NHS HDL(2004)17 abcdefghijklm. revised Health Service charges to take effect from 1 April 2004;

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1 NHS HDL(2004)17 abcdefghijklm Health Department Primary Care Division St Andrew's House Directorate of Service Policy and Planning Regent Road EDINBURGH EH1 3DG Dear Colleague 1. THE NATIONAL HEALTH SERVICE, CHARGES FOR DRUGS AND APPLIANCES FROM 1 APRIL THE NATIONAL HEALTH SERVICE (TRAVELLING EXPENSES AND REMISSION OF CHARGES) (SCOTLAND) (AMENDMENT) REGULATIONS 2004 Summary 1. This letter advises NHS Boards and Trusts of: revised Health Service charges to take effect from 1 April 2004; revised publicity material and forms. 2. Amendments to the National Health Service (Travelling Expenses and Remission of Charges) (Scotland) (No2) Regulations 2003 are contained in the attached Annex. Action 3. NHS Boards and Trusts are asked to bring the Memorandum to this letter as quickly as possible to the attention of all staff involved in dealing with matters relating to prescription charges and refunds, pre-payment certificates, elastic hosiery, fabric supports and wigs. 4. The exemption and remission of charges categories are given in the Appendix to the attached Memorandum. Bulk supplies of the Memorandum are being sent under separate cover. 5. Note amendments to the NHS (Travelling Expenses and Remission of Charges) (Scotland) (No2) Regulations Yours sincerely 31 st March 2004 Addresses For action Chief Executive, NHS Boards Chief Executives, NHS Trusts Chief Executive, Common Services Agency For information: Chief Executive, State Hospital Board for Scotland Chief Executive, NHS Health Scotland Chief Exective, NHS 24 Executive Director, NHS Education Chief Executive, NHS Quality Improvement Directors of Primary Care Enquiries to: Mrs Maureen McFarlane Primary Care Division 1 st Floor-East Rear St Andrew's House EDINBURGH EH1 3DG Tel: Fax: maureen.mcfarlane@scotland.gsi.gov.uk DR HAMISH WILSON Head of Primary Care Division abcde abc a 1. AMI02003

2 ANNEX 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 2004 through the primary care services will be 6.40 per item. This charge will also apply to all items of elastic hosiery supplied, ie the charge for each elastic stocking will be 6.40 ( 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 6.40 per item from 1 April It should be noted however that support tights, which are supplied only through the hospital service, will attract a charge of per pair. Charges for fabric supports and wigs are listed at paragraph 4 below. NB Pre-payment certificates cover hospital out-patient charges for drugs and appliances (other than fabric supports and wigs) supplied through the hospital service. 1.3 Pre-Payment Certificates: For all applications received on or after 1 April 2004 the charges for pre-payment certificates will be as follows:- Certificates valid for 4 months Certificates valid for 12 months The new rates will apply to all applications for pre-payment certificates which are received by community pharmacists, dispensing doctors or Practitioner Services Division on or after 1 April The new rates will apply even where the start date of the certificate is backdated to before 1 April to allow for recovery of prescription charges already paid. The new rates should not be applied to certificates where application is received prior to 1 April 2004, regardless of the starting date of the certificate. Pre-payment certificates should not be issued with starting dates more than 7 days earlier, or one month later, than the date on which the application is received. abcde abc a 2. AMI02003

