How to appeal pcn for not having nhs medical exemption certifcate

[HaleyBrookeandPeyton]

Does anyone have any experience of appealing a pcn for not having a nhs medical exemption certificate?

Long story short, DH has a ife threatening condition that was picked up at birth and requires medication for the rest of his life - it is a condition listed on the nhs medical exemption list.

DH is now 50 & has always had a prescription for this medication which is re-issued every 3 months & has always ticked the 'medical exemption' box in the prescription as that what he has always been told to do. So for the past 50 years he has never paid for his prescriptions.

Last week he received a notice of a pcn from the nhs business unit saying they had done a check in the prescription he had filled between July -September 2024 & was found not to be exempt.

Long story short, he has spoken to them & they have confirmed he doesn't have a medical exemption certificate- although they admit that if he can prove his medical condition (which he can), he will be exempt going forwards.

Turns out DH has never heard of applying for a certificate so doesn't ever remember doing so & has never been asked to, or received any other correspondence about it. Genuinely didn't know he had to as his medical condition was found at birth & won't ever get better.

I've always paid for my prescriptions so didn't know you needed to apply for a certificate for medical reasons as he has always had this condition and has always got free prescriptions because of it & has never been written to before.

When he spoke to them, their records only went back 2 years & they said for that time, he didn't have a certificate & that even when he does get one they only last 5 years.

They said they can only be backdated for 1 month so even when he gets a certificate he will have to pay £100 fine plus the prescription fee, which he is obviously not happy about (& can't afford).

He hasn't physically handed in a prescription for years (phones in his request to the pahrmacy) and the pharmacy staff have been ticking the medically exempt box as they can see what medicine he has prescribed & that means you are medically exempt so it has never come up.

Does anyone know what the chances are of getting the pcn appealed or what to write?

Thanks for your help.

What they have told you is correct:

search.app?link=https%3A%2F%2Fwww.nhsbsa.nhs.uk%2Fcheck-if-you-have-nhs-exemption%2Fmedical-exemption-certificates&utm_campaign=aga&utm_source=agsadl1%2Csh%2Fx%2Fgs%2Fm2%2F4

It's fortunate he hasn't been caught to this point to be honest, I'd apply ASAP and pay taking the one month backdate as a win.

Oh goodness, what a mess. I do agree with the previous poster though. He's lucky that it's not been picked up before as well as them only being able to go back such a short period. I don't think he should really be considering looking for a way to not pay it tbh, just apply for the exemption now and accept the unintended wrongdoing has resulted in a fine that could've been higher.

Technically, the above posters are correct. It is the exemption certificate that entitles you to fee remission, not the medical condition. However, the the National Health Service (Penalty Charge) Regulations 1999 2(g)(ii) states that:

(g)that a person is not liable by virtue of a penalty notice—
(i)to pay at any time so much of any amount referred to in section 122B(1)(a) or (b) of the Act for which he is jointly and severally liable with another as at that time has been paid, or ordered by a court to be paid, by that other(2), or
(ii)to a penalty charge, or a surcharge, if he shows that he did not act wrongfully, or with any lack of care, in respect of the amount recoverable as mentioned in section 122B(1)(a) or (b) of the Act(3).

He could argue that, having known that his condition was eligible for exemption, and having had the condition since birth, he thought that this was the eligibility for exemption.

He would be wrong, because box E does state 'Medical Exemption Certificate' but they may use their discretion to waive it.

https://www.nhsbsa.nhs.uk/respond-your-letter This is where he can appeal.

Turns out DH has never heard of applying for a certificate so doesn't ever remember doing so & has never been asked to

The box you tick for exemption specifies you are exempt because you have a certificate - you say he hasn't filled one for years so whoever has been doing this on his behalf is at fault and I would absolutely be appealing based on the fact he didn't tick the box, someone else took that decision (you say based on his medication) which is really silly of them, to say someone has a certificate when they have no idea of that's true.

All that said, he must have known because at some point he surely has filled a prescription

Unfortunately they will not waive the PCN. They say it is the person's responsibility. He's best to pay it and apply for the certificate and move on.

It's worth appealing. It is better than just paying.

Thanks for the replies.

I think he'll try appealing & see what they say.

I think what they say is true - you don't know what you don't know. He has been told from when he was small that he was exempt from prescription charges as the medication he needs to stay alive is exempt from charge and he never questioned it - why would he?

GPs, pharmacy staff, etc have never mentioned that he needed a certificate- he always said what his condition is and they all said that you don't have to pay due to that and he took it at face value.

Plus, he has never received anything like the letter he got last week and he has never paid for any prescriptions - he has 3 months supply at a time and has done for 50 years. If someone had ever told him, he would have applied as he does qualify but he genuinely didn't know.

When he gets his certificate - do you receive a letter when it is due to expire asking you to reapply again? Or do you just have to remember?

My DD has a certificate.

She gets a letter telling her to apply again.

You don't know what you don't know isn't going to help.

The box that gets ticked specifies a 'medical exemption certificate' so saying he didn't k if he needed one won't work in that respect

However, if someone else is ticking the box during the process GP - chemist then that's a breach of something and it needs to be investigated. I don't think your husband should be held responsible for a chemist (or whoever) taking it upon themselves to tick a box

Oh your username made me nostalgic for my one tree hill days @HaleyBrookeandPeyton! I’m sorry I’ve not got anything useful to add except to say you have nothing to lose by appealing, especially as it’s a condition he’s had his whole life.

I do sympathise because I was on a medication that is normally exempt (thyroxine) but wasn't in my case. Pharmacy staff were always adamant that I was exempt and I had to stop them ticking the exempt box every single time I collected a prescription. It was only because I actually knew (due to my job) that I needed to pay, otherwise I'd have taken their word for it. Why wouldn't you take the word of pharmacy staff? It's not unreasonable to take their word for it IMHO.

I'm not sure you're going to be able to get out of paying, but it really sucks because he hasn't been deliberately dishonest, just got caught up in red tape.

I can totally see how he didn't realise given he had never been challenged his whole life.

They may be able to consider that factor.

But a lot of offences are strict liability, and rightly so (otherwise everyone would claim they didn't know they weren't allowed to do things)

It is a risky business appealing though if you know you're in the wrong even if not intended. I did so on behalf of a family member and ended up getting a higher fine than initially stated which is why I'd be careful- hopefully they will waive it though as he's eligible it's just the admin.