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CHAPTER4 Social aspects of primary care
Benefits forpeople onlowincome
Benet cap Limits the total amount of state benet that most people
aged 16– 64y can receive. The amount of the cap varies according to where
the person lives and personal circumstances.
Income Support (IS) can be claimed by people aged ≥16y and:
• Pregnant, a carer, or a single parent looking after a child <5y, or unable
to work due to sickness or disability, or aged 16– 20y and in full- time
education/ training (excluding higher education)
• Working <16h/ wk (some voluntary work may be allowable)
• Under Pension Credit qualifying age (E p. 106)
• On a low income or have no income
• Have <£16,000 in savings
Jobseeker’s Allowance (JSA) Can be claimed by people aged ≥18y
and under state pension age who are unemployed or working <16h/ wk.
Claimants must be:available to work full- time, actively looking for full- time
work, not in full- time education and not claiming IS. There are 2 types of JSA:
• Contribution based— for people who have worked, paid sucient
National Insurance (NI) and have not claimed JSA in the past 2y. Payable
for 6mo
• Income based— for people who have not paid sucient NI or have
made a JSA claim in the past 2y. Eligible if savings <£16,000, partner
(if applicable) is working <24h/ wk, and not claiming Pension Credit,
Employment Support Allowance, Universal Credit, or IS
Tax Credits Two types:
• Working Tax Credit (WTC)— for people on low income working
≥16h/ wk (>30h/ wk if aged 25– 59y and no childcare responsibilities)
• Child Tax Credit (CTC)— for people with children <16y (or 16– 20y and
in full- time education/ training) who are working and on low income.
Acredit is payable for each child born before 1.4.2017; if children are
born after that date, credits are only payable for 2 children per family.
Additional allowances are made for disabled children
Pension Credit E p. 106 Child Benet E p. 827
Housing Benet Payable to families on low income to pay rent. Only 1
member of a couple can apply. People with >£16,000 in savings are not eligible.
If savings of £6000– £16,000, Housing Benet may be paid at reduced rate.
Universal Credit Benet rst introduced in October 2013 to replace:
• Income Support • Income- based JSA
• Child Tax Credit • Housing Benet
• Working Tax Credit
• Income- related Employment and Support Allowance
0 Universal credit is being rolled out across the UK with the aim that
all new claimants will receive Universal Credit rather than ‘legacy benets’
by 2022.
Local authority payments Council Tax Reduction, Community Care
Grants, and Crisis Loans for general living expenses have been replaced
with payments from local authorities. Local schemes vary.
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BENEFITS FORPEOPLE ONLOWINCOME
Short- term advances Provided by the DWP if nancial hardship be-
cause of issues with benet payments.
Budgeting Loans Can help pay for:
• Furniture • Home security
• Household items, e.g. washing machine • Costs of job hunting
• Clothes/ footwear • Maternity costs
• Costs of moving home • Funeral costs
• Rent advances • Repayment of certain loans
• Home maintenance
Applications are made online. Only people claiming IS, income- based JSA,
income- related Employment Support Allowance, and Pension Credit for
>6mo can request budgeting loans. People claiming Universal Credit must
apply for a Budgeting Allowance instead.
Automatic health benets People on certain low- income benets
(‘passport’ benets) may be able to claim:
• Free NHS prescriptions (E p. 113)
• Free NHS dentistry, eye tests/ glasses, wigs and fabric supports
• Some hospital travel costs
• Milk, vitamins, and fresh fruit/ vegetables for pregnant and breastfeeding
women and children <5y
• Free school meals
0 Passported benets gradually d as income i.
Cold weather payments Paid automatically to people with low in-
come, or on retirement pension, if the temperature is <0°C for ≥7
consecutive days.
Food banks Provide emergency food supplies on presentation of a vou-
cher. Arrangements for provision of vouchers vary across the UK, but generally food vouchers are issued by Jobcentre Plus oces, social workers,
Citizen’s Advice, and some GP surgeries.
Benet fraud Occurs when people deliberately claim benets they are
not entitled to, e.g. by providing inaccurate information or not reporting any
change in circumstances. Suspected benet fraud can be reported online via
M www.gov.uk or via the National Benet Fraud Line F 0800 854 4400.
Further information
Budgeting Loans M www.gov.uk/ budgeting- help- benets
Child Tax Credit M www.gov.uk/ child- tax- credit
Citizen’s Advice M www.adviceguide.org.uk
Housing Benet M www.gov.uk/ housing- benet
Income Support M www.gov.uk/ income- support
Jobcentre Plus F 0800 055 6688 M www.gov.uk
Jobseeker’s Allowance M www.gov.uk/ jobseekers- allowance
Universal Credit F 0800 328 5644 M https:// www.gov.uk/ browse/
benets/ universal- credit
Working Tax Credit M www.gov.uk/ working- tax- credit
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CHAPTER4 Social aspects of primary care
Pensions
Retirement pension Astate retirement pension is currently payable to
people of state pension age even if still working. Claim forms should be received automatically— if not, request one through the local Jobcentre Plus
oce. Pensions are taxable. State pension age is gradually increasing— in
women from 60 to 67y and in men from 65 to 67y.