3 3. As you are aware from 1 April 2002 community pharmacists and dispensing doctors have been able to supply Prescription Pre-Payment Certificates (PPCs) over the counter. Both hold refund application forms. Patients are being encouraged to obtain their PPCs from contractors wherever possible. However, in the meantime, PPCs will continue to be available from the CSA. Responsibility for issuing reminder letters and duplicate PPCs, as well as processing PPC refund applications will remain with the CSA Practitioner Services Divisions. The arrangements for this scheme are set out in Circular HDL(2002)14. CHARGES FOR FABRIC SUPPORTS AND WIGS 4. As from 1 April 2004 the charges for these items, which are supplied only through the hospital service, are as follows:- Surgical Brassiere Abdominal or Spinal Support Stock Modacrylic Wig Partial Human Hair Wig Full Bespoke Human Hair Wig COLLECTION OF CHARGES IN HOSPITALS 5. NHS Boards and Trusts are asked to ensure that hospital authorities make arrangements for collecting and bringing to account charges made in hospitals. PUBLICITY ABOUT PRESCRIPTION CHARGES AND PREPAYMENT CERTIFICATES 6. A bulk supply of revised publicity material will be sent to NHS Boards/Trusts for distribution to GPs, pharmacy contractors, appliance suppliers, general dental practitioners, opticians and ophthalmic medical practitioners. 7. Leaflets HC11/HC11(LP) patients' leaflets are being updated and will be issued in due course. Remaining stock of earlier versions should be destroyed when you receive the 1 April 2004 version. 8. Leaflet HC12 "Charges and Optical Voucher Values" is being updated to include revised figures from 1 April 2004 and will be issued in due course. Any remaining stocks of the HC12 effective from 1 April 2003 should be destroyed after 31 March The April 2004 version will be issued as soon as it is available. PRESCRIPTIONS FROM WALES 9. As you are aware since 1 April 2001 there have been some differences between Wales and the rest of the UK in respect of prescription charges and exemption from charges. In Wales the level of charge remains 6.00 reducing to 5.00 with effect from 1 October 2004 and every person under the age of 25 receives free prescriptions. However, prescriptions written in Wales (or in respect of patients who live in Wales) which are presented for dispensing in Scotland must be charged at the rates which apply in Scotland. abcde abc a 3. AMI02003

4 This means that from 1 April 2004, the prescription charge per item for prescriptions written in Wales (or in respect of persons who live in Wales) will be 6.40, where the prescription is dispensed in Scotland. The National Health Service (Travelling Expenses and Remission of Charges) (Scotland) (Amendment) Regulations The NHS (Travelling Expenses and Remission of Charges) (Scotland) (No2) Regulations 2003 have been amended to extend the eligibility categories of persons entitled to full remission of charges for drugs, medicines, appliances, pharmaceutical services and the payment of travelling expenses to include people, and their families, in receipt of working tax credit with a severe disability element; amend relevant income levels of people at the time an award of a tax credit is made from 14,200 to 14,600, in accordance with changes in Inland Revenue assessment rules. 11. In addition it enables travelling expenses to be paid to patients receiving community dental service treatment at a hospital by removing the rule that expenses can only be paid in respect of services provided under the care of a hospital consultant. 12. It also responds to points raised by the Subordinate Legislation Committee recommendation when the 2003 Regulations were considered, adds a definition of severe disability and transfers the definition of child to the interpretation section. 13. Copies of the NHS (Charges for Drugs and Applainces) (Scotland) Amendment Regulations 2004 and the NHS (Travelling Expenses and Remission of Charges) (Scotland) Amendment Regulations 2004 will be sent to NHS Boards/Trusts in due course. SCOTTISH EXECUTIVE HEALTH DEPARTMENT St Andrew's House EDINBURGH EH1 3DG March 2004 File ref: NIP/6/ abcde abc a 4. AMI02003

5 Memorandum to HDL (2004) General Medical Practitioners Pharmacy Contractors Appliance Suppliers NATIONAL HEALTH SERVICE CHARGES FOR DRUGS, APPLIANCES, WIGS AND FABRIC SUPPORTS AND THE COST OF PRE-PAYMENT CERTIFICATES FROM 1 APRIL This Memorandum advises doctors, pharmacy contractors and appliance suppliers of:- the charges which will apply from 1 April 2004 for drugs and appliances supplied under the NHS (Charges for Drugs and Appliances) (Scotland) Amendment Regulations 2004; availability of revised publicity material and forms. PRESCRIPTION CHARGES 2. Regulations have been laid before Parliament to increase prescription charges from 1 April 2004 as follows:- Item Charge a. Each prescription item, i.e. each appliance and each quantity of a drug (including oxygen cylinders), 6.40 except b. Elastic hosiery, including stockings (excluding tights) 6.40 each (i.e per pair) c. Tights supplied through the hospital service per pair d. Surgical brassiere e. Abdominal or spinal support f. Stock modacrylic wig g. Partial human hair wig h. Full bespoke human hair wig Item charges a. and b. above will also be payable for items supplied via hospital pharmacies to out-patients. Item charges at c. to h. above apply where the consultation at which the supply of the item is authorised takes place on or after 1 April abcde abc a 1. AMI02003

