Thousands of patients across the UK are being slapped with hefty administrative fines from the NHS Business Services Authority (NHSBSA). This is occurring because they reportedly filled prescriptions without qualifying exemptions. Consumer advocates are expressing alarm about civil penalties that can go up to five times the value owed to a consumer, capped at £100. They claim that this enforcement regime disproportionately punishes the most vulnerable.
The yearly cost of a PPC is £108.10. This option provides patients with chronic conditions an affordable method to take care of their medication expenditures rather than requiring them to pay for each medication separately. Now thousands of patients are facing surprise penalties themselves, the result of poor communication and bureaucratic error.
A major problem stems from the NHSBSA’s insistence that patients must inform them directly of any change in address. This is a relatively new practice, but one that has developed due to the NHSBSA database functioning in a silo away from the broader NHS database. It is important that NHSBSA are notified of any change of address so that the correct prescription charge applies. If not, they may miss key renewal letters related to their PPC designation. This can result in their direct debit payments being stopped, sometimes without warning.
In recent months, patients have been getting hit with penalties of up to £150. This was due to them inadvertently ticking the wrong PPC exemption box on their prescription forms. One patient was very angry when they found their direct debit had just been cancelled. It turned out they never got the renewal letter and thus did not know to send back a response. This disturbing scenario exemplifies the dangers that arise when patients cannot be properly educated about their responsibilities.
Gary Rycroft is a consumer lawyer, and partner at Joseph A Jones & Co solicitors. He underscored the shortcomings with the NHSBSA’s approach. He said the fines were “perverse and inequitable.” He argued that the authority’s terms and conditions confuse patients, putting them at risk of financial penalties for not adhering to rules they weren’t even aware of.
“The words amount to a contractual promise that PPCs will renew automatically unless the patient takes active steps to prohibit that.”
Furthermore, NHSBSA’s longstanding practice of sending renewal letters to previous addresses has been criticized. If the NHSBSA cannot deliver a letter sent, the NHSBSA might end PPC. Clinical patients are unlikely to be informed about this shift. The failure to communicate has left hundreds of thousands of patients with specialty drug needs in a bind. They are routinely subjected to unwarranted charges of rule violations, incurring crippling fines that compound their already substantial health burdens.
The state of affairs has elicited passionate responses from advocates, legislators, and mayors. In 2019, a UK parliamentary select committee condemned the PPC process. They called it a “heavy-handed rush to judgment” and noted the “shockingly complacent” view of patients who would be penalized without cause. The committee’s recommendations indicated clear demand for improvement and change in the way in which the NHSBSA processes PPC renewals and engages with patients.
The Covid-19 pandemic further complicated the picture. Earlier shifts in NHSBSA practices led to increased dependency on postal communication, which turned out to be inconsistent at best. The record is clear—patients are speaking up. They have found that these changes have increased the burden on them to administer prescriptions and exemptions appropriately.