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Prescription charges adversely impact on patient care, say 40% of GPs

Two out of five GPs think prescription charges are having an adverse effect on patient care, with some patients having to choose between food and medication, Pulse has found.

GPs say they are told of patients ‘all the time’, particularly those with long-term conditions, who are not collecting their prescriptions because they can’t afford them, with 39% of respondents to a Pulse survey saying that the cost is adversely impacting on patient care.

Some GPs reported they are ‘reluctant’ to prescribe certain medications because of the cost of the prescription, although the majority - 52% of the 425 GPs surveyed - argued the charges are not having an adverse effect.

Meanwhile 27% of GP respondents said they want to see prescription charges scrapped, with 65% opposing the move saying it is a necessary cap on demand.

Pulse reported earlier this year that Dr James Cave, editor of the BMJ Group’s Drugs and Therapeutics Bulletin, had called for an end to all prescribing charges, saying they were a ‘poorly conceived, manifestly unfair tax’.

The Prescription Charges Coalition, a group of 30 organisations, including the British Heart Foundation and the Royal Pharmaceutical Society, are currently campaigning for prescription charges to be scrapped for people with long-term conditions.

But the likelihood of charges being lifted seems remote in light of the 40p price hike for the single prescription charge, which the Government announced in March, and CCGs saying they will crack down on GP prescribing to curtail millions of pound overspends.

Responding to Pulse’s survey, Dr Lucy Marchand a GP in Milton Keynes said: ‘I see patients all the time who haven’t been able to get prescription meds they need for hypertension and blood pressure etc that aren’t picking them up because they say they haven’t enough money to get them.’

While Dr Yera Shah, a GP in Hemel Hempstead said: ‘I am reluctant to prescribe several meds due to the cost of the scripts sometimes. Other times, patients are reluctant to cash scripts in as they can’t afford them.’

Dr Sarah Nelson, a GP in Worthing, West Sussex said that she was unsure whether charges should be dropped entirely, suggesting: ‘It might be more appropriate to extend them to more patient groups, but drastically lower the amount per item.’

However she did recognise the impact that charges could have on patients: ‘With multiple drugs for long term conditions such as asthma and hypertension, some low income patients do need to decide whether to eat or take their meds.’

She added: ‘Since wealth versus poverty is one of the biggest determinants of life expectancy, who are we to say that patients that prioritise food and fuel over medications are wrong?’

Dr Bill Beeby, deputy chair of the GPC prescribing subcommittee and a GP in Middlesbrough told Pulse that the current system, which has been in place for more than 40 years, was ‘grossly unfair’.

He suggested the NHS should look to harness more technological solutions, and suggested patient prescription charges could be tracked to trigger a cap when they have paid the equivalent of a prescriptions prepayment certificate.

Dr Beeby told Pulse: ‘There are a whole host of ways that they could make it fairer, I don’t know whether I’m of the “make it free” or “keep some charges” camp, it depends on my mood because there are arguments for and against.’

‘However, the current system is grossly unfair, it doesn’t in anyway relate to the cost of the drugs, it doesn’t relate to any sort of real need, it’s just quite random.’

He added: ‘But it’s not up for debate because the Government isn’t interested in changing it. Talking about things that might disadvantage many people, definitely isn’t going to be on the agenda.’

Survey results

Question: Do prescription charges adversely affect patient care?

Yes - 164 (39%)

No - 220 (52%)

Don’t know - 41 (9%)

 

Question: Should prescription charges be abolished?

Yes - 113 (27%)

No - 277 (65%)

Don’t know - 35 (8%)

 

About the survey: Pulse launched this survey of readers on 30 June 2014, collating responses using the SurveyMonkey tool. The 29 questions asked covered a wide range of GP topics, to avoid selection bias on any one issue. The survey was advertised to readers via our website and email newsletters, with a prize draw for a Samsung HD TV as an incentive to complete the survey. As part of the survey, respondents were asked to specify their job title. A small number of non-GPs were screened out to analyse the results for this question. Both question were answered by 425 GPs.

 

 

Readers' comments (10)

  • and their cigarettes, vodka, expensive TVs!
    Erm, the headline seems to omit the fact that the majority do not believe patient care is adversely affected are against the abolition of prescription charges!

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  • The difficulty is no one seems clear on why a prescripton charge was introduced in the first place.
    Do not forget the devolved NHS do not levy a charge, so its an " english" issue.
    It is the only "propotionate to illness" taxation in an otherwise alledgedly unlimitited " free at the point of delivery" system.
    If that was the aim the raft of clinical exemptions without means test make a mockery of it.
    If it was intended as a "deterrent" to face to face consultations to foster self medication over the counter the raft of clinical exemptions mean it does not work, overwhelming number of scripts issued are to exempt individuals.
    It seems to me, the product of a"lets slide in a contributary element proportionate to use and hope no one notices" taxation strategy of the 1970's.
    I suggest it is time to either officially announce this and rework the basis of charging or abolish the charge in the alledgedly National health Service.