6 CHARGES IN RESPECT OF HOSPITAL-BASED SERVICES In-patients 3. No charge may be made for any NHS appliance supplied to a hospital in-patient. Out-patients 4. Out-patients may be charged only for those appliances specified in the appropriate Regulations i.e. 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. Day Surgery Patients 5. 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). PRE-PAYMENT CERTIFICATES (PPCs) 6. Pre-payment certificates offer a saving to people who need more than 5 prescribed items in a period of 4 months, or more than 14 items in a year and who are not exempt from prescription charges. A PPC is also valid for hospital out-patient charges for drugs and appliances (but not for fabric supports and wigs supplied through the hospital service). 7. The cost of all PPCs supplied in response to applications received on or after 1 April 2004 will be as follows:- Certificates valid for 4 months Certificates valid for 12 months The new rates will apply to all applications for pre-payment certificates which are received by community pharmacists, dispensing doctors or Practitioner Services Division on or after 1 April The new rates will apply even where the start date of the certificate is backdated to before 1 April to allow for recovery of prescription charges already paid. The new rates should not be applied to certificates where application is received prior to 1 April 2004, regardless of the starting date of the certificate. Pre-payment certificates should not be issued with starting dates more than 7 days earlier, or one month later, than the date on which the application is received. abcde abc a 2. AMI02003

7 9. Over the Counter Sale of PPCs From 1 April 2002 community pharmacists and dispensing doctors have been able to supply Prescription Pre-Payment Certificates (PPCs) over the counter. They also hold refund application forms. In the meantime PPCs will continue to be available to patients via the CSA, but patients will be encouraged to obtain their PPCs from contractors wherever possible. The arrangements for this scheme are set out in Circular HDL(2002) Responsibility for issuing reminder letters and duplicate PPCs, as well as processing PPC refund applications will remain with the CSA Practitioner Services Divisions. COMMUNITY PHARMACISTS AND APPLIANCE SUPPLIERS: SORTING OF PRESCRIPTION FORMS 11. In general, prescriptions written on or after 1 April 2004 will be assumed to attract the increased charge. 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 has been collected. DISPENSING DOCTORS 12. Dispensing doctors should collect prescription charges at the new rate from 1 April 2004 and remit them to NHS Boards/Trusts in the normal way. PUBLICITY ABOUT PRESCRIPTION CHARGES AND PREPAYMENT CERTIFICATES 13. Leaflet HC11/HC11(LP): Patients' leaflets are being updated and will be issued as soon as possible. Remaining stocks of earlier versions should be destroyed when you receive the April 2004 version. 14. A revised leaflet HC12: "Charges and Optical Voucher Values" is being updated to include revised figures from 1 April 2004 and will be issued as soon as possible. Any remaining stocks of the HC12 effective from 1 April 2003 should be destroyed after 31 March The April 2004 version will be issued as soon as possible. 15. Any questions arising from this Memorandum should be addressed to the relevant NHS Board/Trust. SCOTTISH EXECUTIVE HEALTH DEPARTMENT St Andrew's House EDINBURGH EH1 3DG March 2004 File ref: NIP/6/ abcde abc a 3. AMI02003

8 APPENDIX NHS HEALTH CHARGES: EXEMPTION AND REMISSION CATEGORIES The categories of exemption and remission from prescription charges are set out below. The patient doesn t have to pay because he/she: is under 16 years old; is 16, 17 or 18 and in full-time education; is 60 years of age or over; has a valid maternity or medical exemption certificate (EC92); has a valid War Pension exemption certificate; has a valid prescription pre-payment certificate; gets, or has a partner who gets Income Support; has a partner who gets Pension Credit guarantee credit (PCGC); gets, or has a partner who gets income based Jobseeker s Allowance; is entitled to¹, or named on a valid NHS Tax Credit Exemption Certificate; is named on a current HC2 charges certificate. ¹ The certificate entitles the patient, their partner (if they have one) and any children named on the letter accompanying the certificate. abcde abc a 4. AMI02003