FOI-02930

Thank you for your request for information about the following: 

##Request 

<p><i>‘Under the Freedom of Information Act 2000, I request copies of the following documents currently held by NHS Business Services Authority:</i></p> 

<p><i>1. Internal staff guidance, training materials, or policy manuals relating to the assessment and issuance of NHS prescription penalty charge notices.</i></p>

<p><i>2. Any documents or criteria used by staff when verifying whether an individual had a valid Prescription Prepayment Certificate at the time of a prescription.</i></p>

<p><i>3. Any internal procedures or flowcharts followed when considering an appeal against a penalty charge.</i></p>

<p><i>4. Templates or scripts used for communicating with patients during the penalty or appeals process (letters, emails, or call handling).</i></p>

<p><i>5. Any internal definitions or thresholds used to determine “fraud” or “misuse” in the context of NHS prescription charges.</i></p>

<p><i>Please provide these documents in electronic format. If any part of this request exceeds the cost limits or falls under a valid exemption, please identify the specific exemption being applied and provide partial disclosure where possible.’</i></p>

##[On 30 June 2025 you clarified your request as follows] 

<p><i>‘Yes – I am requesting the full breadth of information outlined in my previous emails. This includes all internal documentation, training, process flow, policy, data, and audit records related to the Penalty Charge Notice (PCN) process, regardless of scope.</i></p>

<p><i>FOI-02930 – Full Clarified Request</i></p>

<p><i>A. PCN Enforcement and Process Governance</i></p>

<p><i>Please disclose:</i></p>

<p><i>Internal training manuals, presentations, and call scripts used for PCN issuance, appeals, and enforcement.</i></p>

<p><i>All process maps, flowcharts, and staff guidance regarding how exemption checks are carried out, how appeals are assessed, and how charges are escalated.</i></p>

<p><i>All internal policies or criteria regarding the use of discretion, including who can apply it, when it’s allowed, and how consistency is ensured.</i></p>

<p><i>Equality Impact Assessments, fairness reviews, or audits that examine how PCNs are issued or appealed.</i></p>

<p><i>A breakdown over the last 3–5 years of:</i></p>

<p><i>PCNs issued to people on means-tested benefits.</i></p>

<p><i>PCNs issued to people not on benefits.</i></p>

<p><i>Related outcomes: cancellations, appeals, refunds, successful challenges.</i></p>

<p><i>B. Staff Legal Qualifications and Decision Legitimacy</i></p>

<p><i>NHSBSA has publicly claimed that staff are adequately trained to issue legally enforceable fines. I am formally requesting:</i></p>

<p><i>Proof of any formal legal training received by PCN enforcement and appeal staff (including syllabus, accreditations, and qualifications).</i></p>

<p><i>Internal policies or statements defining what level of legal understanding is deemed sufficient.</i></p>

<p><i>Any correspondence, audit findings, or internal notes acknowledging lack of legal training among PCN staff.</i></p>

<p><i>If your organisation is authorising financial penalties without legal training, that raises serious public interest concerns.</i></p>

<p><i>C. Governance and Oversight</i></p>

<p><i>Additionally, please provide:</i></p>

<p><i>The name and contact details of any external oversight body, ombudsman, or government department that holds NHSBSA accountable for PCN-related behaviour.</i></p>

<p><i>A copy of your internal complaints escalation policy, specifically for situations where the complaint is about NHSBSA itself and cannot be resolved internally.</i></p>

<p><i>Any correspondence, memos, or policies relating to external scrutiny or ministerial review of your PCN processes.’</i></p>

##[On 14 July 2025 you clarified your request as follows] 

<p><i>‘To clarify point A.5 of my request:</i></p>

<p><i>I am requesting data for the last 5 financial years, including the current year to date where available.’</i></p>

The NHS Business Services Authority (NHSBSA) received your request on 16 June 2025, with clarification received on 30 June 2025 and 14 July 2025.  

We have handled your request under the Freedom of Information Act 2000 (FOIA). 

##Our response 

I can confirm that the NHSBSA holds some of the information you have requested, and a copy of this information is attached. 

Please read the below notes to ensure correct understanding of the data. 

##Part A – Penalty Charge Notice (PCN) Enforcement and Process Governance 

##Questions 1 and 2 

##External documents 

I can confirm that the NHSBSA holds the requested information; however, 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.    

Please see the below link to our knowledge base which staff use to explain how PCNs are applied: 

https://faq.nhsbsa.nhs.uk/knowledgebase/category/?articlecategory=Exemption%20Checking%20Services%20%28ECS%29&id=CAT-01005&parentid= 

Please see the below link to the PCN regulations, which add further context: 

https://www.legislation.gov.uk/uksi/1999/2794/contents/made 

Please see the following link to view the section 21 in full - https://www.legislation.gov.uk/ukpga/2000/36/section/21 

##Internal documents 

The link to the Knowledge Base articles above does provide the majority of information which staff use when handling queries regarding penalty charge notices. However, there are also internal copies of these articles which provide additional notes for staff. 

The NHSBSA does hold the requested information; however, we estimate that the cost of compliance with the request would exceed the appropriate limit under section 12 of the FOIA.  

We estimate that the cost of complying with your request would exceed the non-central Government limit of £450. The limit has been specified in The Freedom of Information and Data Protection (Appropriate Limit and Fees) Regulations 2004 and represents the estimated cost of one person spending 18 hours in determining whether the NHSBSA holds the information, and locating, retrieving, extracting and checking the information. 

