The long-term plan has lots of ideas about how the NHS can evolve but getting rid of prescription charges is not among them, our correspondent insists…

 

 

It is no surprise to hear that the prescription charge is to go up to £9 an item on April 1.

The news was given in a written statement to parliament by Baroness Blackwood, a mere under-secretary at the Department of Health and Social Care, with the additional information that the prescription charge income netted by the government is expected to rise broadly in line with inflation.

All very low key, no great political ructions, all very routine…

Back at the dawn of time in 1948, the NHS was meant to provide a completely free health service for everyone but a growing drugs bill prompted the introduction of prescription charges in 1952.

Back then the plans, first put forward by the Attlee government in 1951, caused a major furore, leading to the resignation of a string of ministers including the ‘father’ of the NHS Aneurin Bevan and the future Prime Minister Harold Wilson.

Following Labour's election defeat in October 1952, the Conservative government set the charge at one shilling per prescription form.

By 1956 the NHS had taken off and pharmacies in England were dispensing 228 million items per year at a cost of £58 million. The government raised the charge to one shilling per item to compensate. Three years later this went up again, to two shillings per item.

In 1965, under Harold Wilson, Labour abolished prescription charges. This caused the NHS drugs bill to soar, as many low-cost items that patients had previously bought for themselves were increasingly prescribed (funny thing, that!).

Labour restored prescription charges in June 1968 at a higher rate of two shillings and sixpence per item, but introduced a range of exemptions for old and young people, people on benefits and people with chronic diseases such as diabetes.

Upon decimalisation in 1971, the prescription charge was 20p per item, where it remained until July 1979, when the new Thatcher government increased it to 45p. Charges were increased twice in 1980, to 70p and then to £1 in December. They have risen every subsequent year since 1982.

There has been the token criticism from the Royal Pharmaceutical Society about next month’s increase. There has not been any comment from the British Medical Association because basically it is not a problem for its members.

There will be grumbles from various patient groups and a few more items will be endorsed ‘ND’ as the unfortunate few decide what they feel they can do without.

Of course, those of you who practice in other parts of the UK will not feel the same sense of frustration as pharmacists in England. We must be up front here. Not that many people pay the prescription charge. A quick look on Check34 shows that of the 7,500 items or so I dispense every month, only 7.5% attract a charge.

I don’t have a problem with asking people to pay something towards the cost of their NHS treatment. I’ve often wondered how GPs have wriggled out of taking a consultation fee from patients - say £9 unless you are a pensioner or suffering from a long-term condition.

A fee charged at the point at which a patient enters the system seems so much more logical than an arbitrary levy on the medicine you are prescribed.

But the bottom line is that the prescription charge became an anachronism years ago. The exemptions list has not been revised in the 50 years since it was introduced – except for the addition of cancer as a condition in 2009. Many people with long-term conditions such as Parkinson’s disease still end up paying.

The pension age has gone up to 67 for most people, yet the exemption age has remained at 60. The item charge bears no relation to the cost of the medication we are providing.

Although the national average item value was £8.38 for November 2018 (again, according to Check34), this figure is horribly skewed by expensive items and the majority of items cost way less than £9.

With government clamping down on the prescribing of medicines for minor and self-limiting conditions, one of the reason charges were introduced in the first place has been removed.

The NHS Long Term Plan has lots of ideas about how the NHS might evolve but getting rid of the prescription charge does not appear to be among them. Health secretary Matt Hancock is happy to put faxes in the skip and outlaw pagers but some other old habits are obviously harder to kick!

One bit of good news that has leaked out of the woodwork recently is that Boots is planning to switch from monitored dosage systems to patient pack dispensing in care homes.

Having led the pack in offering MDS to care homes free of charge to help drum up business, the company has now presumably decided that the time has come to make economies – and the cost and effort involved in supplying MDS is significant, as we all know.

The move has been dressed up as being in line with recommendations made by the National Institute for Health and Care Excellence and the Royal Pharmaceutical Society but since these were made in 2014 and 212 respectively, that doesn’t really come across as convincing.

As a compliance aid, MDS is fine for folk living at home or in sheltered or warden-assisted accommodation but I have never understood the rationale for providing it to care or nursing homes where most medication is administered by the staff. I won’t be sad to see them dropping out of favour in that environment.

Care home staff may find the move to patient packs means they have to think more about what they are doing and it will take longer to pop tablets out of blister packs than a single MDS compartment. But time-saving apart, it is hard to see what advantage MDS offers in care homes.

Except that…care homes do not have a good track record when it comes to medication errors. Recent figures suggest that nearly 42% of medication errors occur in care homes and medicines administration accounts for the majority of those.

And this is despite the fact that all care home staff who administer medicines are required to undergo a recognised training course and a practical assessment to ensure they are competent.

 

Something to keep an eye on, then…

 

 

Picture: Tom Merton (iStock)

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