The Practice filled in her exemption form without an appointment to discuss it with her first
19. Miss K complains that the Practice filled out her medical exemption form without any discussion with her about how her medical conditions affect her before it did so.
20. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications that something has gone wrong.
21. Miss K told us that in early March 2025 she attended the Practice to ask it to send off a new prescription exemption form for her. Prescription exemptions allow eligible people to receive free NHS prescriptions. The decision to offer someone a prescription exemption is based on specific medical conditions, disabilities, or financial circumstances. Miss K told us that she had had a prescription exemption for the last five years.
22. Miss K explained that she feels that the Practice should have made an appointment with her to discuss why she needed a prescription exemption before it filled the form in. She told us that it did not, and therefore the form was initially rejected, and she was unable to receive her exemption certificate.
23. Miss K told us that as a result of this, there was a delay in her receiving her prescriptions, as she could not afford to pay for them herself. This meant she was without her prescribed pain and sleep medication for a period of three weeks.
24. In its complaint response on 31 March 2025 the Practice explained to Miss K that it was unable to sign off her medical exemption form initially as it ‘did not find records of any physical disability that meant that you were unable to go out without the help of another person as per the NHS guidance criteria’.
25. It also explained to Miss K in this response that there are ‘other criteria’s for qualifying for prescription payment exemption including being on universal credit and or other benefits which you may be eligible for at that time.’
26. Our adviser explained to us that on the exemption form there is a long list of different medical conditions such as diabetes, epilepsy, and other similar chronic health conditions. There is also a category which says about a person not being able to go out without the assistance of another person.
27. Our adviser said it is not immediately clear in Miss K’s medical records what her disability was, as although she has polio, this is not specifically listed as one of the chronic illnesses on the exemption form. Her medical records also do not mention her care needs.
28. Our adviser explained that in this instance, it would be correct for the Practice not to sign off Miss K’s exemption form, as it did not have enough information available to it from her medical records about how Miss K’s polio affects her.
29. The GMC guidance explains that clinicians should not ‘rely on assumptions about the treatment options a patient will prefer or the factors they will consider significant’. In line with this the clinician did not make any assumptions about Miss K’s disabilities and how they affect her when filling in the form.
30. We asked our adviser if the Practice should have booked an appointment with Miss K to discuss how her disabilities affect her before it filled the form in. Our adviser explained that there is no specific requirement in any guidance or legislation that says that if it is unclear in a patient’s medical records how their disability effects them that you have to discuss this with them before you look to fill the exemption form in.
31. When Miss K’s form was rejected on 10 March 2025, it contacted her on the same day and explained that the form was rejected and offered her the next available appointment with a GP on 17 March 2025 to discuss this further.
32. The GMC guidance explains that clinicians need to give patients the information they want or need in a way they can understand. It also says that you should be willing to explain your reasons for the options you offer.
33. In line with the GMC guidance the Practice promptly and clearly communicated its decision to not approve the prescription exemption form with Miss K on the same day. It also offered Miss K an appointment to discuss its reasoning for doing so, and her options should she disagree with the decision, with a GP.
34. We therefore consider that in line with the GMC guidance, the Practice filled in Miss K’s medical exemption form with the information it had available from her medical records and offered her an appointment to discuss this further as soon as it was able to. As such, we have seen no indications of failings in this aspect of the complaint.
35. We appreciate it would have been frustrating for Miss K for her initial medical exemption form to be rejected. We were sorry to hear that this led to a delay in her receiving her prescriptions and understand that this will have been distressing for her.
The Practice did not send the second exemption form when it said it would
36. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications that something has gone wrong.
37. Miss K told us that after her appointment with the Practice on 17 March 2025 to discuss how her disability affected her it asked her to bring in a new exemption form. Miss K explained that she did so shortly after her appointment.
38. Miss K explained that on 31 March 2025 she called the Practice to chase her exemption certificate. Miss K says that she was told that there was no new form sent out and it reiterated that her previous form had been rejected.
39. In its complaint response the Practice explained that the receptionist mistakenly told Miss K that the second form had not been sent out. It clarified that the second form had been sent. The receptionist apologised to Miss K for her error.
40. Whilst it is not clear from the medical records when the form was sent, the Practice have provided us with evidence of communications between staff which show a discussion took place about Miss K’s exemption form and it was confirmed that the form had been sent out by the end of March.
41. Our Principles say public bodies should do what they say they are going to do. If they make a commitment to do something, they should keep to it. They also say public bodies should behave helpfully, dealing with people promptly, within reasonable timescales.
42. It is not clear exactly when Miss K brought her new form in, and then when the Practice sent this off, but we can see from the information provided by the Practice that this had been done by 27 March.
43. Even if Miss K had brought her new form in the day after her appointment, the maximum time it took the Practice to send the form was just over a week. As such, we do not consider that there was an unreasonable delay in the Practice sending the form. We consider the Practice acted in line with Our Principles and reviewed and sent out the exemption form as it said it would, and did this within a reasonable timescale.
44. We acknowledge that it will have been distressing for Miss K to be without her prescription exemption form. After consideration, we have found that the Practice did send off her second exemption form and did this in a timely manner.
45. We would like to thank Miss K for taking the time to bring this complaint to us and wish her the best with any ongoing healthcare.