This site is intended for Healthcare Professionals only

NHS fraud checking

NPA Essential

NHS fraud checking

The NPA has produced guidance and suggested scripts to help pharmacy teams initiate conversations, in cases where patients claim exemption from NHS prescription charges but do not provide evidence

From July this year, pharmacy teams in England have been required to advise patients who claim exemption from NHS prescription charges, where evidence is required but not presented, that the NHS routinely checks claims to verify exemption status.

What must patients be advised?

  • If evidence of exemption is not supplied, where it is required, then the patient/ representative must be advised that “checks are routinely undertaken to ascertain entitlement to non payment of NHS prescription charges, where this is claimed, as part of the relevant arrangements for preventing or detecting fraud or error”.
  • The manner in which patients are advised of this will be at the discretion of pharmacists and their teams; however, the information should be verbally provided and in “appropriate terms” i.e. there should be no suggestion of fraud or wrongdoing.
    • The phrase “appropriate terms” has not been defined, but pharmacists and their teams should ensure that the advice is delivered in a sensitive and professional manner
    • Posters and leaflets will not be considered sufficient but can be used to initiate the conversation.

Which patients must be advised about NHS fraud checks?

  • When exemption from NHS prescription charges is claimed and evidence is required but not provided
  • Where the date of birth is hand written on the prescription, not computer generated, or not included in the electronic prescription message.

If the “evidence not seen” box needs to be crossed (or the equivalent in an electronic prescription message) then the patient must be advised in “appropriate terms” about NHS fraud checks.

Which patients do NOT need to be advised about NHS fraud checks?

  • Patients who are age exempt AND their date of birth is computer generated on the prescription (or included in the electronic prescription message)
  • This covers children under 16 years of age and patients 60 years of age and above
  • Prisoners on release patients – as long as the practice address box on the front of the prescription is printed with the letters ‘HMP’. 

What if the patient is not sure whether they are exempt?

In situations where patients are unsure whether they are exempt from NHS prescription charges (or where patients request an FP57 form), they need to pay for their prescription(s), and the pharmacist can issue an FP57 form at the time the prescription charge(s) is/are paid. Patients should be advised on the procedure to be followed for claiming a refund.

What are the potential consequences for patients who claim exemption incorrectly?

If patients claim exemption for NHS prescriptions but are not entitled to claim, they could face a penalty charge of up to £100 in addition to the original prescription charge(s). If payment is not made within the required timeframe, a further charge of up to £50 may apply.

The above is an extract from ‘NHS Fraud Checking: Guidance Notes’. NPA members can access the complete resource, including suggested scripts for pharmacy teams to use, from information-and-guidance.

Copy Link copy link button

NPA Essential