BACKGROUND

PRESCRIPTION CHARGES AND THE COST OF PREPAYMENT CERTIFICATES

1. Regulations have been made and laid before Parliament providing for the following revisions:-

1.1 Prescription Charges: The prescription charge for drugs and appliances supplied on or after 1 April 1997 through the primary care services will be £5.65 per item. This charge will also apply to all items of elastic hosiery supplied, ie the charge for each elastic stocking will be £5.65 (£11.30 per pair).

1.2 Charges for Items Supplied by Hospitals to Out-Patients: The prescription charge for drugs and most appliances supplied to hospital out-patients will also be increased to £5.65 per item from 1 April 1997. It should be noted however that tights supplied only through the hospital service, will attract a charge of £11.30 per pair. Charges for fabric supports and wigs are listed at paragraph 4 below.

1.3 Prepayment Certificates: For all applications received by the Board on or after 1 April 1997 the charges for prepayment certificates will be as follows:-

Certificates valid for 4 months £29.30

Certificates valid for 12 months £80.50

2. Health Boards are asked to note that the new rates should be applied to all applications for prepayment certificates which are received by the Board on or after 1 April 1997. (No account may be taken of the backdating of the date of validity of the certificate before 1 April where the applicant has opted for this concession to allow for recovery of prescription charges paid within that period). The new rates should not be applied to certificates where application is received prior to 1 April 1997 regardless of the starting date of the certificate. Prepayment certificates should not be issued with starting dates more than 7 days earlier, or one month later, that the date on which the application is received. (ESC(P)34.1968 refers).

3. A prepayment certificate offers a saving to people who are not exempt from prescription charges and who need more than 5 prescribed items in a period of 4 months, or more than 14 items in a year. Pre-payment certificates also provide exemption from hospital out-patient charges for drugs and appliances (other than fabric supports and wigs) supplied through the hospital service.

CHARGES FOR FABRIC SUPPORTS AND WIGS

4. As from 1 April 1997 the charges for these items, supplied only through the hospital service, are as follows:-

        Surgical Brassiere £ 19.75

        Abdominal or Spinal Support £ 29.05

        Stock Modacrylic Wig £ 47.00

        Partial Human Hair Wig £123.00

        Full Bespoke Human Hair Wig £179.50

COLLECTION OF CHARGES IN HOSPITALS

5. Health Boards and NHS Trusts are asked to ensure that hospital authorities make adequate arrangements for collecting and bringing to account charges to be made in hospitals.

PUBLICITY ABOUT PRESCRIPTION CHARGES AND PREPAYMENT CERTIFICATES

6. A revised leaflet HC12 "Charges and Optical Voucher Values" is being prepared and will be issued in due course. Any remaining stocks of the HC12 effective from 1 December 1996 should be destroyed when the April 1997 version is received.

7. Leaflets HC11 and HC13 are being updated and will be issued in due course. Remaining stock of earlier versions should be destroyed when you receive the April 1997 version.

8. A large print version of HC11 will be available for order from April 1997. A supply of these leaflets is being sent direct to organisations for the visually handicapped.

9. An audio tape of HC11 is to be produced. A limited stock will be held in the stores in London. Availability of this audio tape is being notified direct to organisations for the visually handicapped.

10. A large print version of the claim form HC1 is to be printed. It will be held by the Health Benefits Division and issued to individuals in response to telephone requests: 0191- 203 5555.

11. A bulk supply of the revised publicity material will be sent to Health Boards for distribution to GPs, chemist contractors, general dental practitioners, opticians and ophthalmic medical practitioners. As boards know the usage of these forms in their area they should decide how many copies should be sent to each practitioner. Bulk supplies of the revised publicity material will also be sent to Trusts for use by the public and appliance suppliers.

12. Prepayment Certificates: A revised application form for the purchase of prepayment certificates (form EC95 (Rev April 1997) is being printed. Any remaining stocks of the forms showing April 1996 fees should be destroyed on receipt of the April 1997 revised version.

