NHS BSA: Prescriptions and Dental Exemption check
Source: gov.uk (2025-09-25)

A check to confirm whether patients who have signed a declaration to claim free prescriptions or dental treatment and have not been confirmed through Real Time Exemption Checking, are eligible to do so.

1. Summary

1 - Name

NHS Prescriptions and Dental Exemption check

2 - Description

The purpose of the exemption checking service is to confirm if patients who have signed a declaration to claim free NHS prescriptions or dental treatment and have not been confirmed through Real Time Exemption Checking, are eligible to do so.

3 - Website URL

https://www.nhsbsa.nhs.uk/understanding-penalty-charges

4 - Contact email

xxx@xxx.xx

Tier 2 - Owner and Responsibility

1.1 - Organisation or department

NHS Business Services Authority

1.2 - Team

Health Exemption Services

1.3 - Senior responsible owner

Head of Operational Service

1.4 - Third party involvement

Yes

1.4.1 - Third party

Department of Work and Pensions (DWP)

1.4.2 - Companies House Number

N/A

1.4.3 - Third party role

DWP allows API (Application Programming Interface) access to NHSBSA in order to check if a patient holds a valid exemption on specific dates.

1.4.4 - Procurement procedure type

Single source procurement.

The ability to check Department of Work and Pensions (DWP) data is chargable and is paid for by NHSBSA as a package, DWP is the only source of the required data and so this route is followed.

1.4.5 - Third party data access terms

NHSBSA provides patient data to DWP to identify and verify claims from patients that they are entitled to exemption or remission from patient charges. Term of access is managed through a Data Sharing Agreement between the parties.

Tier 2 - Description and Rationale

2.1 - Detailed description

The purpose of the exemption checking service is to confirm if patients who have signed a declaration to claim free prescriptions or dental treatment and have not been confirmed through Real Time Exemption Checking, are eligible to do so.

Basic customer details including NHS number, name, D.O.B and address are used to check a patient’s exemption status within specified dates.

NHS Business Services Authority (NHSBSA) will check for valid exemption certificates against its internal databases, using the patients NHS number and/or a combination of other personal identifiable information. If a valid exemption certificate is not found, a secondary check is made with Department of Work and Pension (DWP), to confirm eligibility using benefit records.

2.2 - Benefits

The NHS as a whole benefits from the reduced cost of prescription error/fraud.

2.3 - Previous process

Prior to exemption checking by matching NHSBSA to DWP data, NHSBSA would request evidence of exemption from the patient physically or by email.

2.4 - Alternatives considered

N/A

Tier 2 - Deployment Context

3.1 - Integration into broader operational process

If a patient is exempt from paying charges, no action is taken. If a valid exemption cannot be found, an Enquiry Letter is sent by post asking patients to verify their exemption status using the ‘Respond to your letter’ service. Details of how to check exemptions can be found in the letter. Any evidence of an exemption which has not been found by our systems can be submitted by email or post. If a patient is unable to verify their exemption, a Penalty Charge Notice (PCN) will be issued by post.

Penalty Charges are calculated using criteria set out in The National Health Service (Penalty Charge) Regulations 1999. This is the cost of the original prescription or dental charge plus an additional penalty charge of 5 times the original charge owed, up to a maximum £100. Once a Penalty Charge Notice has been issued, if no payment has been made within 28 days, a surcharge may be added, amounting to 50% of the penalty charge issued.

3.2 - Human review

If NHSBSA are unable to confirm an exemption using the API method an enquiry letter is sent to the patient asking them to evidence their exemption. No manual check takes place before an enquiry letter is issued. This requires a review by the patient to check their exemption status and personal details, and by NHSBSA to confirm this proof of exemption received to consider its validity and potentially close the record.

3.3 - Frequency and scale of usage

Each month c. 1.2 million checks are initiated and made by NHSBSA prior to making contact with patients as part of our exemption checking sampling process.

Each month, an additional c.15,000 checks are initiated and made by patients using the online ‘Respond to your letter’ gateway.

3.4 - Required training

For NHSBSA the tool is part of an automated internal process. The only input required from NHSBSA is to feed in patient details, and then capture ‘confirmed’ or ‘non confirmed’ outcomes from the tool, these jobs run automatically.

Patients making use of the tool do so through the ‘Respond to your letter product’ which is available online through our website has guidance on how to provide this information.

3.5 - Appeals and review

If NHSBSA are unable to confirm an exemption using the API method an enquiry letter is sent to the patient asking them to evidence their exemption.

Tier 2 - Tool Specification

4.1.1 - System architecture

Exemption Checking is evaluation of business rules based on patient data which also involves making API calls to internal and external systems. If an exemption is found, the case is closed. If not, business rules are used to determine if further evidence is required from the patient.

