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NHS charges

Prescription charge overhaul would raise £1bn a year for NHS, says think tank

Raising money for the NHS from revamping the prescription charge system raises concerns with the pharmacist professional body.

Shelf of medicines with prescriptions

Source: Kumar Sriskandan / Alamy

The Royal Pharmaceutical Society says the proposal to make everyone pay a £2.50 prescription charge is an ”unfair tax” on health

A leading think tank is advising the government to review prescription charges in England to raise an additional £1bn a year to help fund NHS and social care in future.

The King’s Fund has recommended cutting the prescription charge from £8.05 to £2.50. Under its proposals, medical exemptions and the low-income scheme would be abolished for all people, including pensioners, but no one would face a medicines bill of more than £104 a year, as seen with the current cap imposed with pre-payment certificates.

The proposals are contained in a report looking widely at how health and social care systems can be brought together in a better way. It recommends a ring-fenced budget for the NHS and social care, with a single commissioner for local services.

Some 1 billion prescriptions are dispensed annually in England, with around £450m raised from prescription charges in 2012–2013. The think tank notes that while 40% of the population are liable to pay the prescription charge, in practice 90.6% of prescriptions are dispensed free of charge.

Of the 9.4% of prescriptions that are paid for, 5.2% are through cash payments and the remaining 4.2% are covered by pre-payment certificates, which provide a cap on the maximum people have to pay. These certificates cost £29.10 for three months and £104 for a year.

The King’s Fund says certificates are a “considerable bargain” and the current charging regime “makes little sense”.

“Prescription charges may not be a popular part of the NHS but they are a long-established one. However, for someone who pays for their prescriptions and needs two or three medications at a time, the £8.05 charge per item is a significant sum. We believe there is a way to reform these charges that would, at the same time, raise some additional money,” says the report.

The report notes that the vast bulk of the income that the NHS currently receives from charges comes from two main sources – dentistry and prescriptions.

Dissent from pharmacy body

David Branford, the chairman of English Pharmacy Board at the Royal Pharmaceutical Society (RPS), the professional body for pharmacists, said taxing health based on wealth is “just plain wrong”.

“Older people typically require more medicines than most to maintain a good quality of life and should not be penalised because of their circumstances,” he says. “The proposal to make everyone pay a £2.50 prescription charge for each medicine merely extends this current unfair tax on health to everyone and heaps unfairness on top of illness.”

Branford says there is much evidence to show that prescription charges lead to individuals being selective about which medicines they purchase. This leads to inadequate treatment, worsening health and expensive hospital admissions, the cost of which must be set against any cost-savings from charges, he argues.

“If the government really wants to save money across the health service there are lots of ways the skills of pharmacists could be used much more effectively to make an impact on the bottom line,” he says. “Commission us to provide services which help reduce the burden on hard-pressed A&E and GP surgeries, enable us to reduce the amount of wasted medicines by spending more time with patients and let us lead on giving public health advice in pharmacies.”

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2014.20066348

Readers' comments (2)

  • Whilst I agree with the principle that everyone should pay, I feel that £2.50 per item is too high.

    We see in every part of life, that consumer behaviour is regulated by the pricetag. By changing the dynamic of prescribed medicines from 'free' to having a real cost to the patient, potentially we encourage more rational and economic behaviour on the part of the patient.

    Perhaps the patient demands to see their prescriber for their routine review rather than dodges it in order to rationalise their regular therapy and consequently reduce their costs. Perhaps universal prescription charges become a driver towards medicines optimisation?

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  • A £2.50 per item prescription charge capped at the price of a "season ticket" will certainly provide over time a much-needed incentive for people to think about ways in which they might change their lifestyles in order to avoid the need for medication. And given that so much of the illness we are now seeing is related to too much eating / drinking / smoking and, worryingly, medicine taking, patients can easily pay this increased prescription charge by cutting down on eating / drinking / smoking and medicine taking (I'm thinking in particular of inappropriate use of OTC painkillers and inappropriate prescribing of antibiotics, which are now increasingly being recognised as the likely cause of the current asthma and eczema epidemic amongst other things).

    And further beneficial health outcomes might also accrue if patients were expected to order their own repeat medication and attend pharmacies in person to collect their medicines rather than expecting everything to be done for them [at no charge]. The way things are going, the next thing we'll be offering will be a free suppository fitting service! Or even taking the medicines for these patients to save them the trouble? Yes, I am being deliberately provocative because I am not a politician seeking to please an electorate. But I am just reflecting the thinking of dispensary staff with whom I've worked who are faced with dealing with a wall of prescriptions they dispense for demanding patients who then often do not bother even to collect their medication.

    So, yes, bring on a universal prescription charge. However, in my view, a 50p charge or even a 10p charge per item would serve a useful purpose if at the same time free prescription collection and delivery services are outlawed except for those who are truly housebound and have no relatives, friends or neighbours to help them. And that in turn will make it easier for pharmacists to carry out medicine use reviews on those who really need them, i.e. those patients we currently never see in the pharmacy.

    In Wales, we have to charge a nominal sum for plastic carrier bags. Because they are not free, no-one wants one anymore. A 10p charge per repeat prescription item requested will quickly have a similar effect on the number of medicines re-ordered by those who are not actually taking them. And it won't look like the government is trying to "tax the sick".

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