13. Revised form EC57 - Prescription Charge Receipt: Form EC57 is being revised and will be issued in an updated format. It will be issued without requisition and old stocks should be used up.

14. The reverse of prescription forms will shortly be revised to include a date of birth box for patients who are claiming remission from charges because they are receiving DSS benefits. Patients will be asked to complete the box on a voluntary basis. An explanation that any information given may be checked with DSS will also be added. There is no requirement on pharmacy contractors to seek this information.

15. The UK Health Departments have taken this opportunity to revise the layout of the back of the prescription form. Full details will be given in a forthcoming Circular.

16. The revised prescription form will be distributed as part of the normal ordering process and existing stock should be used up.

CHANGES TO THE NHS LOW INCOME SCHEME

17. Regulations will shortly be laid before Parliament to make some changes to the NHS Low Income Scheme (LIS). They will:-

17.1 introduce a short claim form (HC1(RC)) for people who live permanently in residential care or nursing homes and who receive some help with the cost from a Local Authority (but do not receive Income Support). This form will be available from the homes;

17.2 make clear that people who are entitled to less than 10p Income Support or Income-based Job Seeker's Allowance (and are therefore not paid the benefit) may make a LIS claim by writing to the Health Benefits Division, enclosing their Income Support or Income-based JSA award notice. They will be sent a certificate for full help for 6 months without the need to make a claim on form HC1;

17.3 provide for everyone aged 60 or over to have a higher pensioner premium included in their requirements. This may result in some people becoming entitled to full help, for example free NHS dental treatment or sight tests;

17.4 provide for anyone in a residential care home or nursing home who is entitled to LIS help with health costs to be sent a 12 months certificate.

 

REGULATIONS

18. Copies of the NHS (Charges for Drugs and Appliances) (Scotland) Amendment Regulations 1997 and the NHS (Travelling Expenses and Remission of Charges) Amendment Regulations 1997 which give effect to these changes will be sent to Health Boards in due course.

The Scottish Office Department of Health

St Andrew's House

Edinburgh
EH1 3DE

14 March 1997

File ref: PLN/3/40

Memorandum to MEL (1997) 11

General Medical Practitioners

Chemist Contractors

Appliance Suppliers

CHANGES TO THE NHS LOW INCOME SCHEME

1. This Memorandum advises doctors, chemist contractors and appliance suppliers of:-

the charges which will apply from 1 April 1997 for drugs and appliances supplied under the NHS (Charges for Drugs and Appliances) (Scotland) Amendment Regulations 1997;

availability of revised publicity material and forms;

changes to the NHS Low Income Scheme.

PRESCRIPTION CHARGES

2. Regulations have been laid before Parliament to increase prescription charges from 1 April 1997.

Item Charge

a. Elastic hosiery (except for tights) £5.65 (ie £11.30 per pair)

b. Each other appliance and each quantity of a drug (including oxygen cylinders) £5.65

The above charges will also be payable for items supplied by hospitals to out-patients. See paragraph 3, below for exemption and remission of these charges.

c. tights supplied through the hospital service £11.30 per pair

d. surgical brassiere £19.75

e. abdominal or spinal support £29.05

f. stock modacrylic wig £47.00

g. partial human hair wig £123.00

h. full bespoke human hair wig £179.50

The charges set out at 2d to h above apply where the consultation at which the supply of the item is authorised takes place on or after 1 April 1997. See paragraph 4, below for exemption and remission of these charges.

