What’s This Letter
EN
Read my letter

Other · United Kingdom

NHS Penalty Charge Notice — a wrongly ticked exemption box, and 28 days to pay

An NHS Penalty Charge Notice says you received a free or reduced-cost NHS prescription or dental treatment while, per NHSBSA's records, you were not entitled to the exemption you ticked. It asks for the original charge plus a penalty, with 28 days before a surcharge is added.

How serious: routineAlso called: NHS PCN, Prescription penalty charge, Dental penalty charge, NHSBSA penalty

The notice is issued because NHSBSA's records show you were not entitled to the exemption ticked when you received a free or reduced-cost prescription or dental treatment. Common causes are an expired exemption certificate, a misunderstood benefit category, or a wrongly ticked box.

It asks for two things: the original NHS charge you should have paid, and a penalty. By law the penalty is the smaller of £100 and five times the unpaid charge (regulation 3, SI 1999/2794).

Foreign residents get caught out frequently because UK exemption categories are confusing. If you actually held a valid exemption at the date of treatment, the notice can be challenged with evidence.

Who sends it

The NHS Business Services Authority (NHSBSA) — the NHS body that checks claims for free prescriptions and dental treatment and issues penalty charges.

A letter headed 'Penalty Charge Notice' from the NHS Business Services Authority, referring to a named prescription or dental treatment date, showing the original charge, a penalty amount, and a 28-day payment deadline with a warning of a 50% surcharge.

The deadline

28 days to pay before the surcharge is added — regulation 2(1) of the National Health Service (Penalty Charge) Regulations 1999 requires payment 'within the period of 28 days beginning with the date on which the penalty notice was sent'

There are 28 days to pay before the surcharge is added. Regulation 2(1) of the National Health Service (Penalty Charge) Regulations 1999 requires payment 'within the period of 28 days beginning with the date on which the penalty notice was sent' — the clock starts on the sending date, not the day the letter arrives (reg 2(1), SI 1999/2794).

If you do nothing

A surcharge is added by law: 'The amount of the surcharge shall be 50% of the amount of the penalty charge' (reg 4(2), SI 1999/2794). The penalty itself is capped: 'The amount of the penalty charge shall be whichever is the smaller of - (a) £100, and (b) the amount... multiplied by 5' (reg 3) — that is, five times the unpaid NHS charge up to £100, on top of repaying the original charge. The debt then remains recoverable.

Compute your date

The rule above is what the law sets. Put in the dates on your own letter and it becomes a date.

How it escalates

  1. 01After 28 days: a 50% surcharge is added to the penalty charge (a maximum surcharge of £50 on the £100 maximum penalty).
  2. 02The original charge, penalty and surcharge remain a recoverable debt.

Your options, procedurally

  • The original charge plus penalty can be paid within 28 days (phone lines exist for prescription and dental penalty payments).
  • NHSBSA can be contacted with evidence — a certificate or benefit award, for example — if you actually held a valid exemption at the date of treatment, to have the penalty withdrawn.
  • NHSBSA can be contacted to arrange payment, or to dispute the notice if you believe it was issued in error.

How to respond

Response types

  • File the objectionChallenge the Penalty Charge Notice · National Health Service (Penalty Charge) Regulations 1999 (SI 1999/2794), reg 2(3) - no liability where the person shows entitlement, or shows that they did not act wrongfully or with any lack of careForm: No numbered form; the challenge is made through the NHSBSA 'Respond to your letter' online service or in writing
  • Confirm paymentPay the penalty charge and the original NHS charge · SI 1999/2794, reg 2(1) - payment within 28 days beginning with the date the penalty notice was sent; reg 4(2) - 50% surcharge if it is not paid
  • Ask for instalmentsSet up a Direct Debit payment arrangement with NHSBSA

Where and how

  • NHSBSA 'Respond to your letter' service
  • Post (first class / ordinary mail)
  • Royal Mail Signed For / Special Delivery Guaranteed
  • Telephone

What makes it count

The statutory clock is unusual and strict: regulation 2(1) requires payment 'within the period of 28 days beginning with the date on which the penalty notice was sent', so the printed send date is counted as the first day and there is no added time for delivery and no roll-forward for weekends. A challenge does not on the face of the regulations suspend that period, so where the outcome is uncertain the safe course is to submit the challenge and, if it is not resolved, deal with payment before day 28. The NHSBSA online service is timestamped; email evidence is capped at 6MB per message, which usually means sending certificates as separate messages rather than one large attachment, and every message must quote the PCN reference.

Common questions

How much is the penalty?

The smaller of £100 and five times the unpaid NHS charge, on top of the original charge itself (reg 3, SI 1999/2794).

When does the 28 days start?

On the date the penalty notice was sent, not the date it arrived (reg 2(1), SI 1999/2794).

What if I was actually entitled to the exemption?

NHSBSA can be sent evidence, such as a certificate or benefit award valid at the date of treatment, to have the penalty withdrawn.

What is added after 28 days?

A surcharge of 50% of the penalty charge (reg 4(2)) — at most £50 on the £100 maximum penalty.

Sources

Facts verified against the sources below on 28 August 2026.