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Reform exemptions to prescription charges

By Mike Broad - 27th May 2010 3:32 pm

A wider definition of long-term conditions should be adopted when considering whether patients should be exempted from paying prescription charges, a report urges.

The review into prescription charges, led by Prof Ian Gilmore, president of the Royal College of Physicians, says GPs should decide whether a patient should be exempted under a broad definition of long-term conditions.

A patient would qualify if they had a condition for at least six months and needed ongoing management of the condition. The exemption would last for three years.

However, health minister Simon Burns poured cold water on the plans, saying a decision on charges and exemptions cannot be made before the spending review due in the autumn.

The prescription charge is currently £7.20 and raises about £435m per year for the government.

The review, which was commissioned by the previous government, suggests that disagreement over whether a patient is suffering from a long term condition should be resolved using existing processes - there shouldn’t be an appeals process. Existing processes include seeking a second opinion, or joining another GP practice.

The review accepts its proposals will not be popular with GPs, particularly the potential to damage their relationship with patients if they decide their condition does not warrant exemption.

Prof 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“The present list of exempted conditions is outdated and arbitrary, and the approach in this respect has gained strong support from professional and patient groups alike.”

Last year, in England, cancer patients were added to the exemption list.

The BMA has called on the Department of Health to abolish prescription charges in England altogether, and Gilmore’s review also calls for consideration of wider reform.

Wales introduced free prescriptions in April 2007, and Scotland and Northern Ireland are currently reducing charges prior to free prescriptions in April 2011 and April 2010 respectively.

Dr Hamish Meldrum, chairman of BMA council, said: “The prescription charge system that presently applies in England is a mess. It is full of anomalies and runs counter to the principle of an NHS that is free at the point of use.

“These proposals are a step in the right direction and, as such, are to be welcomed. However, 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.

“We really have to question whether the small financial benefit of retaining charges outweighs the many disadvantages of taxing the sick.”

Read the full report.

Tags: Prescription charges
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Government stalls on free prescriptions pledge

The Observer - 25th January 2010 12:31 pm

Gordon Brown is facing a backlash from charities representing up to 15 million people with long-term health conditions after it emerged a promise to give them all free prescriptions is likely to be shelved until after the general election.

The prime minister made the pledge to people with conditions such as asthma, heart disease, diabetes and depression in his speech at the Labour party conference in September 2008.

Instead of implementing the change for all those patients, it is now expected to be included in the party’s manifesto.

A coalition of 20 health charities fears that, with Labour behind in the opinion polls and the Tories giving no firm commitment to the plan, the promise will never be realised.

Mikis Euripides, director of policy and public affairs for Asthma UK, which is leading the coalition, said: “If the Labour party decides to put something in the manifesto instead of acting now, that would be a complete failure on the part of the prime minister to keep a promise.”

Free prescription review “may run out of time”

Healthcare Republic - 29th December 2009 6:43 pm

Plans to scrap prescription charges for long-term conditions may fall by the wayside in the build-up to next year’s general election, an Asthma UK spokesman has warned.

Last year, Prime Minister Gordon Brown revealed that prescription charge exemptions were planned for patients with long-term conditions. The DoH asked Royal College of Physicians’ president Professor Ian Gilmore to lead a review into how exemptions could work. Professor Gilmore’s review has yet to be published, however.

Asthma UK is leading the Prescription Charges Coalition, a group of organisations campaigning for the government to abolish prescription charges for people with long-term conditions. The charity’s director of policy and public affairs, Mikis Euripides, said the government needs to publish Professor Gilmore’s review and details of its plans early in 2010 if the changes are to take place.

“The government will need to introduce legislation,” he said. “Assuming there is a May general election, it will need to do that by February because of the time it will take. We are concerned that if nothing happens, the government won’t have enough time.”

If the election were earlier than May, it would already be too late to put legislation through, he added.

Patients not applying for free cancer drugs

BBC Health - 31st August 2009 4:37 pm

Nearly two thirds of the 150,000 cancer patients in England have not applied for free prescriptions - five months after they became available.