Please see the following calculations which sets out the estimated cost for compliance with this request: 

There are 148 articles, and it would take approximately 10 minutes to check each article. 

148 x 10 = 1,480 minutes (24 hours and 40 minutes) 

Please be advised that due to the way that the information is held by the NHSBSA, it is not possible to submit a refined request under the appropriate limit. 

Please see the following link to view the section 12 in full - https://www.legislation.gov.uk/ukpga/2000/36/section/12 

##Question 3 and 4 

I can confirm that the NHSBSA holds the requested information; however, the requested documents contain information which could be used to avoid paying charges and therefore commit fraud.  

This information is exempt under section 31(1)(a) of the FOIA (law enforcement) as disclosure would prejudice the prevention or detection of crime.  

Section 31 is a qualified, prejudice-based 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.  

##Public Interest Test:  

##Considerations in favour of disclosure:  

Public interest in openness and transparency of public authority dealings. 

Contribute to public understanding of the NHSBSA’s procedures and actions regarding dental and prescription charges and penalty charge notices.  

##Considerations against disclosure:  

Public interest in avoiding prejudice to the prevention or detection of crime. 

The legal duty to ensure that fraud is prevented against services provided by the NHSBSA.  

Releasing the documents would provide the public with information which could be used to avoid paying charges and therefore commit fraud.  

There would be a financial impact to the NHS if correct charges are not being paid.  

##Conclusion:  

The NHSBSA recognises that there is a public interest in disclosure of the information to promote transparency and assurance of NHSBSA's exemption checking service processes. The NHSBSA releases Knowledge Base articles publicly which provide information and transparency regarding penalty charges. These Knowledge Base articles coupled with information already in the public domain (https://www.nhsbsa.nhs.uk/nhs-penalty-charges-and-enquiry-letters), contribute significantly to public transparency and understanding of the service. However, with regard to the requested documents the public interest in maintaining the exemption outweighs the public interest in disclosing the information as more weight is afforded to the arguments outlined above to avoid prejudice to the prevention or detection of crime.  

Please see the following link to view the section 31 exemption in full - https://www.legislation.gov.uk/ukpga/2000/36/section/31  

##Question 5 

A copy of the data is attached. 

All data relates to the Prescription Exemption Checking Service (PECS) for the last five financial years, including 2025/26 to date. Please note, we paused the issuing of PCNs in 2020 during the Covid-19 pandemic, and resumed during 2021, therefore the figures for this year are significantly lower. 

We are unable to determine that someone who was issued a PCN was on benefits, only that they claimed the benefit on the prescription. As we did not find a data match, an enquiry letter was sent before the PCN was issued. 

For means-tested benefits we have combined all Department of Work and Pensions (DWP) benefits including Tax Credits. 

For PCNs issued to people not on benefits, this is for the NHSBSA exemptions only, HC2 certificates, maternity exemption certificates, medical exemption certificates and prescription prepayment certificates. 

For Q5.3 "Related outcomes: cancellations, appeals, refunds, successful challenges" we have provided the total data, this is a combination of those on means tested benefits and not on benefits. We classify cancellations as a successful challenge.  

Successful challenge includes both Exemption Confirmed and Cancelled cases. We do not hold data showing how many appeals we have received. 

##Part B - Staff Legal Qualifications and Decision Legitimacy 

The NHSBSA does not hold this information as staff do not require formal legal training to issue PCNs.  

All PCNs are issued in accordance with the National Health Service (Penalty Charge) Regulations 1999.  Our staff do not issue the penalty charges themselves. Each month we receive a dental and prescription file containing all treatments received where an exemption has been claimed. This is an automated process where these claims are checked for any NHSBSA exemptions and then are checked against DWP qualifying benefits. All cases where an exemption is not confirmed will progress to a letter being issued.  

##Part C - Governance and Oversight  

##Question 1 

The NHSBSA is accountable to NHS England and the Department of Health and Social Care (DHSC). Their contact details are below: 

NHS England 

PO Box 16738 

Redditch 

B97 9PT 

Telephone 0300 311 22 33 

Email: <a href=mailto:england.contactus@nhs.net>england.contactus@nhs.net</a>     

Web http://www.england.nhs.uk/contact-us/foi/ 

Ministerial Correspondence and Public Enquiries Unit 
Department of Health and Social Care 
39 Victoria Street 
London 
SW1H 0EU 
United Kingdom 

Email: <a href=mailto:dhsc.publicenquiries@dhsc.gov.uk>dhsc.publicenquiries@dhsc.gov.uk</a>  

##Question 2 

I can confirm that the NHSBSA holds the requested information; however, 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 from the link below: 

https://www.nhsbsa.nhs.uk/contact-us/complaints  

Please see the following link to view the section 21 in full - https://www.legislation.gov.uk/ukpga/2000/36/section/21 

##Question 3  

I can confirm that following a search of our paper and electronic records, I have established that the information you requested is not held by the NHSBSA; however, 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 from the link below: 

https://committees.parliament.uk/work/4002/penalty-charge-notices-in-healthcare-inquiry/publications/ 

Please see the following link to view the section 21 in full - https://www.legislation.gov.uk/ukpga/2000/36/section/21 

##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 2025”. 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: Loss Recovery, PCN, PECS, Prescription Exemption Checking Service
Organization: Freedom of Information Disclosure Log