Basic pension Flat rate amount— dierent for single people and married
couples. If not enough NI contributions have been paid, amounts may d.
>80y, a higher rate is payable which is not dependent on NI contributions.
Variations onbasicpension
• Increase for dependants— if spouse/ partner is <60y and on low income
• Additional pension— second state pension for ♂ born before 6.4.1951
and ♀ born before 6.4.1953. Based on earnings, NI contributions, and
additional pension contributions through the State Earnings- Related
Pension Scheme (SERPS) (1978– 2002) and/ or State Second Pension
Scheme (2002– 2016)
• Graduated pension— based on earnings from 1961 to 1975
• Extra pension— for people who defer claiming their basic pension for
up to 5y. Extra pension is payable when pension is eventually claimed
Pension Credit Tops up state pension for pensioners with weekly in-
come below a threshold amount. Threshold varies according to factors such
as whether the person lives alone or is part of a couple, savings, and other
benets received. Receipt of Pension Credit confers automatic eligibility for
Housing Benet (E p. 104) and Budgeting Loans (E p. 105). Claims can be
made via the Pension Credit Claim line (F 0800 99 1234).
National insurance credits Protect Basic State Pension for people
who do not work because of illness, unemployment, child care responsibilities, or because they are carers.
Christmas bonus One- o payment made to people receiving a retire-
ment pension a few weeks before Christmas.
Other benets just forpensioners
• Free colour TV licence All pensioners >75y; currently under review
• Winter fuel payment Annual payment to all pensioners >60y
Cold Weather Payment Paid automatically to people with low in-
come or on retirement pension if the temperature is below freezing for 7
consecutive days.
Benets for:
• Low income E p. 104
• Disability E p. 108
• Bereavement E p. 102
Maintaining independence E p. 198
Pensions forex- Servicepersonnel
War Pensions Scheme For personnel who have served in the British armed
forces and whose injuries and illnesses are related to their service, and
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PENSIONS
arose prior to 6 April 2005. No time limit for claims. Administered by the
Veterans Agency. Includes:
• War Disablement Pension Based on percentage disability and may
be a one- o lump sum (if <20% disabled) or paid as a regular weekly
sum (pension). In addition, pensioners may be awarded a mobility
supplement for walking diculty (holders can apply for the Motability
Scheme and Road Tax Exemption— E p. 199) and/ or a Constant
Attendance Allowance (E p. 91) if high levels of care are needed
• Medical treatment Some services and appliances may be paid for by the
Veterans Agency (includes prescription charges, nursing home fees)
• War Widows and Widowers’ Pensions For spouses/ civil partners of
Service and ex- Service personnel where death was related to service;
an additional allowance is paid on reaching the age of 65y with further
increases at 70y and 80y
Armed Forces Compensation Scheme (AFCS) Administered by the Veterans
Agency. Provides benets for illness, injury or death caused by service in
the armed forces on or after 6 April 2005. Time limit for claims is 7y from
the event, from the time when medical advice was rst sought or after
retirement— whichever is soonest. There is an exceptions list for late- onset
conditions. Provides:
• Lump sum for signicant illnesses/ injuries— 15 levels of award
• Tax- free Guaranteed Income Payment (GIP) for life for injuries at the
higher tari levels (1– 11) to compensate for loss of earnings capacity
• Guaranteed Income Payment for Survivor’s (SGIP) where an attributable
death occurs
Patient information
Citizens Advice M www.adviceguide.org.uk
Pension Service F 0800 99 1234 M www.gov.uk/ state- pension
Royal British Legion F 0808 802 8080 M www.britishlegion.org.uk
SSAFA The Armed Forces Charity. F 0800 731 4880 M www.ssafa.org.uk
Veterans Agency F 0808 1914 218 M www.gov.uk/ veterans- uk
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CHAPTER4 Social aspects of primary care
Benefits forsickness anddisability
Benets forpeople unable towork due toillness
Statutory Sick Pay (SSP) Weekly sum paid through the employer’s normal
payroll mechanisms from 3d into illness and for up to 28wk to employees
who are:
• Age ≤16y and under state pension age
• Incapable of work due to sickness or disability
• Earning ≤ the NI lower earnings limit (in 2018/ 19, £116/ wk), and
• Unable to work for ≤4d consecutively (including days when the person
would not normally work)
Claimants can self- certify that they are unt to work for the rst week;
thereafter medical certication is required (E p. 95). In many cases, employers have additional schemes that are more generous than SSP. People
ineligible for SSP may be eligible for Employment and Support Allowance or
Maternity Allowance (E p. 765).