The £7.20 prescription charge was abolished for cancer patients after decisions in the rest of the UK to scrap all fees. People have to fill in exemption forms to qualify, but charities said GPs were not promoting the scheme.

Doctors’ groups responded by saying bureaucracy was putting patients off.

The five-year exemption forms are only one page long and would save the average cancer patient £100 a year.

Prescription charge increase is daylight robbery

By Stephen Campion, chief executive of HCSA - 7th August 2009 5:21 pm

It is not often that I bare my soul to a public audience but, like most men of my age, my GP has prescribed statins and ace-inhibitors to control my cholesterol and blood pressure. There are millions like me all over the country who, subject only to a six monthly check up, trot over to the local pharmacy when necessary to replenish stocks for the medicine cupboard.

But no amount of ace-inhibitors could have stopped me from reacting the way I did when I popped over to my local chemist this week. Usually I am prescribed two months supply. Each prescribed medication costs £7.20, so I am faced with a bill of £14.40 every couple of months. But this time I was “allowed” only one month’s supply.

At a stroke (pardon the pun but so nearly true) my drug costs have doubled. Why? Because according to my pharmacist, the local PCT has instructed that all prescribed drugs be limited to one months supply in order - wait for it - to reduce wastage.

I despair! For me this is not about money but the principle. This is logic of the mad house. It cannot be right for an unelected, unaccountable and unseen PCT to levy such a massive hike in charges for those who need prescribed medication.

What next? A fortnight’s supply and then a week’s supply? This is not a stealth tax; it is deliberately designed permanently to deprive patients of their money. It is tax by stealing.

I see some loan shark got a few years in jail for ripping clients off and demanding extortionate charges. After the trial one of his victims said: “These people prey on people’s misfortune.” How true!

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What does that IKEA bathrobe for 20 quid tell us?

By Sarah Burnett-Moore - 22nd June 2009 12:24 pm

This week Andy Burnham gave the NHS a vessel of empty promises. This glib new minister claims to have been inspired by dedicated hospital workers, so let me unpick the new Labour pledges.

I’ll start with Burnham’s apparently impeccable CV - faith school, Cambridge, parliamentary researcher, spin doctor, MP. In fact the bloke has never had a proper job and I don’t anticipate that he’ll do a decent job now.

When he talks, he holds his hands in that Tony Blair, ‘I’ve just dropped my football’ position, except his football is bigger than Blair’s ever was. Heaven help us if there’s a correlation between the amount of spin and the size of the imaginary football (I’d say at a rough estimate we can anticipate it’s going to be quadrupled).

If you look at his personal website, there’s a typo on the welcome page. For a chap with an MA in English, that does not fill me with confidence in his ability to sort out the single biggest organisation in the UK, and indeed the third biggest employer in the world (for all you anoraks, the Chinese Army wins followed by the Indian State Railway).

Let’s not forget, this is the chap who whinged repeatedly to the Parliamentary fees office, that if they didn’t allow him one single claim for over £16,000 he might have to get a divorce. He also charged tax payers £19.99 for an IKEA bathrobe, wearing one would be grounds for divorce alone in my opinion.

According to The Mirror, in an article written in the most oleaginous flattering terms, he had this epiphany when he met a hospital porter. To quote: “He spent two weeks travelling around the country, spending a day alongside frontline staff.” So what the heck was he doing the other 13 days? Racking up more ridiculous expense claims no doubt…

So what are the promises? Free prescriptions will be considered. Apparently 80% of the population never pay anyway and cancer patients get free prescriptions - I’ve always had to pay for my NHS prescriptions for Tamoxifen, so how does that work?

Further improvements in NHS dentistry are essential. It should be pretty easy to improve the handful of remaining NHS dentists, if you can find one.

Burnham also insisted he “would finish the job of ending the scandal of mixed-sex wards”. Hold on a sec, no one has even started the job yet.

