FOI-03878

##Request

<i>Please provide data on penalty charge notices (PCNs) issued for misclaiming exemptions for NHS dental treatment or prescriptions.

Question 1. The total number of claims made by those indicating they were exempt adults patients for:
i) free NHS prescriptions and
ii) NHS dental treatment, by NHS financial year, 2017/18 to 2025/26

Question 2. The number of PCNs issued to patients suspected of misclaiming:
i) free NHS prescriptions and
ii) NHS dental treatment, by NHS financial year, 2017/18 to 2025/26

Question 3. The cash value of PCNs issued to patients suspected of misclaiming:
i) free NHS prescriptions and
ii) NHS dental treatment, by NHS financial year, 2017/18 to 2025/26

Question 4. The number of PCNs challenged by fine recipients for misclaiming:
i) free NHS prescriptions and
ii) NHS dental treatment, by NHS financial year, 2017/18 to 2025/26

Question 5. The number of challenges that resulted in PCNs being overturned for misclaiming (by patients issued with a PCN following a claim for an exemption they were subsequently considered ineligible for)

i) free NHS prescriptions and

ii) NHS dental treatment, by NHS financial year, 2017/18 to 2025/26

Question 6. The cash value of PCNs overturned for misclaiming:

i) free NHS prescriptions and

ii) NHS dental treatment, by NHS financial year, 2017/18 to 2025/26

Note on definitions:

By 'adult' please include anyone over 16 or 16-18 and not in full time education.

By 'free NHS prescriptions' I mean all NHS prescriptions, from any recorded health professional.

By 'misclaimed' I mean patients issued with fines following a claim for an exemption they were subsequently considered ineligible for</i>

The NHS Business Services Authority (NHSBSA) received your request on 3 June 2026. 

We have handled your request under the Freedom of Information Act 2000 (FOIA).

##Our response

When claiming free NHS prescriptions, it is the patient's responsibility to ensure they are claiming correctly. If they have an NHS exemption certificate, it is up to the patient to check their certificate is valid and in date.

The NHSBSA developed a technical solution called Real Time Exemption Checking (RTEC) which lets your local pharmacy see if you need to pay for your NHS prescription. Pharmacists are encouraged to use RTEC to see if a patient has a valid NHS exemption certificate to claim free prescriptions.
 
The NHS Business Services Authority provides the exemption checking service on behalf of NHS England to recover unpaid patient charges for NHS prescriptions and dental treatment. This is done to protect public funds and provide value for money for the taxpayer. If we identify that an NHS prescription was incorrectly claimed for free, an initial enquiry letter is sent to patients. This gives patients an opportunity to check their exemption and contact us to confirm that they were exempt from paying. If they don’t contact us within 28 days, or if they weren’t exempt, a penalty charge notice (PCN) is then issued.

##Question 1 - The total number of claims made by those indicating they were exempt adults patients for: i) free NHS prescriptions and ii) NHS dental treatment, by NHS financial year, 2017/18 to 2025/26

Under Section 21 of the FOIA we are not required to provide information in response to a request if it is already reasonably accessible to you. 

The information you requested is available on the NHSBSA and NHS Digital website.

Please see the following link to view the section 21 in full - https://www.legislation.gov.uk/ukpga/2000/36/section/21

##Free NHS Prescriptions 

##2017/18 – 2024/25

https://view.officeapps.live.com/op/view.aspx?src=https%3A%2F%2Fnhsbsa-opendata.s3.eu-west-2.amazonaws.com%2Fpca%2Fpca_exemption_categories_2024_25_v001.xlsx&wdOrigin=BROWSELINK.

Please be sure to read the notes at the top of the Exemption Categories worksheet for a full understanding of the data set.

##2025/26

https://www.nhsbsa.nhs.uk/statistical-collections/prescription-cost-analysis-england/prescription-cost-analysis-england-202526 

This can be found under the “Management information” title, this is near the bottom of the webpage. The document is called “Exemption category management information”

##NHS dental treatment, by NHS financial year, 2017/18 to 2025/26

##2019/20 to 2024/25

Please see link to the NHSBSA website below:

https://www.nhsbsa.nhs.uk/statistical-collections/dental-england/dental-statistics-england-202425 

Table 1C shows the data under the Patient Type grouping “Exempt”.

##2017/18 and 2018/19

The information you requested is available on the NHS Digital website linked below:

https://digital.nhs.uk/data-and-information/publications/statistical/nhs-dental-statistics/2022-23-annual-report 

##2025/26 data

The NHSBSA does hold the requested information; however, we consider that this information is exempt from disclosure under section 22 of the FOIA. This provides an exemption from the duty to disclose information where the requested information is intended for future publication. 

The Information Commissioner’s Office guidance states that “the public authority must, at the time of the request, hold the information and intend that it or “any other person” will publish it in future. This means that it must have a “settled expectation that the information will be published at some future date”.

The information is intended for future publication for dental exemptions information will be at the end of August 2026.

Section 22 is a class-based, qualified exemption and is subject to the public interest test. This means that not only does the information have to prejudice one of the purposes listed, but before the information can be withheld, the public interest in preventing that prejudice must outweigh the public interest in disclosure.

##Considerations for disclosure:

* public accountability
* the need for public authorities to be transparent in their dealings

##Considerations against disclosure: 

* the information is intended for future publication once finalised
* the information is currently in draft and therefore subject to change
* there is an inherent public interest in not disclosing information which could be misleading to the public and may not accurately reflect the final document

##Conclusion:
We consider that the advantage to releasing this information now (rather than upon the planned publication) is outweighed by the potential prejudice to the completeness and consistency of the data provided.

Please see the following link to view the section 22 in full - Freedom of Information Act 2000 (legislation.gov.uk) 

##Question 2 – 6

I can confirm that the NHSBSA holds the information you have requested, and a copy of the information is attached.

##Data Queries

Please contact <a href="mailto: foirequests@nhsbsa.nhs.uk"> foirequests@nhsbsa.nhs.uk</a> ensuring you quote the above reference if you have any specific questions regarding this response; or, if you feel you may be misunderstanding or misinterpreting the information; or, if you plan on publishing the data.

##Reusing the data and copyright

If you plan on producing a press or broadcast story based upon the data please contact <a href="mailto: communicationsteam@nhsbsa.nhs.uk">communicationsteam@nhsbsa.nhs.uk</a>. This is important to ensure that the figures are not misunderstood or misrepresented.

The information supplied to you continues to be protected by the Copyright, Designs and Patents Act 1988 and is subject to NHSBSA copyright. This information is licenced under the terms of the Open Government Licence detailed at:

http://www.nationalarchives.gov.uk/doc/open-government-licence/version/3/ 

Should you wish to re-use the information you must include the following statement: “NHSBSA Copyright 2026”. Failure to do so is a breach of the terms of the licence.

Information you receive which is not subject to NHSBSA Copyright continues to be protected by the copyright of the person, or organisation, from which the information originated. Please obtain their permission before reproducing any third party (non NHSBSA Copyright) information.

Tags: NHS Dental, NHS Penalty Charges, NHS Presciption Services, PCNs, free prescriptions
Organization: Freedom of Information Disclosure Log