EXEMPTION AND REMISSION OF CHARGES

3. The standard NHS prescription charge applies to the items listed at 2a, b and c, above, unless a person is exempt or eligible for remission of prescription charges:

Exemption categories

i. a person who is under 16 years of age;

ii. a person who is under 19 years of age and is receiving full-time education;

iii. a person aged 60 or over;

iv. a woman with a valid exemption certificate issued by a Health Board because she is an expectant mother or has within the last 12 months given birth to a live child or a child registered as still-born under the Births, Deaths and Marriages (Scotland) Act 1965 as amended by the Still-birth (Definition) Act 1992;

v. a person with a valid exemption certificate issued by a Health Board on the grounds that he/she has one or more of the following conditions:

permanent fistula (including caecostomy, colostomy, laryngostomy or ileostomy) which requires continuous surgical dressing or requires an appliance;

epilepsy requiring continuous anti-convulsive therapy;

a continuing physical disability which prevents the patient leaving home without the help of another person (temporary disabilities do not count even if they last for several months);

diabetes mellitus except where treatment is by diet alone;

hypoparathyroidism;

diabetes insipidus or other form of hypopituitarism;

forms of hypoadrenalism (including Addison's disease) for which specific substitution therapy is essential;

myasthenia gravis;

myxoedema or other conditions where supplemental thyroid hormone is necessary

vi. a person receiving a War or MOD Disablement Pension holding a valid exemption certificate issued by the Secretary of State in respect of the supply of drugs and appliances for the treatment of the accepted disablement only.

Remission categories

vii. people and their partners receiving:

Income Support

Family Credit

Disability Working Allowance

Income Based Job Seeker's Allowance

viii. people aged 16 or over, and their partners, covered by a valid NHS Charges Certificate for full help (AG2/HC2) issued by the Health Benefits Division of the Prescription Pricing Authority.

4. NHS charges for wigs and fabric supports apply to the items listed 2d to h, above, unless a person is exempt or eligible for remission of charges:-

Exemption categories

i. a hospital in-patient at the time the wig or fabric support is supplied;

ii. a person who is under 16 years of age;

iii. a person who is under 19 years of age and is receiving full-time education;

iv. a person receiving a War or MOD Disablement Pension who needs a wig or fabric support because of a disability for which the War or MOD Pension is being paid.

v. people and their partners receiving:

Income Support

Family Credit

Disability Working Allowance

Income Based Job Seeker's Allowance

vi. people aged 16 or over, and their partners, covered by a valid NHS Charges Certificate for full help (AG2), issued by the Health Benefits Division of the Prescription Pricing Authority;

vii. people aged 16 or over with a valid NHS Charges Certificate for limited help (AG3/HC3), and their partners, may be entitled to partial charge remission.

APPLIANCES FOR WHICH AN NHS CHARGE IS PAYABLE

5. Health Boards and NHS Trusts are reminded that no charge may be made for any NHS appliance supplied to a hospital in-patient. NHS out-patients may be charged only for those appliances specified in the appropriate Regulations - ie wigs, abdominal and spinal supports, dentures and bridges, elastic hosiery and contact lenses, and for prescribed appliances etc which are listed in the Drug Tariff (and for contact lens fluid supplied as part of contact lens therapy). The revised NHS charges set out in this Memorandum will be payable, except in those cases where the patient is exempt or eligible for remission of charges.

HOSPITAL DAY SURGERY PATIENTS

6. Drugs administered to day surgery patients in hospitals are free of charge as are those drugs supplied until such time as the patient can attend their General Practitioner. Day surgery patients who get a prescription from a hospital doctor which is dispensed in the hospital pharmacy are liable for prescription charges (unless they are exempt or eligible for remission of charges).

COST OF PREPAYMENT CERTIFICATES

7. In respect of all applications received by Health Boards on or after 1 April 1997 the cost of prepayment certificates will be as follows:-

Certificates valid for 4 months - £29.30

Certificates valid for 12 months - £80.50

8. A certificate continues to offer a saving to people who are not exempt from prescription charges and who need more than 5 prescribed items in a period of 4 months, or more than 14 items in a year. Besides entitling the holder to claim exemption from prescription charges, a prepayment certificate also provides exemption from hospital out-patient charges for drugs and appliances (other than for fabric supports and wigs supplied through the hospital service).

