Sharp rise in NHS penalty notices

THE number of fines handed down to patients for wrongly claiming free NHS treatment has risen 30-fold in the past five years, with fines now topping £126 million.

But of the 5.6 million penalty charge notices (PCNs) sent out across England and Wales since 2014 for wrongly claiming exemption from prescription and dental charges, almost a third (1.7 million) were issued in error and later refunded.

The figures were revealed in a new report from the National Audit Office. It estimated the NHS lost around £212 million in 2017-2018 from incorrect exemption claims, but admitted rules around entitlement were “overly complicated leading to genuine mistakes and confusion for many people.”

NHS Business Services Authority (NHSBSA) administers the distribution of PCNs to those who, either fraudulently or in error, have claimed a free prescription or dental treatment when they were not entitled to do so; or have a valid exemption which cannot be confirmed at the time of checking.

Last year more than 24 million checks were carried out on prescription claims, compared to just 750,000 in 2014-2015.

The value of PCNs also increased significantly over this period, from £12 million to £126million per year for prescriptions and from £38 million to £72 million per year for dental treatments. The 5.6 million PCNs issued in the past five years have a total value of £676 million. Of these, £133 million (20 per cent) were collected; £297 million (44 per cent) were resolved without a penalty charge being paid; and £246 million (36 per cent) remain outstanding.

The 1.7 million PCNs that were withdrawn had a value of £188 million.

The British Dental Association (BDA) has seized on these errors and called for clarity on penalty charges. In a response to the report, it said: “The BDA has deep concerns that the increasingly aggressive approach to penalty charges has fuelled a drop in attendance among low income and vulnerable patients.”

It quoted official statistics that show a fall of two million treatments delivered to patients exempt from NHS charges since 2013/14 – a decrease of 23 per cent in four years.

Charlotte Waite, Chair of the BDA's England Community Dental Services Committee, said: "There can be no excusing the fact innocent people, fully entitled to claim free care, have been slapped with over £180 million in fines.

"Other UK nations have chosen a different path. Change can begin by ending this blind 'fines first' approach, with a simple letter, asking patients to spell out their entitlement."

Following concern from the BDA and other bodies, the Public Accounts Committee has announced plans for an inquiry into the PCN system which will be held “over the coming months”.