NHS charges
The briefing provides information on NHS charges and looks at proposed changes to the charging regime.
This paper sets out the basis for various NHS charges. It covers exemption criteria and explains variations in the devolved nations. The briefing details recent changes to NHS charges, including prescription charge rates and freezes, and the introduction of a hormone replacement therapy (HRT) prescription prepayment certificate in 2023.
It also discusses proposed changes to the charging regime, including calls to extend the list of medical exemptions from prescription charges, as well as current government policy.
The legal basis for NHS chargesThe National Health Service Act 1946, which set up the NHS in England and Wales, contained a provision that NHS services should be provided free of charge unless that Act expressly provided for a charge. This provision has been carried forward into the legislation which replaced the 1946 Act – the NHS Act 1977 and subsequently the NHS Act 2006.
Since the founding of the NHS, amendments have been made to allow charges for NHS services including prescription, dental and optical charges.
The future of NHS chargesIn the context of financial pressure on the NHS, there have been calls for the introduction of additional charges for services, such as GP appointments. The British Medical Association has voted against motions to introduce such charges.
There have also been calls to extend free prescriptions, for example to include a wider list of long-term conditions for which people are eligible for free prescriptions.
In the 10 Year Health Plan for England, the government said the introduction of further NHS charges would be “a sign of failure”.
Prescription chargesA list of current and historic prescription charges is available from the NHS Business Services Authority.
From 1 May 2024, the prescription charge for England is £9.90. On 28 April 2025 the government announced it would freeze prescription charges at this cost; this is the first prescription charge freeze in England for three years.
Individuals in England are entitled to free prescriptions if they meet certain exemption criteria. Where a patient claims for a free prescription to which they are not entitled, the NHS Business Services Authority (NHSBSA) can charge for the treatment retrospectively and can issue a penalty charge.
Individuals may also be able to save money by purchasing a prescription pre-payment certificate, or a hormone replacement therapy prescription pre-payment certificate.
Prescriptions are issued free of charge in Wales, Scotland, and Northern Ireland.
Dental chargesNHS dental charges in England were introduced for most adult patients in 1951. Dental charges are determined by type of treatment and are divided into bands. Individuals are not required to pay for NHS dental treatment if they meet certain exemption criteria.
Dental charges in Wales are also divided into bands, with exemptions available to certain patients. In Scotland, NHS dental examinations are free of charge. Chargeable patients (who do not meet the exemption criteria) are required to meet 80% of the cost of any additional treatments, up to a maximum of £384. Chargeable patients in Northern Ireland are also required to pay 80% of the dentist’s fee for treatment up to a maximum of £384.
Charges for wigs and fabric supportsCharges for NHS wigs and fabric supports are applicable to patients in England. The current charges and exemption criteria are available on the NHS webpage: Wigs and fabric supports on the NHS.
NHS wigs and fabric supports supplied through a hospital are free for patients who live in Scotland or Wales. In Northern Ireland, all prescriptions are provided free of charge and this includes wigs, as well as medication and surgical appliances.
Eye tests and optical vouchersThere are no set charges for eye tests in England in the same way as there are for prescriptions, dental treatment and wigs and fabric supports. Patients may however be entitled to free NHS sight tests if they meet certain criteria, and some groups are also entitled to NHS optical vouchers towards the cost of glasses or contact lenses.
Information on eligibility criteria for free eye tests and optical vouchers in Wales and Northern Ireland is available on Welsh Government and Northern Ireland Direct webpages.
In 2006, the Scottish Government introduced free eye tests for all UK residents in Scotland. NHS eye tests in Scotland are free for people who usually live in the UK, refugees, asylum seekers, and, in some cases, eligible overseas visitors. Optical vouchers are also provided to patients who meet certain criteria.