of penalty charge notices issued because it was believed a patient was claiming they had a valid maternity exemption certificate when they did not in each of the following five financial years: 2019-20, 2020-21, 2021-22, 2022-23, 2023-24
4. The number of penalty charge notices which were issued because it was believed a patient was claiming to have a valid maternity exemption certificate when they did not which were successfully challenged in each of the following financial years: 2019-20, 2020-21, 2021-22, 2022-23, 2023-24

Date Range: 01/04/19 to 31/03/24

The NHS Business Services Authority (NHSBSA) received your request on 24 February 2025.

We have handled your request under the Freedom of Information Act (FOIA) 2000.

Our response

I can confirm that the NHSBSA holds the information you have requested.

Questions one and two

Under Section 21 of the FOIA we are not required to provide information in response to a request if it is already reasonably accessible to you.

Prescription exemption information is available at the following web link: https://www.nhsbsa.nhs.uk/statistical-collections/prescription-cost-analysis-england/prescription-cost-analysis-england-202324

The file on this page titled 'Exemption category management information' contains the relevant information under the ‘Exemption_categories’ tab. This dataset is broken down by financial year, as per the request. Column D, 'Total Items', provides the total number of prescriptions per exemption category.

Dental exemption information is available at the following web link:

https://www.nhsbsa.nhs.uk/statistical-collections/dental-england/dental-statistics-england-202324

The file on this page titled ‘NHS Dental Statistics for England - 2023/24: National overview summary tables' contains the relevant information under the ‘Table_1f’ tab. This dataset is broken down by financial year, as per the request. Column L, 'Total’, provides the total courses of treatment per exemption category.

Caveats:

Please note, the data that is recorded in relation to the reason for an exemption, referred to as the 'exemption category', is not reliable for the following reasons.

Only one exemption category can be recorded on a prescription, so patients with a maternity exemption certificate, or who would otherwise qualify, may have been processed under a different exemption category.

Pharmacies are able to use Real Time Exemption Checking (RTEC). This service confirms to the dispenser that a person is exempt from the charge, but in early versions of the system, no record of the reason found by RTEC was passed on to NHSBSA prescription processing systems or the data warehouse. In these cases, the exemption reason will be listed as 'Z - No Declaration/Declaration Not Specific'.

This situation has changed and most RTEC checked items are being submitted with a specific exemption category recorded - this will begin to be reflected in the statistics in due course, but it will take time for data that is complete to become available.

For the time being, users should consider the volume of items reported in the statistics as category 'Z' to represent how incomplete the data on any specific exemption is at that time. In other words, for any time period when many items are reported as 'Z', it is likely that all other specified, non-age-related exemption figures are under-estimates of the actual number of times that those exemptions were used.

The processing of paper prescriptions may also have resulted in inaccuracies of exemption categories. In many cases, the mark(s) on the rear of the form intended to indicate one, or more, exemption reason(s) is not clear and can be misinterpreted by the NHSBSA scanners. NHSBSA do not perform validation or verification of which exemption category has been marked or recorded during scanning.

Please see the following link to view the section 21 in full –

https://www.legislation.gov.uk/ukpga/2000/36/section/21

Question three: The number of penalty charge notices issued because it was believed a patient was claiming they had a valid maternity exemption certificate when they did not in each of the following five financial years: 2019-20, 2020-21, 2021-22, 2022-23, 2023-24

Financial year 2019/2020: 86,660 Penalty Charge Notices (PCNs) were issued where a maternity exemption certificate was claimed

Financial year 2020/2021: No PCNs were issued. The issuing of PCNs and enquiry letters was suspended during this period, due to the Covid-19 pandemic.

Financial year 2021/2022: 1,201 PCNs were issued where a maternity exemption certificate was claimed

Financial year 2022/2023: 55,843 PCNs were issued where a maternity exemption certificate was claimed

Financial year 2023/2024: 62,287 PCNs were issued where a maternity exemption certificate was claimed

Question four: The number of penalty charge notices which were issued because it was believed a patient was claiming to have a valid maternity exemption certificate when they did not which were successfully challenged in each of the following financial years: 2019-20, 2020-21, 2021-22, 2022-23, 2023-24

Financial year 2019/2020: 36,276 PCNs from question three were successfully challenged

Financial year 2020/2021: No PCNs were issued. The issuing of PCNs and enquiry letters was suspended during this period, due to the Covid-19 pandemic.

Financial year 2021/2022: 211 PCNs from question three were successfully challenged

Financial year 2022/2023: 8,691 PCNs from question three were successfully challenged

Financial year 2023/2024: 4,996 PCNs from question three were successfully challenged

Please note that some patients may not have had a maternity exemption certificate in place but were able to prove that they were entitled to have one at the time they claimed their NHS prescription. This would be considered a successful challenge.

Data Queries

Please contact foirequests@nhsbsa.nhs.uk ensuring you quote the above reference if you have any specific questions regarding this response; or, if you feel you may be misunderstanding or misinterpreting the information; or, if you plan on publishing the data.

Reusing the data and copyright

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 2025” 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.