GPs should police free prescriptions in England, recommends DH review

By Nigel Praities

All patients with conditions 'likely to last over six months' should be eligible for free prescriptions in England, with GPs set to play a key gatekeeper role, according to a major review published by the Department of Health today.

The long-awaited review - authored by Professor Ian Gilmore, president of the Royal College of Physicans - says GPs should have the responsibility for deciding which patients are eligible for free prescriptions.

The review into prescription charges was commissioned by the previous Labour administration, and the new Conservative-Lib Dem coalition said today they would consider its findings as part of the spending review later in the year.

Pulse revealed the panel set up to review prescription charges in England was considering recommending free prescriptions to those with conditions lasting over six months.

The final review goes even further, recommending that everyone currently eligible for free prescriptions should have them and that the exemption should last for three years.

And it dismissed the idea of a list of conditions which would be exempt from presciption charges as unwieldy. Instead, it will be left up to GPs in the majority of cases to determine if a patients condition is likely to last for more than six months and require continuing treatment - thereby qualifying for free prescriptions.

However the review admits the process could become ‘burdensome' for practices.

‘It is likely that the patient's GP will be best placed to fulfil this role. This is because of the nature of the primary care relationship with patients, and also because of their prescribing role,' says the review, adding that GPs could be assisted in their assessments of patients by nurse practitioners.

Professor Gilmore said: 'Although this review was commissioned by the previous Government in a more favourable financial climate, and, disappointingly, was not published or responded to by them, I believe it still represents a useful way forward for exempting patients with long-term conditions from prescription charges.'

'The present list of exempted conditions is outdated and arbitrary, and the approach in this respect has gained strong support from professional and patient groups alike. Furthermore, the report outlines a way in which exemptions could be phased in the fairest way possible when the financial landscape allows it.'

The Department of Health welcomed the review, but said any decisions on future changes to the system of prescription charges would be taken in the context of the next spending review, which is due to report in the autumn.

A DH spokesperson said: ‘We thank Professor Gilmore for his thorough review.'

‘We know the NHS faces many challenges and therefore any decisions on future changes to the system of prescription charges and exemptions will be dependent on our future financial settlements.'

BMA chair Dr Hamish Meldrum, said the proposals were 'a step in the right direction', but warned: 'Changes to the system short of abolition would still be unfair on the reduced number of patients who do not qualify for exemption. They would also run the risk of adding to bureaucracy, and increasing GPs' workload.

'Wales and Northern Ireland have abolished prescription charges, and Scotland is in the process of doing so. The BMA believes that England should follow suit.'

A person should qualify for exemption from prescription charges when, in the medical practitioner's view:

(1) they are likely to have a long term health condition that will persist for a period of at least six months; and

(2) there is a need for continuing management of the condition, although this does not have to be limited to management with medication.

Including:
- Long term health conditions where the condition may resolve over time.

- Asymptomatic conditions (such as hypertension)

- Treatment with drugs, including drugs for prevention; psychological therapies; periodic monitoring and review

- Patients exempt under the current rules, including the various criteria under which cancer patients are currently exempted from prescription charges.

Terminal conditions, even if the prognosis is that the patient will not live beyond 6 months

Source: Professor Ian Gilmore, Implementing Exemption from Prescription Charges for People with Long Term Conditions, May 2010

Click here to read the full report.