Funding - prescription charges
September 2008
(This briefing paper applies to England)
The prescription charge system is outdated and the BMA has long called on the Government to initiate a fundamental review of the whole system of prescription charges and exemption categories. A review of prescription charges, announced in July 2007, due in summer 2008.
There are many unacceptable inequities and anomalies in the present system. Although around four out of five prescriptions are exempt (see below for list of exempt categories), the price of a prescription (£7.10 from 1 April 2008) often hits those who cannot afford such charges. There are many people with chronic conditions who are not exempt and those on low incomes find it very difficult to pay. This causes a disproportionate levy on a limited section of the population.
With each rise in prescription charges, the BMA's concern is that more and more patients will be dissuaded from visiting the doctor when they are ill. All GPs have anecdotal evidence of patients asking which of two or more items on a prescription form are the most important as they cannot afford to pay for more than one at a time.
The BMA does not wish to see the specific clinical categories increased but there are many other groups of patients who require lifelong treatment, such as those with cystic fibrosis and Parkinson’s Disease, who are more disadvantaged than some of those presently exempt.
The anomalous position of the exemption applying to all prescribed items for patients in the "chronic sick" list continues to pose problems for doctors with other more deserving patients who have to pay charges for the same drugs. For example, the system allows a diabetic with chronic bronchitis to be exempt from all charges whilst a chronic bronchitic with heart failure must pay for all prescriptions.
The level of charge is now such that often it exceeds the actual cost of the drug. It is unreasonable for a patient to be prevented from purchasing that medicine privately from the pharmacist or dispensing doctor if the cost is less than the charge which would otherwise be levied.
The BMA's General Practitioners Committee supports prescription-exempt patients obtaining all over the counter medicines free of charge.
Other issues which need to be addressed:
- Women are exempt for the duration of pregnancy and for a year afterwards. This latter period is no longer necessary as women's health is rarely hazarded as a result of pregnancy today.
- Many patients in the age exempt categories are well able to pay which would spread the overall burden more fairly.
- Certain drugs have to be given in association with another drug. If the two substances can be combined in one tablet, only one charge is made. However, if the chemical nature of the substances is such that this is impossible or the dose combinations vary, the patient has to pay two or more charges for a combination pack. This particularly occurs with hormone treatment and starter packs for hypertension.
- Current exemption certificates have to be renewed every five years even for conditions which are permanent. This seems to be unnecessary paperwork.
The following categories of people are entitled to exemption from NHS prescription charges:
- Men and women aged 60 and over;
- Children under 16;
- Young people in full-time education aged 16, 17 and 18;
- Pregnant women and women who have had a child in the previous 12 months who hold a valid exemption certificate;
- People who hold a valid exemption certificate for a War disablement pension but only in respect of medication for the disablement;
- People suffering from the following conditions who hold a valid exemption certificate:
forms of hypoadrenalism (including Addison's disease) for which specific substitution therapy is essential;
diabetes insipidus or other forms of hypopituitarism;
diabetes mellitus (except where treatment is by diet alone);
hypoparathyroidism;
myasthenia gravis;
myxoedema;
epilepsy requiring continuous anti-convulsive therapy;
continuing physical disability which prevents the patient from leaving his residence without the help of another person. - A person or partner receiving Income support; Pension Credit guarantee credit; or Income-based Jobseeker's Allowance
- Tax credit where income is £15,050 per year or less and meeting qualifying conditions
The regulations apply to England. Arrangements in Scotland, Wales and Northerm Ireland are a matter for their Devolved Administrations.
Prescriptions have been free for everyone in Wales since 1 April 2007. Scottish Ministers pledged in April 2008 to phase out all prescription charges by 2011. In Northern Ireland the cost of a prescription will be reduced to £3 in January 2009 and then will be free of charge by April 2010.
Statistics
- The price of a prescription in 1979 was 20p. From April 2008, the price is £7.10.
- Prescription charges are expected to raise some £435 million for the NHS in 2008-09 (excludes charges collected by dispensing doctors).
- Around 88 per cent. of prescription items dispensed in England are exempt from prescription charges.
- Prescription prepayment certificates (PPC) cost £27.85 for 3 months and £102.50 for 12 months. They offer a saving to anyone who needs more than 3 items in 3 months or more than 14 items in 12 months.
- The value of optical vouchers available for children, people on low income and individuals with complex sight problems, to help them with the cost of purchasing glasses will rose by an average of 2.7% from 1 April 2008.
Background
The 1946 NHS Act introduced a comprehensive health service which was to be free of charge. The Amending Act 1949 allowed for the introduction of prescription charges. On 1 June 1952, charges were introduced for the first time and continued until their abolition on 1 February 1965. Prescription charges were reinstated in 10 June 1968, and have been in force since, and the list of specified medical conditions has been reviewed on a number of occasions.
For further information, please email parliamentaryunit@bma.org.uk