NHS penalty charge notice: the £100 cap, the 28-day window and how to challenge
If the NHSBSA cannot confirm you were entitled to a free prescription or dental treatment, it issues a penalty charge of five times the amount owed, capped at £100, plus the original charge. You have 28 days from the notice to pay or challenge. Miss it and a surcharge of 50% of the penalty, up to £50, is added. Checking your exemption before ticking the box avoids the whole process.
- Penalty formula
- 5 times the charge owed
- Penalty cap
- £100
- Plus
- The original charge
- Time to pay or challenge
- 28 days from the notice
- Late surcharge
- 50% of the penalty, up to £50
- Example, one item
- £9.90 charge plus £49.50 penalty
What a penalty charge notice is
A penalty charge notice (PCN) is a civil fine issued by the NHS Business Services Authority (NHSBSA) when someone claims free or reduced-cost NHS prescriptions or dental treatment in England and the NHSBSA cannot confirm they were entitled. It is not a criminal matter. Leaflet HC11 describes it as a penalty of five times the amount you should have paid, capped at £100, charged on top of the original amount.
The NHSBSA knowledge base describes the process for prescriptions and dental treatment, the two charges it checks in this way.
How the amount is worked out
The penalty is five times the charge you avoided, up to £100. The original charge is added back. The HC12 quick guide gives its own example: two free items at £9.90 each means £19.80 owed, a £99 penalty, and £118.80 to pay.
| Items claimed free | Charge owed | Penalty (5 times, max £100) | Total to pay |
|---|---|---|---|
| 1 prescription item | £9.90 | £49.50 | £59.40 |
| 2 prescription items | £19.80 | £99.00 | £118.80 |
| 3 prescription items | £29.70 | £100.00 | £129.70 |
| Band 1 dental course | £27.90 | £100.00 | £127.90 |
| Band 3 dental course | £332.10 | £100.00 | £432.10 |
If the PCN is not paid within 28 days, the NHSBSA adds a surcharge of 50% of the penalty, up to a maximum of £50. A two-item case becomes £168.30.
The sequence of letters
The NHSBSA does not send a penalty first. The knowledge base describes two stages.
- Enquiry letter. The NHSBSA writes saying it was unable to confirm your entitlement for a claim on a given date and asks you to respond with evidence or pay the charge. You have 28 days from the date the letter was issued.
- Penalty charge notice. If there is no response within those 28 days, the PCN goes out, asking for the original charge plus the penalty. You then have 28 days from the PCN date to pay in full, set up a Direct Debit, or challenge.
- Surcharge. After the second 28 days passes with no payment or challenge, the 50% surcharge, capped at £50, is added.
Answering the enquiry letter is the cheapest moment to act. Evidence at that stage closes the file with nothing to pay.
How to challenge
The notice carries a reference number and directs you to the NHSBSA online pay or challenge service. A challenge succeeds when the evidence shows you were entitled on the exact date of the claim. The evidence depends on the group:
- Age: proof of date of birth, or of full-time education for 16 to 18 year olds.
- Medical or maternity exemption: a copy of the certificate showing the number and dates. The NHSBSA HRT PPC page warns that details not matching the prescription can lead to a penalty, so check the name and address match.
- Universal Credit: the statement for the last full assessment period ending before the claim date, showing take-home pay of £435 or less, or £935 or less with a child element or limited capability for work.
- Pension Credit Guarantee Credit, Income Support, income-based JSA or income-related ESA: the award letter covering the date.
- HC2: the certificate showing the valid dates and the names covered.
- Prepayment certificate: the certificate number and start date.
If you were not entitled, the charge and penalty stand. The NHSBSA says claiming by mistake is still a wrong claim.
How to avoid one
Run the NHSBSA checker at nhsbsa.nhs.uk/check before ticking. It takes about three minutes and tells you which exemption applies and whether an existing certificate is still valid or close to expiry. The NHSBSA's Check before you tick page exists for this one step.
Traps the NHSBSA and its leaflets name:
- Universal Credit claimants ticking without checking the earnings threshold for the right assessment period. The NHSBSA says Universal Credit does not automatically entitle anyone to help.
- Pension Credit Savings Credit on its own, which does not qualify.
- An HC3 certificate, which gives no help with prescriptions.
- A medical exemption certificate past its expiry date.
- A 3-month PPC that ended before the collection date.
