Peter Lapsley: Unfair charges

Peter Lapsley The decision by the Scottish Parliament to follow Wales and Northern Ireland, and to abolish prescription charges from April next year leaves the Department of Health out on a limb where England is concerned. The case for doing away with the charges is incontrovertible. At £7.20 per item (£28.25 for a three-month exemption certificate or £104 for an annual one), they make nonsense of a health service said to be “free at the point of delivery” and to be provided ‘according to need, rather than ability to pay’. They cost almost as much to collect as the roughly £450 million they bring in in revenue. And they are patently unfair, discriminating against the most vulnerable people in society.

Stories are rife of patients asking their GPs which of their prescriptions are the most important because they cannot afford them all, having only some of their prescriptions fulfilled, or spinning out a month’s treatment for two or three months to postpone having to pay for repeat prescriptions.

In England, prescriptions are free for children under 16, those aged 16 to 18 who are in full-time education, and for people aged 60 and over; for pregnant women and mothers of children less than a year old; for people entitled to NHS tax credit exemption or HC2 certificates; or for people receiving income support, income-based jobseeker’s allowance, income-related employment and support allowance, or pension guarantee credit. They are also free for many people with a number of chronic conditions including cancer, a permanent fistula, hypoadrenalism, hypopituitarism, hypothyroidism requiring thyroid hormone replacement, diabetes mellitus, myasthenia gravis, epilepsy, and permanent, continuing physical disability.

So lengthy a list may appear to be exhaustive but it is not. It excludes people with a range of conditions such as asthma, multiple sclerosis, rheumatoid arthritis, and Parkinson’s disease, all of which require long-term medication.

Even so, 88% patients are exempt, leaving only 12% (just over six million people) paying for prescriptions. But included within that 12% are some of the least well-off in society. By this I mean people who earn just too much to qualify for income support and other benefits but not enough to enable them easily to afford prescriptioncharges.

Both the British Medical Association and consortia of medical charities representing patients have called repeatedly for the abolition of prescription charges in England. The Department of Health has proved inexplicably reluctant even to review the list of chronic conditions which provide exemption from the charges, let alone to scrap the charges altogether, which is what should undoubtedly be done if Britain really is to become the ‘fairer society’ about which the government goes on at such length.

In May this year the report on a review led by Professor Ian Gilmore, President of The Royal College of Physicians, was published: Prescription charges review: implementing exemption from prescription charges for people with long term conditions.

The problem was that it was limited by its terms of reference to recommending the extension of free prescriptions to chronic conditions not already included in the catalogue of exemptions, rather than the scrapping of the charges altogether.

It therefore risks perpetuating much of the unfairness of the present system, rather than resolving it. The government has said that any decisions on changes to the system of prescription charges and exemptions will have to be taken in the context of this autumn’s Spending Review.

It is to be hoped that they will go beyond Professor Gilmore’s recommendations, follow the examples set by Scotland, Wales and Northern Ireland, and scrap prescription charges altogether.

Peter Lapsley is patient editor, BMJ.