I have been asked to pay a fine of £150 by the NHS Business Services Authority (NHSBSA) who suspect I have checked the Prepaid Certificate (PPC) box on the prescription I collected. As someone with a chronic disease, I’ve been paying per click with monthly direct debit for nine years because it’s cheaper than paying for each prescription separately.
I was told that my direct debit payments were held up by NHSBSA when I failed to respond to a renewal letter that I never received. So far, PPC has been automatically renewed. I was told this practice started during Covid and the letter was sent to an address I left five years ago and returned to the sender. Apparently, the NHSBSA database is separate from the NHS database, so you have to notify the former separately if you move.
Needless to say, I got the letter detailing the fine at the correct address, and they were able to call me on the mobile number they have on my file to make sure I pay. I am happy to pay for any medication collected since revocation of authorization, but is the fine fair or even legal?
Saint, Toaster, Northants
It is definitely not fair. Fines are supposed to punish fraudsters. Misunderstanding, not fraud, is the cause of your distress. In 2019, a select parliamentary committee concluded that the PPC process was “too quick to judge” by the NHSBSA, which checks waivers for prescriptions and dental treatments on behalf of the NHS, and accused the Department of Health and Social Care and the NHS of “compassionate behaviour”. shockingly” about the unfair punishment of patients.
Of course, you should check the pay-per-click expiration time and keep an eye on debits, but that’s not as easy as it sounds. Pay-per-click cards are now electronic, not plastic cards, and the NHSBSA Terms and Conditions state that certificates will naturally renew automatically, and patients who do not wish to renew should cancel direct debit.
There are no details on when automatic renewals do not apply. The Terms and Conditions do not specify that NHSBSA must be notified separately of a change of address. They simply say they should be informed of ‘mistakes’ or ‘changes of circumstances’.
The notification clause is mentioned in the purchase confirmation, but it is the terms and conditions that form the legal basis for the contract.
In my view, it is reasonable for patients to assume that the NHSBSA and NHS databases will be in sync if they inform their GP of a change of address, and that their PPC will continue to renew. In fact, NHSBSA told me it uses the NHS database when examining patients who claim their age, health or finances making them exempt from prescription charges, before issuing a fine.
Others, like you, have fallen into the trap of misleading terms. The Patient Association tells me about a 59-year-old female patient who was fined for not knowing that her pay-per-click service was not automatically renewed. In her case, NHSBSA revoked the mandate because she would be 60 and eligible for free prescriptions nine months after the renewal date. This has also been omitted from the Terms and Conditions.
Fines are holding many patients back – five times the amount owed for prescriptions collected without a valid exemption, up to a maximum of £100, which roughly equals the £108.10 annual cost of a pay-per-click system. An additional fee of 50% is added if it is not paid within 28 days.
NHSBSA tells me that letters advising direct debit about to renew should be sent to patients, and that since you’ve been returned to the sender, you’ve decided to cancel the PPC.
This does not explain why your address has apparently been renewed without issue in the five years since you left that address, or why you have been told that Covid has changed this practice. I asked why, if he could access your current address from NHS records to send the fine, and had your phone number, he couldn’t make another attempt to contact you about the renewal. She responded that it was the patient’s responsibility to verify their exemption when collecting the prescriptions, and despite evidence that you had not fraudulently claimed the free prescriptions, you refused to void the fine.
According to Gary Rycroft, consumer attorney and partner at Joseph A Jones & Co Advocates, NHSBSA’s insistence on fining patients misled by terms and conditions is “harmful and unfair”.
“The words live up to a contractual promise that the PPC will automatically renew unless the patient takes effective steps to prevent this,” he explains. “The failure of the public body to renew when they gave a strong impression that they would do so automatically, and the issuance of fines, described it as mismanagement.”
The DHSC asked if it would ensure that patients were treated fairly, but it has nothing to add to the NHSBSA response. I now suggest that you file a complaint with the Parliamentary Ombudsman and the Health Services.
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