Charging provisions in the NHS in Wales

Section 1 of the National Health Service (Wales) Act 2006 (NHSWA 2006) provides that the Welsh Ministers must continue to promote in Wales a comprehensive health service designed to secure improvement in the physical and mental health of the people of Wales, and in the prevention, diagnosis and treatment of illness. The Welsh Ministers must for that purpose provide or secure the provision of services in accordance with the provisions of NHSWA 2006.

Section 1(3) states that the services so provided must be free of charge except in so far as the making and recovery of charges is expressly provided for by or under enactment, whenever passed.

Part 9 of NHSWA 2006 makes provision in relation to charging powers.

Charges for drugs, medicines or appliances, or pharmaceutical services

Section 121 of NHSWA 2006 provides that the Welsh Ministers may provide for the making and recovery of charges for the supply under NHSWA 2006 of drugs, medicines or appliances including the replacement and repair of those appliances), and such pharmaceutical services as may be prescribed. The regulations may in particular make provision in relation to the supply of contraceptive substances and appliances. The regulations may not make provision in relation to the provision of any relevant dental service (on which specific provision is made by section 125).

Section 122 provides that no charge may be made under the section 121 regulations in respect of:

• the supply of any drug, medicine or appliance for a patient who is resident in hospital,
• the supply of any drug or medicine for the treatment of sexually transmitted disease (otherwise than in the provision of primary medical services),
• the supply of any appliance for a person who is under 16 years of age or is under 19 years of age and in qualifying full time education, or
• the replacement or repair of any appliance in consequence of a defect in the appliance as supplied.

Section 123 provides that the regulations may provide for the grant, on payment of such sums as may be prescribed, of a pre-payment certificate. A pre-payment certificate is a certificate which confers on the person to whom it is granted exemption from charges otherwise chargeable under the regulations in respect of drugs, medicines and appliances supplied during such period as may be prescribed.

Section 136(2) provides that regulations made under section 121 may provide for the sums which would otherwise by payable by a Local Health Board (LHB) (or Special Health Authority) to the service providers to be reduced by the amount of the charges authorised by the regulations in respect of those services.

The National Health Service (Free Prescriptions and Charges for Drugs and Appliances) (Wales) Regulations 2007 have effect as if made partly under section 121 of NHSWA 2006. The regulations provide that there are no charges in respect of drugs and appliances supplied to patients registered with GPs in Wales, or registered with GPs in England but holding valid entitlement cards, where such drugs and appliances are supplied by chemists providing pharmaceutical services (regulation 3), by doctors providing pharmaceutical services (regulation 4), by LHBs (regulation 5) and by prescribers (including independent prescribers) at walk-in centres (regulation 6). The National Health Service (Paramedic Independent Prescriber and Paramedic Supplementary Prescriber) (Wales) (Miscellaneous Amendments) Regulations 2019 expanded the definition of prescribers to paramedic independent prescribers.

Charges in respect of non-residents

Section 124 provides that the Welsh Ministers may make regulations to provide for the making and recovery of charges in respect of the services provided under NHSWA 2006 to such persons not ordinarily resident in Great Britain as may be prescribed. Regulations may provide that the charges may be made only in such cases as may be determined in accordance with the regulations.

The National Health Service (Charges to Overseas Visitors) Regulations 1989 have effect in Wales as if made under section 124 of NHSWA 2006