4.1.2 - System-level input

Patient details including NHS number, name, D.O.B, address, postcode, and exemption claimed are used to check a patient’s exemption status within specified dates of treatment (for dental) or collection (for prescriptions).

4.1.3 - System-level output

Exemption status and if applicable, calculation of penalty charges. The output is delivered in form of Portable Document Format (PDF) letters as well as made accessible via the portal and User Interface (UI) elements.

4.1.4 - Maintenance

Updates to Tools and Rules are delivered by NHSBSA as and when required, for example due to changing Universal Credit eligibility criteria.

4.1.5 - Models

A rule-based model wherein different business rules are applied based on patient data and The National Health Service (Penalty Charge) Regulations 1999 requirements.

Tier 2 - Model Specification

4.2.1. - Model name

Exemption Checking Service

4.2.2 - Model version

2025_01

4.2.3 - Model task

Determine exemption status of a patient for a given prescription or dental treatment and calculate penalty charges wherever applicable.

4.2.4 - Model input

Patient details including NHS number, name, D.O.B, address, postcode, and exemption claimed are used to check a patient’s exemption status within specified dates of treatment (for dental) or collection (for prescriptions).

4.2.5 - Model output

Exemption status and if applicable, calculation of penalty charges. The output is delivered in form of PDF letters as well as made accessible via portal / UI elements

4.2.6 - Model architecture

A rule-based model where in different business rules are applied based on patient data and their exemption statuses

4.2.7 - Model performance

All testing of accuracy took place against the User Acceptance Testing environment with the supplied test pack that provides an indicator on the expected responses.

No testing takes place in the production environment as this will require use of Personally identifiable information (PII) for testing purposes, which is an unacceptable risk.

DWP API access part of the tool provides responses within 5 seconds at the most.

4.2.8 - Datasets and their purposes

Test data was generated for User Acceptance Testing of the API. No live data was used for development of the model.

2.4.3. Development Data

4.3.1 - Development data description

Test Data was generated for developing the tool. No live data from production was used.

4.3.2 - Data modality

Text, image

4.3.3 - Data quantities

A sample covering around 50 to 75 patient records and 100 to 200 prescription and dental records was generated for testing and validation.

4.3.4 - Sensitive attributes

None of the data was sensitive as it was dummy data.

4.3.5 - Data completeness and representativeness

Test data was a complete representation of the target population.

4.3.6 - Data cleaning

N/A

4.3.7 - Data collection

N/A

4.3.8 - Data access and storage

The NHSBSA development team working on the tool have access to the Test Data. The Test Data does not have any sensitive data and is not derived from live production data. The data is retained for all developmental purposes.

4.3.9 - Data sharing agreements

N/A

Tier 2 - Operational Data Specification

4.4.1 - Data sources

NHSBSA uses customer data collected from NHS prescription and NHS dental treatment records. This data is checked for valid exemptions internally against NHSBSA data and externally against DWP data.

4.4.2 - Sensitive attributes

Personal Identifiable Data (Forename, Surname, Date of Birth, Sex, Address, Postcode, NHS Number, Benefit Type).

4.4.3 - Data processing methods

N/A

4.4.4 - Data access and storage

NHSBSA stores patient data. Data is accessible to list of users approved by NHSBSA Service Desk and include operational and support, Digital Data and Technology teams.

Patient data is retained up to 7 years from the date the last action on the data, , archived for a further 3 years and then anonymised for 10 years

The transfers between DWP and NHS are via secure routes with encrypted attachments.

4.4.5 - Data sharing agreements

A data sharing agreement is in place between NHSBSA and DWP which is reviewed regularly.

Data sharing is allowed under Regulation 3(1), 4, 6 and 9 of the Social Security (Information Sharing) (NHS Payments and Remissions of Charges etc.) (England) Regulations 2015 SI 2025/124.

Tier 2 - Risks, Mitigations and Impact Assessments

5.1 - Impact assessments

A Data Privacy Impact Assessment was completed in 2021. A high level summary of this is that patients declaring eligibility for an NHS charge exemption will be sample checked and a penalty charge issued if no valid exemption is found in either: NHSBSA systems DWP systems

Only minor risks were identified, as outlined below, and are actively managed by the Information Asset Owner (IAO).

5.2 - Risks and mitigations

There is a risk that our checks are unable to confirm exemption for a patient who does hold a valid exemption, however this can only be down to either a data mismatch or an exemption being processed clerically by DWP.

This is mitigated by our first contact to patients being an enquiry letter asking them to demonstrate exemption.