PJ Online | PJ Letters: Prescription charges
The Pharmaceutical Journal
From J. N. Logan, MRPharmS
Debbie Andalo's criticism of the rules governing exemption from prescription charges (PJ, 15 June, p833) provides a useful analysis of the situation and prompted me to think what might persuade the Government to do something about it.
Almost all the complaints about the system come from aggrieved patients who are left out of the exemption categories so all the pressure is towards making these categories wider despite the large proportion of prescriptions already provided free. The Government is bound to resist.
The obvious and basic reason for exemption from prescription charges is to make treatment available to those who cannot afford them. So, is it not also obvious that the only criterion for exemption should be low income? Some medical treatments may be essential for life ? so what? Food is essential for life.
All that would be needed would be for the Government to fix a qualifying level of income to trigger exemption with certain payments such as disability benefits excluded. Most children would naturally fall within the exempt category but many pensioners would not. Individual liability could be limited by "season tickets" as at present.
The benefit for the Government would be that the total number of exemptions would fall while making the system manifestly fair.
Another major benefit would be to remove the incentive for patients with marginal diabetes or endocrine disorders to press for a positive diagnosis in order to benefit from life-long total exemption and, no less importantly, to remove the temptation for purveyors of official prescribing guidance to urge doctors not "normally" to treat such conditions.
From Mr P. Jenkins, FRPharmS
The unfair arrangements for levying prescription charges (taxes) are discussed at regular intervals but the Department of Health is still not prepared to act. Several reports have recently been submitted to the DoH but perhaps the reason it takes no notice is that the cases made are just not complete enough.
Many have argued over the years for this tax to be abolished and for the money lost to the Treasury to be raised by fairer means, and indeed have suggested the means. Wiping out all thought of money changing hands would result in improved concordance and better public health.
Patients would benefit from not having cost on their minds while they listen to the pharmacist counselling them on the best use of prescribed medicines. Nor would pharmacists be placed in the invidious role of tax collector.
How then can the "lost" money be replaced? First, there would be no need for the anti-fraud squad to operate in this field where, it is claimed, there is a lot of fraud. If no cash is involved then the possibility for such fraud is eliminated. It could also be argued that if the anti-fraud squad spend more time on other suspected frauds they might recoup more.
In addition a concerted attempt to reduce the waste of prescribed medicines would offset the tax loss. To reduce wastage prescribers must be encouraged not to write much more than the patient really needs at any time. Doctors are always prepared to change their prescribing patterns if they can get cash by hitting targets in their various incentive schemes. So building a scheme with cash incentives for them if they reduce prescribing will help reduce waste and save money.
Admittedly it would cost money to ensure general practitioners participate but as long as the saving on the drugs bill plus other savings equals the prescription tax then the balance is favourable and the amount of unused drugs left in homes is reduced, which is a bonus. The DoH does not have a good record for coming out ahead in negotiations with the medics but perhaps the various benefits involved would encourage both sides to reach agreement.
If this happens then pharmacists will not be tax collectors and a real effort will have finally been made to solve a problem that has vexed patients and pharmacists for so long.
From Mrs J. H. Brown, MRPharmS
There is one simple, and for many pharmacists, potentially welcome solution. A £1 charge for each item and no exemptions. This will at a stroke remove the necessity for staff to check patients' exemptions, which causes delays and a great deal of friction and resentment leading in some instances to aggressive behaviour. Some health authorities will not allow district nurses to fill in the declaration on the back of prescriptions they collect for patients so placing the onus on the pharmacist. It may even encourage doctors to prescribe logically and remove from patients' "repeats" those items that they have replaced or discontinued.
It will also reduce the amount of returned unused medicines, an obscene waste. Not all returns are the result of changes of treatment or patient deaths. How many of us hear "I am entitled to it and I don't pay so I am going to have it"? People do not value anything for which they do not have to pay.
Most people in this area claiming exemption on grounds of low income still seem to be "investing" at least ?1 a week on the national lottery so it is not unreasonable to ask them to invest ?1 per item on their health. For many of the others cost is not an issue as long as it is not as high as ?6.20.
The present system is a shambles, illogical, unfair and open to abuse. Do not ask the pharmacist to endure any more flack. We are all heartily sick of trying to explain the inconsistencies. It is time the public became accustomed to a culture of helping themselves instead of expecting everything for nothing.
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