‘We’re not trying to cheat the system, we need medication to survive’

“Diabetes is a lifelong condition that causes a person’s blood sugar level to become too high” – NHS Choices.

Yes, diabetes is a lifelong condition, the NHS clearly states that message. Healthcare professionals break that jaw-dropping news to us and our families when we are diagnosed, we read about it in the papers, it stays in our minds with every injection, cannula change and finger-prick test we do, and we have no way of getting away from this incurable condition that we live with day in and day out.

It came as a shock to me recently to see the Diabetes Online Community (DOC) sharing letters they had been sent by the NHS Business Service Authority, issuing them with fines for incorrectly claiming that they do not need to pay for prescriptions. Fines including a prescription charge and a penalty charge. Exploring further, I discovered a PDF explaining the charge, detailing the penalties and possible prosecutions. However, this didn’t help me to understand why people with diabetes might be fined. So, being nosey, I looked into a few online conversations and found a few possible reasons:

• Their card had expired
• They had never been issued a card or informed of the need for one after their diagnosis
• The expiry rules had not been provided/explained to them
• Their card had not been asked for when collecting prescriptions (while a card was valid and also when it had expired)
• A relative had collected the prescription not knowing that the card had expired
• Their pharmacist accepted an out-of-date card until a new one arrives
• Their renewal reminder had been sent to the wrong address
• Their renewal forms had not been checked and sent off by their GP (although this is an option, reminders do come with a pre-paid envelope with a return address)

As you can see, from some of the cases above, a person could inadvertently be breaching the rules of collecting a free prescription with a valid card and not realise it. If a person hasn’t been issued a card upon diagnosis would they think to question that? How would they know that they need one if they are being provided with free prescriptions for years after their diagnosis? If a card is not viewed (valid or not) when collecting a prescription is it the responsibility of the patient or the healthcare professional to ensure that happens?

I personally haven’t always been supplied a card, often being told: “We know you, you don’t need to show us your card”. If this process of not being required to provide my card became the norm, would a renewal seem necessary? This is possibly due to the fact that nine out of ten times I’m collecting diabetes supplies which tells the person providing it that I have a lifelong condition and I will always require medication.

I was issued my card when I was diagnosed at 16 (though I should have been receiving free prescriptions at that age without the card). However, rather than the expiry being explained to me I needed to enquire about it myself. I found it very strange that my card would expire when my diabetes wouldn’t.

People with diabetes are not purposely claiming free prescriptions because they want to cheat the system, we do it because we need our medication to survive

In fairness to the NHS they do print the expiry date on the front of the card and provide information explaining that prescriptions can only be issued for free if the card is in date (see their website). More conversations online show that some of the fines are being overturned if you can provide a reason for why you have collected a free prescription without a card, others have been turned down and told that they will face a further fine if they refuse to pay. It would appear that despite still having diabetes, if your card has expired, this is not a lawful reason to collect a free prescription.

It’s difficult to know which way to turn with this article. As I say, the NHS does print the expiry date on the card and does inform most patients of the five-year renewal, but perhaps this is what needs to change. People with diabetes are not purposely claiming free prescriptions because they want to cheat the system, we do it because we need our medication to survive. People with diabetes do not have a date attached to their condition in which it will expire, sadly we have diabetes for life. I think this is where many people’s frustrations lie at the moment and I think this needs to be addressed by ‘the powers that be’.

If the NHS Business Service Authority does deem it necessary to continue with their 5 year renewal process can I make a suggestion to them? Make communication to your patients seamless; ensure that they are aware that they need a medical exemption card, provide them with information about how they obtain this for the first time and why a renewal is necessary, make it clear to us that we need to inform you (not just out GP) of a change in address, ensure that a consistent system is used by healthcare professionals when checking our cards. As suggested on Twitter, even a poster or leaflet in a GP waiting room or in a pharmacy could raise awareness about this issue.

The cost of prescriptions is glaringly obvious when I walk into my pharmacy with a poster on the desk, can the same be done for medical exemption? An expiry date may seem straight forward to those who decide the rules but to those who are in it for life, it may not be as obvious.

If you have been issued with a fine then please contact Jamie Reed MP who has asked for your stories.

You can also sign an online petition started by Gavin Griffiths who is campaigning for lifelong medical exemption cards for people with diabetes that is not diet controlled by clicking here.