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Scrap prescription charges now

Pharmacist holding out an NHS prescription bag

It is time for England to follow the lead of Wales, Scotland and Northern Ireland and invest in the population’s health.

The idea that people should have to make a choice over whether they should eat or pay for essential medicines to treat a life-threatening condition is abhorrent.

But, according to the results of a recent survey carried out by the Prescription Charges Coalition (PCC), that is exactly what is happening for potentially millions of people in 21st century England.

The PCC figures reveal that one-third of the 4,200 people surveyed, who paid for their medicines, admitted to skipping prescriptions or reducing the dose of their medicine. Nearly half of those (46%) said it was because of cost.

England is the only country in the UK to still charge for prescriptions although, through a complicated and arbitrary system of exemptions, about 88% of the population are in fact exempt.

The system has not changed significantly since charges were first introduced in 1952, and the cost of a prescription has risen by 4,200%. This compares with a 1,264% rise in inflation (as measured by the retail price index) during the same period.

Many organisations, including the British Medical Association, the Royal Pharmaceutical Society and the British Heart Foundation, have argued that the system is grossly unfair and that it needs urgent review. The PCC claims that the cost burden falls largely on a small number of working people on low income, who are living with certain long-term conditions and are forced to pay to keep well.

Wales, Scotland and Northern Ireland abolished prescription charges in 2007, 2010 and 2011, respectively, on the grounds that it was a long-term investment to improve people’s health.

But in England, the government has stood firm even in the face of calls in 2009 from Ian Gilmore, who led a Department of Health review of prescription charges in England, for the immediate abolition of charges for those with long-term conditions.

Ministers cited financial pressures on the NHS as the reason behind their decision, and the situation is set to remain the same for the foreseeable future.

But, with 34% of those who skip or reduce their medicines requiring a GP or hospital appointment due to a deterioration in their health, according to the PCC survey, the hidden cost to the health service is enormous and, arguably, far greater than the cost of abolishing the charges altogether.

In an economically rich country we should not be denying people with long-term conditions access to life-saving medicines. This flies in the face of the fundamental principles of an NHS free at the point of use.

The government should take a common-sense approach, look at the economic advantages of abolishing prescription charges and concentrate on ensuring that those who do require medication take it as prescribed.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2017.20203242

Readers' comments (4)

  • Much of the chronic illness we see all around us is caused by eating too much (and in particular, sugar and salt), drinking too much alcohol, abusing psychoactive drugs, and cigarette smoking. These are lifestyle choices that the individuals in question CHOOSE TO PAY FOR. So, it seems to me that a case can be made to incentivise the changing of these lifestyle choices by requiring patients to pay a nominal prescription charge for their medication. I have long believed that a nominal 50p per item charge for everyone, perhaps capped at a maximum of four chargeable items per prescription would go some way to addressing the calls we are now hearing for people to take more responsibility for their own health. A nominal charge of perhaps £10 or £20 should also be payable for use of accident and emergency services, but that is another story. These charges would be no different to the "excess" that we all are expected to pay in respect of car or home insurance.

    To sensationalise the issue by referring to people making choices over whether they should eat or pay for "essential medicines" being used to treat "life-threatening conditions" appears to me to miss the point. Medication may well extend the life of patients with lifestyle-related chronic ill health, but it is not in any sense an "antidote" to the "poison" they are paying for and self-administering. Yes, the NHS has enabled us to live longer with our chronic ill health, but that is not the same thing as saying that, thanks to the NHS, we are all able to enjoy a healthy and productive old age.

    In dermatology, when a patient presents with an avoidable condition such as contact dermatitis, they may be prescribed medication to treat the acute symptoms, but they are always also advised to avoid future contact with the offending substance. Patients will almost always comply with this advice / instruction. Similarly, patients whose illnesses are caused by gluten or peanuts or lactose, or even by their prescribed medication will all want to avoid future contact with the offending substance. Yes, this may happen because the cause and the unpleasant effect are easily linked in the minds of the patients. But when the unpleasant effect of the offending substance does not occur for months and even years (whilst pleasurable effects occur immediately) the unwillingness of patients to change their lifestyle / behaviours is perhaps understandable. But, if the NHS is truly to deliver "patient-centred care", healthcare practitioners should be prepared to tell patients the "brutal truth" when it is their overindulgence that is evidently the cause of their medical problems. And they have similarly to advise patients that the first step must be to address the overindulgence, and that treatment of symptoms with medication should be contingent upon the patient first taking ownership of the problem and addressing the cause of their illness. After all, why bother visiting a GP at all if you do not prepared to take advice and show that you are serious by paying a nominal prescription charge? And indeed, why have we bothered spending all those billions of pounds on medical / healthy living research only for the outcomes to be ignored?

    So, the common-sense approach in my view is to charge everyone a nominal sum for their prescription items, not to hand them out free of charge. The behaviour change that the 5p plastic bag charge in Wales initiated shows that a nominal charge for a prescription item could well change not only behaviour but also the health of the nation for the better.

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  • ^ Totally in agreement with Richard ^

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  • I have long thought this would be the best way forward so thank you, Richard, for describing the system so eloquently. Just need to explain this to the government now ...

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  • Lets for a minute accept that humans behave the way they do and changing social behaviours is difficult. Humans are programmed to over divulge when food is plenty (part of our hunter gatherer genetics), adopt coping mechanisms for busy stressful lives, like drinking alcohol or eating more.

    Lets accept that the poor health from this behaviour over a long period of time (as we live longer, not getting eaten by mountain lions...etc) causes health issues. Not treating those health issue effectively leads to morbidity and progression to other complaints. This advance to more complex disease has greater cost than treating them effectively in the first place.

    So free prescriptions is a very logical way to prevent illness and progression of conditions. This should be done in line with public health and prevention of illness I agree. But you cannot ignore and cast aside the illness that is already here. The UK is a rich country and can afford free prescriptions and cannot afford not to treat the illness that is here now.

    An NHS free at the point of use also means prescriptions

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