Medical Exemption Certificate

[health2015]

Hi All

I have had to renew my medical exemption form which I did and handed it in to the surgery.

I received a letter from doctor at the surgery, to say that he is unable to sign as they have not prescribed levothyroxine since April 2016.

Can they do that?

At the end of the day I still have an underactive thyroid whether I am treating myself or getting treatment from the doctor.

[Clutter]

Health2015,

As far as I'm aware it is the condition not a prescription for Levothyroxine which determines your entitlement to a medical exemption card. Does your practice know you are self medicating and does your practice continue to monitor your blood tests?

[health2015 in reply to Clutter]

Hi Clutter

Thanks for getting back to me.

I have made 3 doctors in the practice aware that I am treating myself with NDT, and was told when I asked if they could prescribe it for me, NO. I am still monitored, and should be having blood tests in the next 3/4 months.

Health2015

[Clutter in reply to health2015]

Health2015,

Then you are entitled to a med ex cert. and the GP is wrong not to sign. I'd have a word with the practice manager and get another doctor to sign it off.

[Hillwoman]

I've had a few problems with med ex forms in the past. Remind the GP or the surgery's manager that the exemption goes with the condition. Whether your GP prescribes your thyroid medication is not relevant. If you've received a formal diagnosis, the GP must sign your application form.

[helvella Administrator in reply to Hillwoman]

Absolutely, Hillwoman, as well you know, the ONLY requirement is to require medication with thyroid hormone due to myxoedema.

Also, health2015, make sure you get the right receipt if you have to pay for anything while this is sorted out.

Refunds of prescription charges

If you need to pay prescription charges before your medical exemption certificate arrives, you can get a refund as long as:

you ask for an FP57 refund receipt when you pay (you can’t get one later)

the start date of your medical exemption certificate is the same or earlier than the date you pay for your prescription (certificates are backdated one month from the date that we receive your application - they can’t be backdated any further)

You must claim your refund within three months of paying.

The FP57 refund receipt tells you what to do.

nhsbsa.nhs.uk/exemption-cer...

[health2015]

Hi Guys

Thanks for your comments.

I have been to see the doctor, and he is not budging on the form signature. I explained that the exemption was for my condition not prescriptions, he said again that they would not sign the form because I am not taking a hormone replacement I am not entitled to the exemption. I told him I was taking NDT which is hormone replacement, but he did not want to know. I asked him why this was not mentioned to me when I had explained to other doctors that I was taking NDT they did not tell me I would lose the exemption. He said it's the same for people with diabetes, they would lose their exemption if they did not get medication from NHS.

The doctor did say that if I decide to give Levothyroxine another go I would get my entitlement then.

I don't know where to go to.

Health2015

[Hillwoman in reply to health2015]

Your GP is absolutely wrong. Medex is dependant on condition, not on type of medication. I cannot urge strongly enough that you get in touch with anyone you can and complain to them: NHSBSA, CCG, PALS, MP. As your practice seems to be doing the same thing to other groups of patients it might even be worth threatening an expose in the local rag!

[health2015 in reply to Hillwoman]

Hi Hillwoman

I have emailed PALS and NHSBSA to explain what has happened, awaiting their reply.

Since I started taking NDT my overall health is good, I haven't been to the doctor for 6 months, (I was always there when I was on levothyroxine), I have saved them money by not getting a prescription from them.and I am able to hold down a 40 hour a week job, you would think that would count for something.

Thank you for the advice

health2015

[Hillwoman in reply to health2015]

Best of luck! PALS ought to intervene with your GP in these circumstances.

[health2015 in reply to Hillwoman]

Hi Hillwoman

Thanks you so much for the info, I am going to print it off and send it to the manager of my surgery.

I emailed PALS yesterday and they could not comment and have suggested I get in touch with NHS England which I have done this morning by email.

health2015

[helvella Administrator in reply to health2015]

The legal statement is here:

Exemptions: general

10.—(1) Subject to paragraph (4), no charge is payable under regulations 3, 4, 5, 7 or 8 by a person who—

(a)is under 16 years of age;

(b)is under 19 years of age and is receiving qualifying full-time education within the meaning of section 173(2) and (3) of the 2006 Act (exemptions from general charging);

(c)is 60 years of age or older;

(d)has a valid exemption certificate on the grounds that they—

(i)are expecting a child, or

(ii)have within the last twelve months given birth to a child (including a child whose death was registrable under the special provisions as to the registration of still-births in the Births and Deaths Registration Act 1953(1)),

or has a valid exemption certificate issued under equivalent arrangements (to regulation 15) having effect in Scotland, Wales or Northern Ireland;

(e)has a valid exemption certificate on the grounds that they are suffering from one or more of the following conditions—

(i)permanent fistula (including caecostomy, colostomy, laryngostomy or ileostomy) requiring continuous surgical dressing or an appliance,

(ii)the following disorders—

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

diabetes insipidus and other forms of hypopituitarism,

diabetes mellitus – except where treatment is by diet alone,

hypoparathyroidism,

myasthenia gravis, or

myxoedema,

(iii)epilepsy requiring continuous anti-convulsive therapy, or

(iv)a continuing physical disability which prevents the person from leaving the person’s residence without the help of another person;

(f)has a valid exemption certificate on the grounds that the person is undergoing treatment for—

(i)cancer,

(ii)the effects of cancer, or

(iii)the effects of cancer treatment;

(g)has a valid exemption certificate issued on any of the grounds in sub-paragraph (e) or (f) under equivalent arrangements which have effect in Scotland, Wales or Northern Ireland;

(h)has a valid exemption certificate in respect of the supply of drugs and appliances for the treatment of accepted disablement, but in either case only in respect of those supplies to which the certificate relates; or

(i)has a valid pre-payment certificate granted under regulation 16 or a valid pre-payment certificate granted under equivalent arrangements (to regulation 16) having effect in Scotland, Wales or Northern Ireland.