Employment and Support Allowance (ESA) can be claimed by people aged
≥16y and under state pension age who are:not in full time education, unable to work due to illness or disability, and unable to claim SSP. There are
2 types of ESA:
• Contributory— for people who have paid sucient NI contributions.
Payable for 1y
• Income- related— for people unable to work for >1y or who have not
paid enough NI contributions, and who are not claiming Universal Credit
Payments do not start until 3d into illness. Claims are made by telephone
(F 0800 055 6688). Claimants can self- certify that they are unt to work for
the rst 7d; thereafter medical certication is required (E p. 94) until WCA
takes place (usually in <13wk). Payments vary according to:
• Age— whether <25y or ≥25y
• Duration of claim— lower rate during the ‘Assessment phase’
(3d– 14wk)
• WCA outcome (E p. 94)— lower rate is paid for people placed
in the ‘work- related activity group’ than for those placed in the
‘support group’
0 People claiming ESA may be able to undertake limited work either as
part of a treatment programme or if limited hours (<16h/ wk) and weekly
income from work is less than a specied amount.
Universal Credit E p. 104 Maternity benets E p. 765
Benets forthose withlong- termdisability
Disability Living Allowance (DLA) Can be claimed for children <16y who full
specied UK residence qualications, and have a disability or illness resulting
in mobility problems and/ or a need for more care than would usually be
expected for a child of that age. Unless terminally ill (when claims are made
under ‘Special Rules’), the disability/ illness must have been present >3mo
and be expected to continue for >6mo. Claims forms can be requested by
telephone (F 0800 121 4600). There are 2 components:
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BENEFITS FORSICKNESS ANDDISABILITY
• Mobility component— for children needing help to get around
outdoors; two levels and age restrictions apply
• Care component— for children needing help with personal care; three
levels. If terminal illness, highest rate is automatically awarded
Personal Independence Payment (PIP) Can be claimed by people aged 16–
64y who full specied UK residential requirements, and have a disability
requiring assistance that has been present >3mo and is expected to last
>9mo (unless terminally ill, when ‘Special Rules’ apply), regardless of ability
to work. Claim forms can be requested by telephone (F 0800 917 2222).
There are 2 payment components assessed against standard criteria:daily
living (activities 1– 9) and mobility (activities 10– 11):
• Daily living component Paid at standard rate if ≥8 points from
activities 1– 9, and at enhanced rate if ≥12 points. Enhanced rate is paid
automatically if the person has a terminal illness
• Mobility component Paid at standard rate if ≥8 points from activities
10– 11, and at enhanced rate if ≥12 points
Attendance Allowance (AA) Can be claimed by people aged ≥65y who are
UK residents, and have a disability requiring assistance that has been present >3mo and is expected to last >6mo more (unless terminally ill when
‘Special Rules’ apply). Claim forms can be requested by telephone (F 0800
731 0122). Ahigher rate is payable if 24h care is required.
Special Rules If a person has a terminal illness and is not expected to live
>6mo, claims for DLA, PIP, or AA can be made under ‘Special Rules’. This
means that the claim is processed much faster and the highest care component rate is automatically awarded. To claim, applicants must complete
a standard application form, but this is supported by a medical statement
(DS1500 form) completed by a hospital specialist or GP.
Carer’s Allowance Can be claimed by people aged ≥16y, on low income and
not in full time education, who spend ≥35h/ wk caring for a person with a
disability who is receiving AA, Constant Attendance Allowance, enhanced
rate of the daily living component of PIP, or the middle- or higher- rate care
component of DLA. Other benets (e.g. state pension) may aect eligibility.
Claims can be made online via M www.gov.uk/ carers- allowance.
Council Tax reduction and local authorit y grants People with disability may be
eligible for Council Tax reductions and/ or certain grants to help them to
live in the community— contact local council.
Industrial injury benets E p. 91
Armed Forces Compensation Scheme E p. 107
Further information
AA M www.gov.uk/ attendance- allowance
Citizen’s Advice M www.adviceguide.org.uk
DLA M www.gov.uk/ disability- living- allowance- children
ESA M www.gov.uk/ employment- support- allowance
PIP M www.gov.uk/ pip
SSP M www.gov.uk/ statutory- sick- pay
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Chapter5
Medicines andprescribing
NHS prescriptions 112
Writing prescriptions 114
Medicines management 116
Repeat prescribing 118
Adverse drug reactions 120
Licensing of medicines 122
Controlled drugs 124
Prescribing for special groups 126
Non-drug interventions and complementary medicine 128
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CHAPTER5 Medicines andprescribing
NHSprescriptions
‘A doctor is a man who writes prescriptions till the patient either dies or is
cured by nature’
At any one time, 43% of adult ♂ and 50% of adult ♀ are taking a prescription
medication. More than 1 in 5 regularly take >3 prescription medications; this
increases with age and >70% of those aged ≥75y are taking ≥3 regular prescribed medications. In England alone, >2.7million NHS prescription items are
dispensed every day— an average of 18.7 items/ head of population/ y.
