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A faulty production line

Should prescription charges be scrapped?

Prescription charging is an unfair and illogical tax, and one that prevents many patients getting the medicines they need, argues BMA chair Dr Hamish Meldrum. But Dr Mark Oliver warns that abolishing charges would put further pressure on the NHS budget and encourage abuse of the prescription system

Prescription charging is an unfair and illogical tax, and one that prevents many patients getting the medicines they need, argues BMA chair Dr Hamish Meldrum. But Dr Mark Oliver warns that abolishing charges would put further pressure on the NHS budget and encourage abuse of the prescription system

As doctors, most of us will be able to recall a situation where we've handed multiple prescriptions to a patient who then asks which is the most important drug. You watch them leave knowing full well that they won't take everything you've prescribed, not because they don't want to, but because they can't afford to. So the patient takes an NSAID without a proton pump inhibitor and ends up developing an ulcer and has to seek further treatment.

According to a survey by Ipsos MORI, in one year about 750,000 people failed to get their prescriptions dispensed because of cost. Not only is this unfair, unpleasant and stressful for individual patients, in many cases it also incurs a greater cost to the NHS.

The Government is conducting a review of prescription charges for those with long-term conditions. This is laudable, as the criteria have been the same since 1968 and the system desperately needs an overhaul.

Back then, children with cystic fibrosis were not expected to live into adulthood, whereas now it's a manageable long-term condition that requires a large number of drugs to be taken throughout life. Patients with an underactive thyroid are exempt from charges and do not have to pay for treatment if they develop a chest infection, yet patients with hypertension do.

But if the Government simply extends the list of exemptions, as it is proposing, how will it decide which conditions deserve exemption or at what stage of a disease a patient should no longer have to pay? Arbitrary lines would be drawn that would create a new set of winners and losers.

Coming up with a fair list of exemptions is almost impossible and just making it longer wouldn't make it fairer. We'd end up with a tiny proportion of prescriptions being paid for, which would be increasingly illogical and nonsensical.

Why tinker?

That's why the BMA's submission to the Government's consultation argued that rather than tinker with the current system it would be better to scrap prescription charging altogether, as has happened in Wales and will soon happen in Northern Ireland and Scotland.

But, opponents cry, what about the cost? Revenues from prescription charges are currently estimated at £450m a year.

The Department of Health expects that exempting cancer patients from prescription charges will cost about £15.6m a year. If the review recommends that antidepressants be exempt from charges, then at a rough estimate the associated cost would be £24m a year. Inhaled steroids for asthma would cost £11m a year and antihypertensive therapies £37m. The revenue raised by charges is bound to fall substantially.

Consider the other benefits associated with getting rid of prescription charges. The Government is looking to implement a vascular screening programme for the over-40s that is likely to pick up a large number of people who should have treatment for raised blood pressure and cholesterol. But what if patients can't afford the prescription charges for their treatment? The current system will undo the potential long-term benefit of vascular screening. Scrapping prescription charges would also lead to reduced hospital admissions and fewer of the complications that result from not taking the right combination of drugs. It is the most logical and fair way forward. Add to that the transaction costs of collecting and policing the present system, and loss of revenue would be far outweighed by the benefits of ensuring patients get the drugs they need.

Even if that wasn't the case, ultimately, the public pays. Prescription charges are a tax, but an unfair, bureaucratic and illogical tax. If the NHS needs the money, far better to raise it from general taxation, which is fair, logical, easy to collect and already pays for most of our healthcare.

Dr Hamish Meldrum is BMA chair and a GP in Bridlington, East Yorkshire

The one health issue guaranteed to kick up a storm among the great British public is any suggestion that patients should be charged for using services, whether it be 10p for a call to a GP's phone, £3 to park at a hospital or £7.20 for a prescription.

The culture of not paying for anything connected with healthcare is so deeply ingrained that it is difficult for politicians to resist public pressure against so-called 'taxes on the sick'.

Yet I believe reasonable charges for items such as those I've listed are helpful for the delivery of healthcare, which is what we should be focusing on. The nanny state attitude typified by calls for free provision of prescriptions and the like is not common to other developed nations, where systems of copayment exist and where services are better. Many services in secondary care are under pressure or difficult to access. Lack of funds is one of the reasons and surely we should explore every avenue to raise necessary money to bring services up to civilised West European standards.

The Department of Health estimates prescription charges bring in about £450m into the NHS each year, and this money helps pay for essential clinical services.

Is it really more important to have free cream for your eczema than to have your neighbour's messed-up son being able to access a decent child psychiatry service?

Is it more important to have free haemorrhoid ointment than to be able to have a colonoscopy quickly when you develop worrying symptoms that could be bowel cancer? Is it more important to have your glyceryl trinitrate free than to be able to get your coronary artery bypass graft done quickly and with good postoperative nursing care? When we have bed shortages in our hospitals, debating free prescriptions suggests we may have our priorities wrong.

Season ticket

People who need many prescriptions, such as myself, have the option of buying a season ticket at a modest monthly cost, interest free. Many groups are exempt from all charges, with more than 80% of prescriptions already delivered free of charge. Charging patients also encourages them not to abuse the prescribing system.

A recent Pulse analysis suggested prescribing rates were rising faster in Wales, where charges have been abolished, than in England. Most of us have seen elderly patients' hoards of free medicines that will never be used.

Free prescriptions may discourage people from seeking advice and medication over the counter at pharmacies and encourage inappropriate use of GP services for minor illnesses, with subsequent reductions in the time available for major medical problems.

The alternative is to abolish charges and rely on taxation at a time of increasing public debt on a gargantuan scale. But how many among the public are keen on paying further taxes now for other people's healthcare? Not many in my experience.

The likely result of abolishing prescription charges would be to put further pressure on those areas of the NHS budget where public pressure for spending is low - the Cinderella services such as psychiatry, dementia, rheumatology and elderly care.

We should focus on investment in areas where known deficiencies in care exist, using all available methods of raising funds. With Government comes the responsibility to explain why money has to be raised and what difficult choices have to be made.

Dr Mark Oliver is a GP in Stafford

Should prescription pricing be scrapped? Yes No

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