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  • As ever when these hysterical stories are produced none of the patient representative groups or clinician groups mention the prepayment card.
    NO ONE on regular meds should need to pay more than about £10 / month. Why is this not pushed more when these stories periodically flare up?

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  • Vinci Ho

    I think we should focus one section of the population which is working but with low wages as children and those over 60 years are exempt for prescription fee anyway.
    This is exactly the issue of poverty at work which is is often avoided by politicians.
    These people simply needs help and many of them do swallow their pride going to food bank as their wages are too low to cover every essential commodities . It is shameful that some politician wanted to label that as creating dependence. There is Chinese saying,' only really want to shave the head when there are too many head lice ' . There are people in this society who really have no choice.
    No matter how much this government bragging about rise in GDP and employment rate, but we all know this is a untruthful and dishonest way to measure the real implication of this economy.
    As I said before, NHS was founded on the principle of social justice . Of course, we need to make sure the system is not abused but the Five Giant Evils of William Beveridge's ideology never go away , probably only present themselves differently , when we defend the principles of social justice.

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  • I don't doubt that there is someone who is genuienly so hard up that buying prescriptions is difficult.
    I would not disagree that the current payment system and exemptions is now far out balance and needs sorting.

    But....
    90% of prescriptions are free. The 10% that are paid for are for people who normally have enough money, i.e. working and not on lots of top up benefits. So how come they can't afford them? I would be sympathetic but I strongly suspect they are choosing 50" TVs, the latest iPhones, Sky subscription etc etc before they choose to pay for a prescription and that they claim the choice between food or prescription as a means of moral blackmail.

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  • Presumably, those that agree with charging are the ones that Pulse found agreed to charging for consultations in the earlier survey of 440 GPs. Is it always 4 hundred and something?!

    As for " 50" TVs, the latest iPhones, Sky subscription etc etc ", if I had a job that kept me on the breadline, then I think I would choose my 'opiates of the masses' that you list here to keep a hold of my 'illusions' of this crap world over an expensive prescription that may or may not help me but does earn a QOF point

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  • It's missing a point. Free health care is no longer viable and NHS is already rationing it's services. All of us, including patients will have to choose which services we would like to cut, in order to continue to have some form of free health care.

    Do you want free prescription? You can, and I know many patents who bully GPs into prescribing paracetamol for their child as they don't want pay £2. But this costs the nation over £10 to be prescribed for "fee" (cost of meds, GP time, admin time, pharmacy fee). In which case, the nation needs to stop complaining about other lack of resources and accept they cannot see their GP for a few weeks and long waiting list for referrals, limited cancer treatment, etc.

    We all need to be responsible for how we use country's welfare system and in broken Britain, it seems selfishness prevails.

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  • Vinci Ho

    Do not disagree that there are two polarities in here:
    (1) those who can certainly afford but 'avoid' paying for prescription fee by any means. Yes, it is a totally valid argument about whether some in those protected groups can still afford to contribute a fee.
    (2) those who are genuinely cannot afford because of poverty ,(at work or not).

    Question, however , is still directed back to any government of whether it seriously and constructively deal with these on making policy? And of course, this is not an unique problem for this country . To the left or to the right , it remains hardest to get the balance right but certainly not one policy fits all , as this current government thought it could provide some 'simple' answers to everything.........

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  • I don't think prescription charging really adversely impacts on patient care.

    It does however seem unfair that the people who contribute and pay into the NHS and those on fairly modest incomes of ~ £12 000 to £18 000 have to pay an £8 charge for a chest infection which is not clearing or an eczema exacerbation. Most of these people will not have a pre payment card.

    Making the NHS "fairer" to people who actually contribute into it will be wholly unnacceptable to the general public and it will be a very different NHS to the one we have now.

    Making all prescriptions free for everyone will not be a good idea either as (some) people will just have OTC medications on their repeats for GPs to manage - as many of those have who are entitled to free medications already have.

    Maybe all cheap (< £3 / week) OTC medications should be removed from NHS prescribing and we should be able to ask patients to buy products over the counter. This could allow us to reduce the prescription charge to £4 or £5 which is more likely to be acceptable to patients who have to pay for their prescriptions.

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  • @3:05pm- Excellent post
    I am presently doing a systematic review on fixed copayment as a form of cost sharing for prescriptions. There is no strong evidence that minimal cost sharing (in this case- fixed copayment) affects medication adherence/utilization. The issue is that we need to find the point of minimal cost sharing.
    There is some evidence that high cost sharing can reduce medication adherence but there is overwhelming evidence that cost sharing reduces expenses on the part of the government/insurance paying for these prescriptions, hence, cost savings.
    I think prescriptions charges should be reduced to a reasonable level and get more people out of the exemption group to pay for prescriptions.
    It is ridiculous that only 10% of the population pays for prescription yet prescription charges keep climbing every year.

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