Peter Lapsley: Unfairer charges

Peter LapsleyThey’ve done it again!

While prescription charges were abolished in Wales in 2007, Northern Ireland in 2010, and Scotland in 2011, the Department of Health in England increased them from £7.40 to £7.65 from 1 April this year. To put that into more graphic context, anyone required to pay the charges would have to find an eye-watering £22.95 if they were to have just three prescriptions fulfilled. The charge raises an annual total of £450m for the Exchequer—a relatively paltry sum in terms of national revenue but a very painful increase for NHS patients, and one which seriously risks denying them access to the treatments they need.

The department argues that 88 percent of people receive their prescriptions for free. What they do not say is that the remaining 12 percent—around 6.3 million people—matter, and that they include some of the most financially squeezed in society, those with just sufficient income to make them ineligible for state benefits.

Every GP in the country must have had patients with multiple prescriptions asking which of them are the most important because they cannot afford to pay for them all. Every pharmacist must have seen patients spinning out a month’s prescription for two or three months in order to avoid having to pay for repeat prescriptions. That seriously undermines the quality of care upon which the NHS rightly prides itself. In truth, the prescription charge is no more or less than a tax on the sick, often on those who can least afford it.

Healthcare available to all regardless of ability to pay, and free at the point of delivery? I think not.

Incidentally, the increase in prescription charges has not amused pharmacists either. It has inclined increasing numbers of people who pay for their prescriptions with credit cards, and pharmacists have to meet the charges levied on each transaction.

The young, the elderly, and pregnant women aside, the catalogue of those exempt from prescription charges is a shambolic hotchpotch of conditions which the Department of Health has repeatedly declined to review, to the considerable frustration of patient groups, presumably because it is seen as too potentially contentious a minefield into which it would be dangerous to venture. There is a far simpler and better solution, though, which is to scrap prescription charges altogether. No patient or health professional could possibly argue with that.

It is to be hoped that the BMA, the Royal Pharmaceutical Society of Great Britain, and the other medical Royal Colleges will make these points to the Department repeatedly and forcefully until eventually the civil servants concerned summon the courage to tell the Treasury that the footling sum raised by the charges is massively offset by the damage it does to the health of large numbers of needy people.

Peter Lapsley is patient editor of the BMJ.