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Free prescriptions? Here's my alternative plan

Gordon Brown's plans for free prescriptions for patients with long-term conditions are half-baked and will probably never happen. Luckily, Copperfield has a better idea...

Gordon Brown's plans for free prescriptions for patients with long-term conditions are half-baked and will probably never happen. Luckily, Copperfield has a better idea...



Prescriptions are free in Wales and charges will soon be abolished in Northern Ireland and Scotland.

Gordon Brown has promised to revise the scheme in England and scrap charges for patients with long-term conditions and those with cancer.

Then again, this is pencilled in for Labour's upcoming fourth term - otherwise referred to as 'never' by political commentators.

So what actually constitutes a 'long-term condition'? Will that patch of recurring eczema on my palm qualify? If so, do I only get free steroid cream or will all my future prescriptions for statins and sildenafil be covered?

As for 'cancer patients' - are they the ones who are still undergoing treatment or are 'cancer survivors' included? How about women whose cervical carcinoma-in-situ was treated before it progressed?

Do they lose their entitlement to a lifetime supply of pharmaceutical goodies?

This half-baked, half-in, half-out proposal will never work. Here's my idea.

In 2004 I wrote a piece describing how an IT glitch resulted in the cost of every item I prescribed appearing on the prescription form.

An asthmatic bloke wondered what the funny code - 68.08 - was next to the name of his combined inhaler. I told him.

Patients discovering how much the NHS was spending on their prescriptions seemed a good thing, so I suggested we adopt it as the norm. I even got quoted in the funnies section at the back of the BMJ.

Recently the idea was discussed by the House of Commons public accounts committee. Despite fears some patients might feel cheated if their meds didn't cost an arm and a leg, it appeared in their published recommendations. Result.

Each year GPs write prescriptions for more than £8,000 worth of drugs, dressings and what have you. Brand-name drugs account for one prescription in five but three-quarters of the total cost.

Never that simple

As every GP knows, switching patients from a branded item to a generic equivalent is never as simple as it might seem at first.

Mr David Curry MP (Conservative) assured his fellow committee members that salbutamol inhalers didn't work as well for his hay fever symptoms as those labelled Ventolin. He expressed similar views about Voltarol, generic diclofenac and back pain.

Thankfully our hero Dr David Colin-Thome had been called to give evidence and had perfected the ideal coping strategy, honed by long years of frontline GP work.

He said: 'I would prescribe Voltarol and Ventolin for you, Mr Curry.' So that's his secret - abject capitulation. No wonder he's such a superb advocate for primary care.

Here's the deal. Abolish the prescription charge for every generic item prescribed, dispense brand name product if no other is available.

When the time comes, allow patient to pay a top-up fee equal to the difference between the drug tariff price and the retail price of the branded product if they wish to carry on using it.

This isn't two-tier medicine as the products are pharmaceutically identical, but if the pharma companies are right and people are prepared to choose with their wallets, the income generated would easily outweigh the £400m per year that prescription charges currently generate.

Real choice for patients? Nah, it'll never catch on.

Dr Tony Copperfield is a GP in Essex. You can email him at tony copperfield@hotmail.com

Copperfield

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