The Pharmaceutical Journal
Vol 280 No 7494 p324
22 March 2008

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What was left unsaid

A prescription charge paradox

What was left unsaid

Although the percentage of prescriptions being dispensed electronically remains low, for the first time there may be signs that the number is creeping upwards (p326). Some explanation for this slow uptake was offered at the 2008 local pharmaceutical committees conference (organised by the Pharmaceutical Services Negotiating Committee) held last week.

It must be a situation familiar to many pharmacists and primary care trusts. On the Isle of Wight — a well defined area — GP surgeries all use the same system. This is not surprising since the primary care trust recommended they all adopted it — and funded them.

Pharmacists, on the other hand, theoretically have nine systems on offer and little financial support (p345). Homer Simpson could have worked out why things are moving so slowly for pharmacy.

And it was revealing that Dawn Primarolo, speaking at the PSNC dinner (p325), was full of optimism about the prospects for the profession. She gave some indications of what would be unleashed by the White Paper when it is published later in the year and confirmed pharmacy’s position in the new world order of primary care.

However, she studiously avoided mentioning how any of this would be funded — and for a minister who, until the reshuffle last summer had spent all her time in political office in the Treasury, she will have been fully aware of the impact of her words, or rather the lack of them.

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A prescription charge paradox

Pharmacists in England who believe the phasing out of prescription charges would be a good thing in all circumstances should look to Wales (where charges were phased out last year). This week, we carry a report (p330) that shows that the phasing out of prescription charges has been linked with a drop in the sale of antihistamines.

It seems that some patients who previously would have bought products from their pharmacies are, instead, seeking a free prescription from their GP.

There are many issues here that need to be considered before wholesale abolition is given the go ahead in England. There are few advocates for the current system with its many anomalies and, without doubt, it needs to be modernised. However, the Government will need to consider what its right and left hands get up to.

On the one hand, there is the move to reclassify more prescription-only medicines and give them P-status. The rationale is that this will give patients more choice, as well as reduce GP workload. On the other, the experience in Wales is, paradoxically, that free prescriptions encourage patients to visit GPs.

On 8 March 2008, The Journal carried a letter from a pharmacist in Glasgow (p273) pointing out that the introduction of the minor ailment scheme in Scotland was reducing sales of over-the-counter medicines.

In both Wales and Scotland, but for different reasons, it seems that pharmacists are losing income (although it may be mitigated by other sources such as capitation fees [p334]) and the NHS is spending more — something the health departments cannot have intended.

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