Pharmacists and dentists should check people’s eligibility for benefit-related exemptions “at the time the transaction occurs” to reduce fraud or error, the National Audit Office has said – but the Royal Pharmaceutical Society has warned this would risk making pharmacists into “prescription police”.

The NAO said the NHS Business Services Authority was developing a system to “reduce the likelihood of fraud or error occurring in the first place” by having pharmacists and dentists perform exemption checks “in real time”. A pilot is currently underway in four pharmacies, according to the NAO.

From 2014-15 to 2018-19, the value of penalty charge notices (PCNs) issued by the NHSBSA to people who claimed exemptions they were not entitled to, or could not confirm at the time of checking, rose from £12m to £126m per year for prescriptions and from £38m to £72m for dental treatments.

The cost of managing the PCN process was £11.2m in 2017-18, or 31 pence for every pound recovered.

Pointing out that 30 per cent of PCNs issued since 2014 were withdrawn “because a valid exemption was confirmed to be in place following a challenge,” the NAO said the current system causes “confusion” and “genuine mistakes” for many patients.

NAO head Amyas Morse said: “Free prescriptions and dental treatment are a significant cost to the NHS, so it is reasonable to reclaim funds from people who are not exempt from charges and deter fraud.

“However, the NHS also needs to have due regard to people who simply fall foul of the confusing eligibility rules. It is not a good sign that so many penalty charge notices are successfully challenged.”

RPS: Scrap prescription charges

However, Royal Pharmaceutical Society England board chair Sandra Gidley warned that the plans risk taking pharmacists away from patients and making them into “prescription police”.

Ms Gidley said the NAO had shone a light on “important issues” and agreed that “the system needs to be simplified before” criminalising those who make genuine mistakes.

But she warned that pharmacists “should not be the prescription police… they want to spend their time helping people with their medicines rather than checking their exemption status”.

Commenting that the “consequences of the relentless rise in prescription charges are well known,” Ms Gidley said it “would be much simpler to have free prescriptions for everyone, as is the case in Scotland, Wales and Northern Ireland, because then no-one would have to worry about filling out a form of declaration”.

This would mean patients “always have the medicines required” and would “enable the investment in issuing and monitoring PCNs to be spent on patient care,” she argued.

PSNC said in October 2018 that digitising exemption data as part of a project known as Real-Time Exemption Checking (RTEC) would offer "clear benefits" to pharmacies and patients and would reduce pharmacists's current workload with regard to exemptions.