CHEMIST CONTRACTORS AND APPLIANCE SUPPLIERS: SORTING OF PRESCRIPTION FORMS

9. In general, prescriptions written on or after 1 April 1997 including those dispensed by chemist contractors and appliance suppliers on prescription forms submitted to the Pharmacy Practice Division will be assumed to be at the increased rate. Where this is not the case (eg a referred-back prescription from a previous month) contractors are requested, in their own interest, to sort into bundles (and label accordingly) prescriptions on which the old charge had been collected.

DISPENSING DOCTORS

10. Dispensing doctors should collect prescription charges at the new rate from 1 April 1997 and remit them to Health Boards in the normal way.

PUBLICITY ABOUT PRESCRIPTION CHARGES AND PRE PAYMENT CERTIFICATES

11. A revised leaflet HC12 "Charges and Optical Voucher Values" is being prepared and will be issued in due course. Any remaining stocks of the HC12 effective from 1 December 1996 should be destroyed when the April 1997 version is received.

12. Leaflets HC11 and HC13 are being updated and will be issued in due course. Remaining stock of earlier versions should be destroyed when you receive the April 1997 version.

13. A large print version of HC11 will be available for order from April 1997. A supply of these leaflets is being sent direct to organisations for the visually handicapped.

14. An audio tape of HC11 is to be produced. A limited stock will be held in the stores in London. Availability of this audio tape is being notified direct to organisations for the visually handicapped.

15. A large print version of the claim form HC1 is to be printed. It will be held by the Health Benefits Division and issued to individuals in response to telephone requests: 0191- 203 5555.

16. If, after receiving a supply of the revised publicity material, you require further copies, please contact the relevant Health Board.

17. Prepayment Certificates: A revised application form for the purchase of prepayment certificates (form EC95 (Rev April 1997) is being printed. Any remaining stocks of the forms showing April 1996 fees should be destroyed on receipt of the April 1997 revised version.

18. Revised form EC57 - Prescription Charge Receipt: Form EC57 is being revised and will be issued in an updated format. It will be issued without requisition and old stocks should be used up.

REVISED PRESCRIPTION FORMS

19. The reverse of prescription forms will shortly be revised to include a date of birth box for patients who are claiming remission from charges because they are receiving DSS benefits. Patients will be asked to complete the box on a voluntary basis. An explanation that any information given may be checked with DSS will also be added. There is no requirement on pharmacy contractors to seek this information.

20. The UK Health Departments have taken this opportunity to revise the layout of the back of the prescription form. Full details will be given in a forthcoming Circular.

21. The revised prescription form will be distributed as part of the normal ordering process and existing stock should be used up.

CHANGES TO THE NHS LOW INCOME SCHEME

22. Regulations will shortly be laid before Parliament to make some changes to the NHS Low Income Scheme (LIS). They will:-

22.1 introduce a short claim form (HC1(RC) for people who live permanently in residential care or nursing homes and who receive some help with the cost from a Local Authority (but do not receive Income Support). This form will be available from the homes;

22.2 make clear that people who are entitled to less than 10p Income Support or Income-based Job Seeker's Allowance (and are therefore not paid the benefit) may make a LIS claim by writing to the Health Benefits Division, enclosing their Income Support or Income-based JSA award notice. They will be sent a certificate for full help for 6 months without the need to make a claim on form HC1;

22.3 provide for everyone aged 60 or over to have a higher pensioner premium included in their requirements. This may result in some people becoming entitled to full help, for example free NHS dental treatment or sight tests;

22.4 provide for anyone in a residential care home or nursing home who is entitled to LIS help with health costs to be sent a 12 months certificate.

23. Any questions arising from this Memorandum should be addressed to the relevant Health Board.

THE SCOTTISH OFFICE DEPARTMENT OF HEALTH

St Andrew's House

Edinburgh

EH1 3DE

14 March 1997

File ref: PLN/3/40