Pharmacies and dental practices send their NHS prescriptions and NHS dental treatment claim forms to us at the end of each month.
We then calculate how much each pharmacy or dental practice needs to be reimbursed by the NHS.
We carry out monthly automated checks on prescription forms and dental treatment claim forms to check for fraud and error.
If we have not been able to confirm you were entitled to NHS prescriptions or dental treatment at the time you claimed, you will be sent an enquiry letter. If you cannot confirm you had a valid reason to claim a free NHS prescription or Dental Treatment and exceptional circumstances do not apply, you’ll be sent a Penalty Charge Notice.
You will be asked to pay the original NHS prescription charge or NHS dental treatment charge plus a penalty charge of up to £100. For more information on penalty charges, please see Understanding penalty charges.
Matching your details
During the automated checking process, your personal details on the prescription or dental form will be checked against our records using ‘matching’ criteria. These personal details include:
- first name
- surname
- date of birth
- first line of address
- postcode
Where they do not match our database, an enquiry letter will be issued.
You can reduce the risk of getting sent a letter by keeping your personal details up to date with us, your GP surgery, dental practice, and benefits organisations.
After an enquiry letter has been sent
If you can show us that you were entitled to claim free NHS prescriptions or Dental treatment at the time, or there has been a mismatch of your details held for your valid exemption, your case will be closed.
If you do not respond to your enquiry letter, you may receive a Penalty Charge Notice. Please see the Responding to Your Penalty Charge Notice for more information - https://www.nhsbsa.nhs.uk/our-policies/privacy/responding-your-penalty-charge-notice
If you receive a Penalty Charge Notice, and have an exceptional reason not to pay, the charge could be eased or removed, but you will still have to pay the original NHS prescription charge or NHS dental treatment charge.
If you cannot challenge the Penalty Charge Notice, you must start paying the charges listed on the letter as soon as possible.
Sharing your personal information
To support more effective planning and improvements to NHS services and patient care, we may share our understanding of patterns and trends gained from patient information with NHS England and the Welsh Government:
- NHS Commissioners and service providers
- Department of Health and Social Care (DHSC)
- Welsh Government Department for Health and Social Services
To prevent, detect and investigate fraud and errors, we may share your information with NHS Counter Fraud Authority.
If an investigation into errors with state benefit entitlement is needed, we may receive or share your information with the Department of Work and Pensions (DWP).
If you are making a payment, we will share your information with our payment providers All Pay and Govpay, who meet all card security requirements. We may also share your payment details with Equifax to make sure they are correct. We receive proof whether payment was successful but do not your card details.
If you do not pay the penalty within the required timeframe, we may share your data with our debt recovery partners as part of the Integrated Debt Services Ltd who collect the debt on our behalf.
Keeping your personal information
Your personal data will be deleted or anonymised when we no longer need to be able to identify you from that information. We will delete your personal data from our systems and files no later than 7 years from when we issued an enquiry letter.