Stella Buller was recovering from the birth of her first child when the NHS letter arrived. It warned her she could face fines and charges of up to £435 for claiming four free prescriptions while pregnant.
Buller, 29, like all pregnant women in England, should have been exempt from prescription charges for up to 12 months after giving birth. But she was never given a pregnancy waiver certificate and has now been told that due to oversight she is not eligible for free medication. She has been given three months to pay the cost of prescriptions collected during her pregnancy or face a three-figure fine.
“It was appalling to get a letter suggesting I had committed an offence,” she said. “The prescriptions all related to my pregnancy and since I have basic maternity benefits, the amounts requested will really go without me.”
Buller is just one of thousands of expectant mothers similarly punished for breaching the NHS administration, the Observer has learned.
Last year, the NHS Business Services Authority, the government body that monitors patients’ entitlements to exemptions on behalf of the health service, issued 38,191 letters questioning women claiming maternity exemptions. More than 80% of them subsequently received a writ of execution because they could not provide a valid certificate.
Under NHS rules, women in England are not eligible for free prescriptions unless their midwife registers them for a pregnancy exemption certificate which pharmacists are required by law to apply for.
But two things often go wrong: midwives make mistakes when applying for the certificates, or forget to apply for them at all, and pharmacists do not ask for proof of exemption.
Two things often seem to go wrong: midwives make mistakes when applying for the certificates, or forget to apply for them at all, and pharmacists do not ask for proof of exemption
This means women whose certificates don’t come true can claim free prescriptions for months without realizing they don’t qualify. They then face overdue bills for their medication, plus fines of five times each prescription of up to £100.
“It is extraordinary that any patient group routinely receives such large fines for access to a service,” said Stella Creasy, a Labor MP. “I’ve had women in my constituency who have been given the wrong forms or none at all and now find they’ve been fined £100 through no fault of their own.”
Alexa Andrews received a demand to pay for antibiotics prescribed after a C-section and now fears she will be billed for more than 50 prescriptions requested during her pregnancy. This can add up to more than €500. Like Buller, the 29-year-old was diagnosed with gestational diabetes and ticked the pregnancy waiver box on her prescription forms, unaware that she needed a certificate. A year later, she found out she was never enrolled in it.
“I have received a letter saying I can expect to be charged and fined up to £100 for medicines collected in September,” she said. “The pharmacy has never mentioned a certificate. I’m already battling post-natal depression and reduced income, and I’m afraid I could be fined £100 for each of my prescriptions in the last 12 months at any time in the future.
Laura Hegarty was ordered to retroactively pay bills for medications dispensed during her complex pregnancy, despite a written admission from her obstetrician that she had forgotten to enroll her in an exemption certificate. “Reportedly, due to the law, common sense cannot prevail over a scribal error and all my prescriptions still had to be paid even though they accept that I was pregnant at the time,” she said.
The Business Services Authority’s remit is to crack down on prescription fraud but has been accused of penalizing patients who have acted in good faith. In 2019, a parliamentary select committee concluded that the criminal process is a “heavy-handed rush to judgement” on the part of the authority and accused the Department of Health and Social Care and the NHS of being “shockingly complacent” about patients being unfairly punished.
Related: Tory MPs express fear over free drug cuts in England for 60-65 year olds
The Business Services Authority claims it is crippled by government regulations that state waivers cannot be reversed by more than a month, even if a patient can prove her dates of pregnancy.
That’s what the health department said Observer it had no intention of dating exemption certificates by more than a month, even if the NHS’s mistake was to blame. It said: “NHS Business Services Authority is promoting pregnancy waiver certificates through various channels and there are clear guidelines for patients and healthcare providers to register for them.”
The General Pharmaceutical Council, which represents pharmacists, declined to comment.
Creasy said: “The law needs to change so that where women have a right and it’s clear they have, they don’t get fined because the NHS failed to give them their own exemption.”