Prescribing forms a major part of any GP’s workload. Bad prescribing
wastes resources, deprives patients from a chance to benet, and may
cause illness. Medicines should be prescribed only when necessary, and, in
all cases, benets of prescribing should be weighed against risks.
Prescription pre- payment certicate (PPC) For patients who live
in England, if not entitled to free prescriptions (Table 5.1) but needing a lot
of medication (>3 prescriptions/ 3mo or >13/ y), it is cheaper for a patient
to purchase a ‘pre- payment certicate’.
There are 3 ways to purchase a PPC:
• Internet M www.nhsbsa.nhs.uk/ HealthCosts
• Telephone F 0300 330 1341
• From a pharmacy registered to sell PPCs. List available at
Mhttps:// www.nhsbsa.nhs.uk/ help- nhs- prescription- costs/
prescription- prepayment- certicates- ppcs
0 Currently, only patients in England pay prescription charges. There are
no prescription charges in Wales, Northern Ireland, or Scotland.
Refunds Send the NHS Business Services Authority a letter explaining the
reason for refund to: NHS Help with Health Costs, Bridge House, 152
Pilgrim Street, Newcastle- upon- Tyne, NE1 6SN.
• Full refund— may be claimed if <1mo after purchase the holder
becomes entitled to free prescriptions or dies
• Partial refund— may be claimed if the holder dies >1mo after issue or if
the holder becomes entitled to free prescriptions 1– 4mo after issue
Reclaiming money To reclaim money spent while awaiting an exemption certicate or PPC, ask for an ocial receipt at the pharmacy when the drug is
paid for (FP57 England). Claim money back from any NHS pharmacy with
proof of exemption or PPC within 3mo.
Drugs cheaper over the counter (OTC) Many drugs commonly
prescribed in primary care (e.g. paracetamol, topical steroid nasal sprays,
oral antihistamines, ibuprofen) are cheaper than a prescription charge to
buy OTC. Before prescribing for patients who pay prescription charges always consider:
• Is this medication available to purchase OTC?
• Would it be cheaper to buy OTC in the quantities required?
In a bid to d prescribing costs, many PCOs in the UK have directed GPs
not to supply drugs to patients via NHS prescription when easily available
to purchase OTC.
John Taylor (1694– 1761)
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Table5.1 Free prescription entitlement inEngland
Circumstances in which free
prescriptions can be claimed
Automatic entitlements
• Prescription for contraceptive
• >60y or <16y of age or age 16– 18y
in full- time education
• Patient or family receiving:Income
Support, Income- based JSA, Incomerelated ESA, or Pension Guarantee
Credit. Some people claiming
Universal Credit also qualify
Maternity exemption (MatEx)
Pregnant women and women who have
had a baby <12mo ago
Certain medical conditions (MedEx)
• DM (unless diet- controlled only)
• Myxoedema or need for thyroxine
• Hypoparathyroidism
• Epilepsy requiring continuous
anticonvulsants
• Permanent stula (e.g. colostomy)
needing stoma dressing/ appliance
• Hypoadrenalism (including Addison’s
disease) and on replacement therapy
• Hypopituitarism, including diabetes
insipidus
• Myasthenia gravis
• Cancer
• Unable to go out without the help of
another person due to a continuing
physical disability
Tax credit exemption
People who have low income and
receive either CTC, or WTC + CTC,
or WTC + disability element
Low- income scheme
Low income and the individual/ family
has assets of <£16,000 in property
and/ or savings
War pensioners— prescriptions related
to pensionable condition only
How to claim?
Tick the relevant box on the back of the
prescription form
Fill in an exemption application form
(FW8) as soon as pregnancy is conrmed
Exemption certicates last 1y from
estimated date of delivery, or if
completed after the baby is born, for
12mo after the baby’s date of birth
Fill in an exemption application form
(FP92A) as soon as the condition is
conrmed
Requires a doctor’s signature to conrm
the condition.
Certicates last 5y or until 60th
birthday, if sooner
NHS tax credit exemption certicate is
received automatically at the time tax
credits are applied for
Complete form HC1 available to order
or download from the NHS Business
Services Authority website (www.nhsbsa.
nhs.uk) or order from F 0345 603 1108
HC2 certicates (full help with health costs)
entitle the holder to free prescriptions
Contact Veterans UK F 0808 1914 218
NHSPRESCRIPTIONS
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0 Leaet HC11, Help with Health Costs, is available from the NHS
Business Services Authority. Information is also available on their website
in a variety of dierent languages. M www.nhsbsa.nhs.uk
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