He wants more health authorities to plough money into gym sessions, exercise bikes and time at swimming pools. Good thought you might think, but here’s the rub. He wants DOCTORS TO MAKE SURE THEY ACTUALLY USE THEM. Sorry to get shouty, but it’s hard even to get all your sodding patient’s to turn up. What are we supposed to do? OFFER THEM A LIFT.

That’s it. Five objectives. Great. Chancellor Alistair Darling has already warned that taxes will have to go up to cover the cost of these earth-shattering initiatives. At this rate, I’m going to have to get in on it and start employing my husband…

Tags: Andy Burnham, Prescription charges
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Review of prescription charges

By Mike Broad - 21st April 2009 11:08 am

In April, prescription charges for cancer patients in England were abolished.

While oncologists are relieved that the government has removed a significant deterrent to their patients accessing appropriate medicines, others want further reform of the charging system. All other conditions subject to prescription charges remain unchanged, despite evidence suggesting the system is both iniquitous and detrimental to patients’ health.

Many ask why cancer should be exempted when asthma, multiple sclerosis and mental health problems aren’t? These also involve the kinds of people who cannot afford the medicines they need – with the prescription charge increasing to £7.20 for 2009/2010 – which can lead to further problems with unplanned hospital admissions.

Back in 2001, research by the Citizens Advice Bureaux showed that 28% of those who had paid charges failed to get all or part of the prescription dispensed because of the cost. This was estimated to be about 750,000 people, with single parent households and those with long term conditions being worst affected.

Then in 2006, Royal Pharmaceutical Society of Great Britain research suggested that patients couldn’t understand the rationale on exemption and felt the charge was too high, particularly for those taking multiple medications.

Wales introduced free prescriptions in April 2007, and Scotland and Northern Ireland are currently reducing charges prior to free prescriptions in April 2011 and April 2010 respectively.

In England, the government has set up a review of prescription charges – led by Professor Ian Gilmore, president of the Royal College of Physicians – to consider which long-term conditions should be exempted. But, it is not the fundamental review of the purpose and value of prescription charges that many would like to see.

The BMA is calling on the Department of Health to abolish prescription charges in England altogether.

It claims that the current exemption categories are often illogical and unfair, and extending these categories to include long-term conditions will add to the inequities in the system and create new ‘winners’ and ‘losers’.

Legislation providing for prescription charges was not passed until the Labour Government’s NHS (Amendment) Act 1949. This enabled such a charge, and exemptions to it, to be introduced by regulations. Although the power was introduced in 1949, the charge itself was not introduced until 1952, under a Conservative Government. Apart from a period between 1965 and 1968, a prescription charge has continued in England ever since.

The current list of exemptions has been unchanged since then and does not reflect changes in medical treatment.

The BMA highlights exemption inconsistencies. Patients on thyroxine replacement therapy for an under active thyroid are exempt from charges, despite it being a cheap drug, while those with asthma and heart disease, who may require multiple medication for a prolonged period, are not. Similarly cystic fibrosis, which requires people to take a large number of drugs throughout their life, is not exempted because 40 years ago patients didn’t survive beyond childhood.

Defining a modern, definitive list of exempted chronic diseases is not easy, and is complicated by increasing polypharmacy and comorbidity.

But then scrapping prescription charges is not yet considered an affordable policy option for the NHS. While only 11% of prescriptions attracted a charge (and this will have lowered with cancer’s exemption), this still generates £450m per year in revenue. Cancer’s exemption will reduce this by about £16m a year.

Jonathan Fielden, chair of the BMA’s CCSC, said: “In NHS terms the revenue from prescription charges is a relatively small sum and comes with immense bureaucracy,” he said.

“It means some individuals are parting with considerable amounts of money to treat their conditions while others, with similar health burdens, are not. It would be more equitable if charging were done away with altogether. Instead of spending money on PFIs or the private sector, we should invest in scrapping prescription charges.”

The Government is clearly opting to take the middle ground agreeing that access to certain medicines needs to be improved, calling for a fairer system of prescription charging in England and setting up a review limited to long term conditions.

If, of course, its findings prove insubstantial or inconsistent when it reports to the health secretary this summer then pressure will continue to mount for a full review of the prescription charging system.

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