(2) No charge is payable under these Regulations in respect of the supply of any drug for the treatment of a sexually transmitted disease within the meaning of section 173(1)(b) of the 2006 Act(2).

(3) Subject to paragraph (4), no charge is payable under regulation 6 or 9—

(a)by a person of a description specified in paragraph (1)(h) in respect of the supply of an item specified in column (1) of Schedule 1; or

(b)by a person of any description specified in paragraph (1) in respect of the supply of an appliance not specified in column (1) of Schedule 1, or of tights or of drugs.

(4) Subject to paragraph (5), a person who wishes to claim entitlement to exemption by virtue of paragraph (1) or (3) must provide any declaration of entitlement required under regulation 3(5) or 4(3), or any declaration and evidence of entitlement required under regulation 5(3), 6(4), 7(4), 8(3) or 9(3).

(5) A person of a description specified in paragraph (1)(a) or (c) is not required to provide any declaration of entitlement required under regulations 3(5) and 4(3) where—

(a)an electronic prescription form or an electronic repeatable prescription is created and the person’s date of birth is recorded on the person’s PDS patient details and is set out on the electronic prescription form or electronic repeatable prescription; or

(b)a non-electronic prescription form or a non-electronic repeatable prescription is issued and the person’s date of birth is printed by means of a computer on the non-electronic prescription form or non-electronic repeatable prescription.

(6) A charge referred to in column (2) of Schedule (1) must, in the case of a person referred to in regulation 6 of the Travel Expenses and Remission of Charges Regulations(3) (entitlement to partial remission and payment), be remitted to the extent specified in that regulation.

(7) Where a charge is remitted in part under paragraph (6), the person making the part payment must, on doing so, sign a declaration in writing that the relevant part of the charge has been paid, complete a declaration of entitlement and provide such other evidence of entitlement to partial remission as may be required by the person supplying the drug or appliance.

(8) An exemption by reference to age or the validity of an exemption certificate must be determined by reference to the age or validity on the day on which—

(a)in the case of pharmaceutical services or local pharmaceutical services provided by a chemist, the order for drugs or appliances is presented for dispensing; and

(b)in any other case, the drugs or appliances are supplied.

(9) Where a claim to an exemption has been made but is not substantiated, and in consequence of the claim a charge has not been recovered, if—

(a)the drugs or appliances were supplied by a chemist as mentioned in regulation 3 or by a doctor as mentioned in regulation 4, then the Board must recover that charge from the person concerned;

(b)the drugs or appliances were supplied by an NHS trust or an NHS foundation trust as mentioned in regulation 6, then that NHS trust or NHS foundation trust must recover that charge from the person concerned; or

(c)the drugs or appliances were supplied as mentioned in regulations 5, 7, 8 or 9, then the body which made the arrangements for the provision of NHS services with the person or body that supplied the drugs or appliances must recover that charge from the person concerned.

legislation.gov.uk/uksi/201...

Anyone who can read that there is NO requirement for the NHS to be the suppliers of any medicine.

Further:

The GP is required to sign the form and send it off to the Pricing Authority who will issue the certificate.

psnc.org.uk/dispensing-supp...

No ifs, buts or maybes. An ABSOLUTE requirement on the GP.

[health2015 in reply to helvella]

Hi Helvella

Thanks for the info. I am printing it off and sending to the manager of the surgery.

I have also contacted NHS England, and awaiting their reply.

Many thanks

health2015

[Hillwoman in reply to health2015]

The information Helvella has provided is crystal clear and it is largely the same text I relied on to sort out a similar problem I had a few years ago.

I would try your CCG as well, because you are likely to get a much quicker decision from them than from NHS England.

PALS have a duty to intervene on your behalf in these circumstances, so I would ask for the name of the head honcho and complain that you are not receiving the service to which you are entitled - either from your GP or from PALS!

[silverfox7]

I started on NDT over thirty years ago now and couldn't claim unless I went back on Levo. I heard many yearslatter it have been changed but I'm wondering if gthecorignal info has been passed down in the practice and never been updated.

[helvella Administrator in reply to silverfox7]

You know the hackneyed old phrase: Ignorance of the law is no excuse?

[Clare0116]

This is appalling patient treatment! The reason you need a Dr is you having a life-threatening myxoedema condition without prescription meds, available at every other GP surgery. If he refuses to prescribe it, he is negligent in his duty and can be reported to the General Medical Council. As the synthetic hormone costs just pennies and is widely prescribed FREE to ALL hypothyroids, his petty "jobs worth" attitude endangering his medical career, is baffling!