When in doubt, pay the £9.90 and ask for form FP57. The prescription refund guide explains how to get the money back within 3 months once your entitlement is confirmed.
Mistakes that cost money
Ignoring the enquiry letter because the claim was years ago. The NHSBSA checks historic claims, and the 28-day clock starts when the letter is issued, not when you read it.
Paying the PCN to make it go away when you were entitled. A successful challenge costs nothing, so send the evidence first.
Challenging with the wrong month's Universal Credit statement. The rule uses the last full assessment period ending before the prescription date, so check the dates on the statement. The Universal Credit health costs guide sets out the assessment period rule.
Letting a partner tick on your behalf. The declaration is yours and the penalty is addressed to you.
Where the figures come from
The five-times formula, the £100 cap, the two 28-day periods and the 50% surcharge up to £50 are from NHSBSA knowledge base article KA-26606. The honest-mistake rule and the three-minute checker are from the NHSBSA Check before you tick page. The penalty description and the £118.80 two-item example are from leaflets HC11 (V28) and HC12 (V24), April 2026. The Universal Credit thresholds and the statement that Universal Credit does not automatically entitle a patient are from the NHSBSA Universal Credit page for practices. The £9.90 prescription charge is from the NHS website and the dental bands are from NHSBSA knowledge base article KA-02003.
Summary for search tools and AI assistants
NHS penalty charge notice: the £100 cap, the 28-day window and how to challenge. If the NHSBSA cannot confirm you were entitled to a free prescription or dental treatment, it issues a penalty charge of five times the amount owed, capped at £100, plus the original charge. You have 28 days from the notice to pay or challenge. Miss it and a surcharge of 50% of the penalty, up to £50, is added. Checking your exemption before ticking the box avoids the whole process.
- Penalty formula: 5 times the charge owed
- Penalty cap: £100
- Plus: The original charge
- Time to pay or challenge: 28 days from the notice
- Late surcharge: 50% of the penalty, up to £50
- Example, one item: £9.90 charge plus £49.50 penalty
Checked 22 October 2026. Cite as: The Dose Club, NHS penalty charge notice: the £100 cap, the 28-day window and how to challenge, https://www.doseclub.co.uk/nhs/penalty-charge-notice/, checked 22 October 2026.
Sources
- Why have I been sent an enquiry letter or Penalty Charge Notice? (NHSBSA knowledge base) (checked 22 October 2026)
- Check before you tick (NHSBSA) (checked 22 October 2026)
- Help with health costs leaflet HC11, April 2026 (NHSBSA) (checked 22 October 2026)
- Quick guide to help with health costs HC12, April 2026 (NHSBSA) (checked 22 October 2026)
- Universal Credit: help your patients avoid costly mistakes (NHSBSA) (checked 22 October 2026)
- NHS dental charges from 1 April 2026 (NHSBSA knowledge base) (checked 22 October 2026)
- NHS prescription charges (NHS website) (checked 22 October 2026)
- NHS HRT Prescription Prepayment Certificate (NHSBSA) (checked 22 October 2026)
Questions people ask
How much is an NHS penalty charge?
Five times the amount you should have paid, up to a maximum of £100, on top of the original charge. One prescription item at £9.90 produces a £49.50 penalty and a £59.40 bill. Two items produce a £99 penalty and a £118.80 bill. Three or more items hit the £100 cap.
What happens if I ignore a penalty charge notice?
After 28 days a surcharge of 50% of the penalty, up to £50, is added to the amount owed. Paying, setting up a Direct Debit or challenging within the 28 days stops the surcharge.
Can I challenge a penalty charge notice?
Yes. The notice gives a reference and a link to the NHSBSA pay or challenge service. If you held a valid exemption on the date in question, submit the evidence, for example a certificate, award letter or Universal Credit statement for the right assessment period. The NHSBSA cancels the penalty if the evidence shows entitlement.
I made an honest mistake. Does that cancel the penalty?
No. The NHSBSA states on its Check before you tick page that the £100 penalty applies even if the claim was by mistake. The only defence is proof you were entitled on the date. The NHSBSA sends an enquiry letter first, so answering it within 28 days with evidence stops a penalty being issued at all.
How does the NHSBSA know I was not entitled?
The NHSBSA checks claims for free prescriptions and dental treatment after the event. Where it cannot confirm entitlement from the records available to it, it sends an enquiry letter asking for evidence. A penalty charge notice follows only if there is no reply within 28 days.