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Prescription charges have been with us for a long time €“ over 60 years, in fact. It was 1952 when they first came in, as a charge for each prescription form, and then in 1956 for each item. Apart from a short reprieve between 1965 and 1968, they have been a thorn in the side of community pharmacy ever since.

I say thorn in the side because, for as long as I have been a pharmacist (and that's quite a few years now), I have had patients telling me they could not afford the charge and asking me to advise them on which item was the most important.

I know that all community pharmacists have similar experiences. But prescription charges have now reached the point where they are counter-productive and contribute both to health inequalities and social exclusion. Reform €“ or better, abolition €“ is long overdue.

In 2006 the Health Select Committee recognised that the current system was flawed, inequitable and unfair: in particular, prescription charges were not universal and had been abolished everywhere in the UK except in England. The list of medical conditions where patients were exempt from charges was inconsistent and arbitrary (why, for example, should a person with diabetes also be exempt from prescription charges for a treatment for migraine?). And blanket exemptions for older people or during pregnancy meant that people on relatively high incomes might be exempt while people on low incomes were not.

The Gilmore Report

The need for reform (some would say abolition) of prescription charges was obvious and, in 2008 the government commissioned Professor Ian Gilmore to examine the case for exempting people with long-term conditions from paying prescription charges.

The Gilmore report recognised the difficulties that would be involved, not least in defining what was meant by 'long-term condition', but found that none was insurmountable and made 10 recommendations that would lead to exemptions from prescription charges for people with long-term conditions. One of the recommendations concerned how new exemptions could be phased in, and proposed a quite elegant solution. The pre-payment certificate scheme, which was already targeted at people with long-term conditions, could be employed with a stepwise reduction in the cost until it was only nominal. That this might not be entirely straightforward was also recognised in the report.

The uptake of the pre-payment scheme at the time was low, largely because of poor awareness, high up-front costs and a system for purchasing that was not patient-centred. Gilmore suggested that awareness and uptake could be improved by making certificates more widely available in pharmacies and enabling people to qualify for a certificate after paying the equivalent cost in accumulated prescription charges managed through a loyalty card mechanism or by registration with a pharmacy.

And the result was ...

So, the case for change is compelling and a mechanism for reform has been proposed. But what has actually happened? The answer is nothing. On April 1, the prescription charge was increased by 20p, in line with inflation.

And yet, since the findings of the Health Select Committee and the Gilmore report, still more evidence has been gathered that points to an ever more urgent need for reform or abolition of prescription charges for people with long-term conditions. In February of this year, the Prescription Charges Coalition, a group of 30 organisations campaigning to end unfair prescription charges for people with long-term medical conditions, published its report on the impact that prescription charges have on employment. 'Paying the Price' is based on a survey of over 5,000 people of working age with long-term conditions for which they need prescription medicines. Most (77 per cent) of those who took part in the survey were in employment and 74 per cent did not receive any benefits.

Overall, 37 per cent of respondents reported that the cost of the prescription charge prevented them from obtaining all the medicines they needed for the treatment of their condition. Of these, 74 per cent said that this impacted on their ability to work normally, with 72 per cent having to take time off work as a result and over half (59 per cent) taking more than six days off work.

The survey also found €“ as you would expect €“ that prescription charges had a disproportionate effect on people on the lowest incomes. For respondents with earnings of between £5,000 and £15,000 a year, the proportion reporting that cost had prevented them from collecting their medicine was 45 per cent. For those with incomes between £15-£25,000 the proportion was 40 per cent. And for those with incomes over £35,000 the proportion was 20 per cent. This aspect of the report is particularly important. Prescription charges have become a factor that limits the life opportunities of people with long-term conditions. It is bad enough that long-term conditions often have a detrimental impact on educational attainment and aspirations, on career opportunities and income, and on premature retirement, but it is nothing short of a disgrace that, on top of all this, many people affected in this way cannot afford to pay for all the medicines they need to treat their conditions.

Self-rationing

Many, especially younger people, resort to self-rationing, attempting to prioritise between medicines that are essential to their survival and those that help them to cope, such as preventative medicines or painkillers €“ a situation with which pharmacists are sadly all too familiar.

So what is to be done? The English Pharmacy Board says: €Linking the prescription charge to the repeat authorisation, rather than to each prescription form, is likely to increase medicine adherence through reduced costs and inconvenience for this very specific group of patients.€ That is so woolly I don't understand what it's supposed to mean.

Alternatively, we could press for the recommendations of the Gilmore report to be implemented. The Prescription Charges Coalition has launched an e-petition to this effect on its website and I will be encouraging all my patients to sign it.

There is a phenomenon called the 'law of unintended consequences'. The unintended consequence of prescription charges is that they are putting many people into medicines poverty. It is unfair and inequitable that patients are being disadvantaged by being forced to make decisions about the medicines they need based on their ability to pay. In an advanced economy like ours, this is surely unacceptable.