The Pharmaceutical Journal
Vol 270 No 7254 p856
21 June 2003

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Concern over workload implications of ending prescription charges in Wales

Wales is on track to abolish prescription charges. Debbie Andalo found that community pharmacists on both sides of the border are concerned about the potential effect of the move on their practice

Community pharmacists in Wales are concerned that their workload could soar when prescription charges are abolished.

Welsh Assembly first minister Rhodri Morgan confirmed earlier this month that the Labour administration will fulfil its election manifesto pledge to abolish all prescription charges. A consultation programme, which will include the most workable options and a timetable for implementation, is being launched with a commitment that changes will be brought in within the next four years.

Wales is now on track to be the first country within the United Kingdom since 1968 to offer free prescriptions for all. The decision will benefit around 1.5 million patients (11 per cent of all patients in Wales) who do not currently receive prescriptions free of charge, but it will also create a £30m loss in prescription charge revenue.

Abolishing charges for everybody in Wales was the obvious next step following decisions by the Welsh Assembly to freeze charges at £6 an item in 2000 and then to abolish charges for all under-25s from April 2001.

Details of how a system of free prescriptions will work and the timetable of the proposed consultation have yet to be decided, but the intention is that there will be a gradual move towards abolishing all charges during the current term of office.

One option being considered is a gradual increase in the list of chronic conditions that are exempt from a prescription charge. Arthritis and lung disease are being mooted as the first likely additions to any extended exemption list.

Issues to be resolved

Community pharmacists and leaders of the profession in Wales have highlighted some issues that need to be resolved before Labour can live up to its election pledge. For example, they are unable to predict the full financial implications of the new policy until more details are known, but they are concerned that any new system will mean more work.

A similar warning about workload was first made by GPs when the political promise appeared in Labour's Welsh Assembly election manifesto before voters went to the polls (PJ, 19 April, p534). GP leaders said at the time that it was imperative that schemes were set up to allow pharmacists to supply medicines within the National Health Service for minor and self-limiting conditions.

Abolishing the prescription charges may have workload implications for community pharmacists as well as GPs if patients decide to seek a prescription for a medicine rather than buy a non-prescription alternative. The chairman of Community Pharmacy Wales, Phil Parry, comments: "It could increase the workload for ourselves and GPs if patients decide to use prescription medicines rather than buying over-the-counter products. Unless we can find a mechanism to deal with that there will be an increase in volume."

Free prescriptions for all could also increase the number of patients crossing the border from England to have their prescriptions dispensed in Wales. Since the Welsh Assembly decided to offer free prescriptions for the under-25s there has been a small increase in the number of all prescriptions dispensed in Wales compared to England. But Mr Parry, who runs a pharmacy in Crymych, Pembrokeshire, says that it is not possible to attribute the rise to the policy change.

He adds: "I don't want to prejudice the consultations that the health minister has said, in the Assembly, that she is setting up, but this issue is going to take some careful working out. From a patient point of view the policy looks good. We are going to have to find a way around any workload implications to try and find a win, win, win situation for everybody."

Bob Gartside, northern regional officer for CPW, said that the decision to abolish charges fits in well with the Welsh approach to the development of community pharmacists becoming supplementary prescribers. He says: "The position in Wales is that a lot of the supplementary prescribers will be in community pharmacy because that is where the work is. My main concern however is workload. Some people are already very hard pressed and have reached the limit of the amount of work they can do and they don't know how they can cope with the extra workload of free prescriptions."

The Royal Pharmaceutical Society's Welsh Executive is to launch a review of how prescription charges act as a barrier to treatment to inform the consultation process. Committee chairman Andrea Robinson says: "We will be fully participating in the consultation process outlined by the First Minister."

Effect in England

Community pharmacist Alan Screen is also a member of the Welsh Executive and is chairman of the Society's Powys branch, although he practises across the border at Bishop's Castle in Shropshire. He hopes that the English and Scottish Parliaments will follow Wales and abolish charges altogether, but he adds: "My main concern is the disparities created by unilateral policy on one side of a border."

Other community pharmacists working in England close to the Welsh border share his concern and are worried their income will drop if patients travel across the border to get their prescriptions for nothing.

John Gentle is a community pharmacist in Oswestry, practising only 400 yards from the Welsh border. He revealed that the 18-year-old son of one of his members of staff regularly travels the short distance into Wales to get his prescriptions for free. Mr Gentle, who is also chairman of Shropshire Local Pharmaceutical Committee, says: "I can't really blame him and I think if I were his parent I would encourage him to do the same. Although the decision to offer free prescriptions to the under-25s didn't create any major difficulties for us, the implications to offer free prescriptions for all may be great."

A spokeswoman for the Welsh Assembly could only confirm that it was committed to abolishing prescription charges for all during this term of government and that consultation would start "shortly." No further details are available.

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