The Pharmaceutical Journal
Vol 277 No 7410 p92
22 July 2006

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NHS charges a mess, concludes parliamentary health committee

Prescription charges, and the current system of other NHS charges, are in a mess and must change, although there is insufficient evidence to decide on the best way forward, the House of Commons Health Committee has concluded following its inquiry into NHS charges. However, in its report published this week, the committee recommends several short-term changes, which it says should be implemented immediately and will lead to small improvements for patients.

During the inquiry the committee heard a number of options for major improvements to the system of NHS charges each with positive and negative consequences, says the report.

The committee recommends that work on the costs and benefits of the different possible systems needs to be carried out urgently so that an alternative charging system, with consistent underlying principles, can be developed (see Panel). It also recommends that evidence should be gathered on public attitudes to health charges, the extent to which health charges affect the use of health services and, in the long term, health, and the extent to which charges reduce “frivolous” demand.

In the meantime, the committee proposes that a monthly prescription pre-payment certificate (PPC) should be introduced to help people on low incomes who cannot afford to buy an annual PPC. It recommends that the cost of a monthly PPC be capped at the cost of one prescription and that of a yearly PPC capped at the cost of 12 prescriptions.

The committee also recommends that the Government should investigate the use of a limited NHS formulary of medicines, which it says could address the problem of GPs prescribing over-the-counter medicines for people who are exempt from prescription charges. It proposes that this could be linked to a system of reference pricing, whereby patients are charged different fees according to which medicines they choose to use within a particular class of drugs.

Rob Darracott, director of corporate and strategic development at the Royal Pharmaceutical Society, gave evidence to the committee’s inquiry earlier this year (PJ, 4 February, p125).

Commenting on the report, he said: “The committee’s conclusion that there is a woeful lack of evidence about the effect of charges, and therefore about the consequences of making changes quickly, is entirely consistent with the Society’s evidence to the committee. The Society’s Council revised its policy on prescription charging in 2004. The policy confirmed our long-held position that there should be no financial barrier to the use of prescribed medicines and that the current system of charges and exemptions is illogical and unfair and called for a major review of the current system in a way that would have little or no deterrent on use.

“We suggested then that research into the impact of charges on people should be undertaken as we concluded that any change to the prescription charge system would require careful planning and implementation, not least to avoid destabilising welcome moves to improve access to medicines from pharmacists through minor ailment schemes and medicines reclassification.”