NHS Prescription Charges

What are NHS prescription charges?

NHS prescription charges are paid by patients for drugs or other treatments prescribed for them by a National Health Service medical practitioner.

The current (2012) basic NHS prescription charge in England is £7.65p. However, many people are exempt from paying this fee; indeed according to the Government, 88% of prescription items are dispensed free of charge.

Those exempt include:

Children under 16, pregnant women, people over 60, young people in full-time education, people in receipt of certain benefits such as Income Support or Jobseekers' Allowance and people suffering from specific conditions, such as certain types of physical disability, diabetes, or epilepsy, for which they hold a valid exemption certificate.

Prescription Prepayment Certificates (PPC) offer considerable savings to people who are in need of regular prescriptions. As from 1st April 2010 a 3 months PPC costs £29.10 and a 12 months PPC £104. In addition, the NHS Low Income Scheme provides income related help to those not already exempt from NHS charges.

These costs apply only to England as prescription charges have been abolished in the rest of the UK. In Wales, prescriptions have been free for everyone since 2007, Northern Ireland scrapped the charges in 2010 and Scotland followed suit in 2011.

Background

Although the NHS, which was founded in 1948, was meant to provide a completely free health service for everyone, a growing drugs bill prompted the introduction of prescription charges in 1952.

The plans were first put forward by the Attlee government in 1951, causing 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 was dispensing 228 million items per year at a cost of £58 million, and 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. Labour relented in June 1968, and restored prescription charges, at a higher rate of two shillings and sixpence per item, but introducing a range of exemptions for old and young people, people on benefits, and people with chronic diseases such as diabetes.

On "decimalisation" in 1971, charges stood at 20p per item, where they remained until July 1979, when the new Thatcher government increased them to 45p. Charges were increased twice in 1980, to 70p and then to £1 in December. They have risen every subsequent year since 1982. During the mid-1980s, charges rose at around 20p per year (with the new prices coming into force on April 1), while in the early 1990s this accelerated to 25p per year. When Labour came to power in 1997, the annual rate of increase was reduced to 10p.

In 2001, the Labour-Liberal Democrat Welsh Assembly Government legislated to abolish prescription charges for people aged 16 to 25 in Welsh pharmacies. This generated widespread concerns that English people would flock to Wales to submit their prescriptions, but evidence to date has shown this did not happen.

For many years, local health authorities were responsible for administering the prescription charging regime. In October 2002, however, this role passed to the Prescriptions Pricing Authority (PPA). The PPA's role was to calculate drug and appliance prices, and make appropriate payments to pharmacists and contractors; produce guidance on prescribing for medical practitioners; manage the system of exemptions; and produce and maintain the Drug Tariff, containing the reimbursement prices of a range of prescribable items and remuneration rules.

In April 2006 the responsibilities of the PPA transferred to the NHS Business Services Authority, an Arms Length Body of the Department of Health which now administers NHS Prescription Services.

Controversies

The founders of the NHS regarded the concept of charging as antithetical to the notion of a service "free at the point of use" and controversy continues to surround the issue of prescription charges.

The range of conditions exempt from charges has been frequently criticised. In 2002, the Wanless Report - commissioned by the Government - condemned the system of exemptions as "illogical". The class exemptions, the report argued, took no account of ability to pay; wealthy pensioners were exempt, but many poor families were not.

A number of chronic conditions were not exempt, including cancer. The Macmillian Cancer Support charity was one of many organisation which campaigned for the abolition of prescription charges in England "so that no one is in the position where they can't afford the treatment prescribed by their doctor or health professional." This particular campaign was eventually successful and as from April 2009 cancer patients in England were made exempt from prescription charges.

The British Medical Association has long called for a "fundamental review" of the whole system of prescription charges and exemption categories, describing it as "outdated and iniquitous". In its response to the Department of Health's 2009 review of prescription charges for those with long term conditions, the BMA stated that it believed extending the exemption categories to include LTCs "would simply add to the inequities in the system and invariably create a new set of arbitrary 'winners' and 'losers'."

The BMA called on the Government to "abolish prescription charges in England altogether."

The Prescription Charges Campaign, an alliance of 24 charities including Arthritis Care, Parkinson's UK and the Terence Higgins Trust, is lobbying the Government to abolish unfair prescription charges for people with all long-term conditions.

Statistics

NHS Prescription Services makes payments to pharmacists dispensing contractors in England for the prescriptions they dispense in primary care.
During 2011-12, almost 1 billion prescription items were processed and payments made of more than £9 billion.

Source: Business Services Authority; Annual Report and Accounts – 2011/12

Increase in NHS prescription charges from 1 April 2012:

Prescription £7.40 – new charge £7.65
Surgical brassiere £25.10 – new charge £25.70
Abdominal or spinal support £37.90 – new charge £38.80
Stock modacrylic wig £61.85 – new charge £63.35
Partial human hair wig £163.80 – new charge  £167.85
Full bespoke human hair wig £239.45 – new charge £245.40

Prescription Prepayment Certificates:
A 3-month PPC remains unchanged at £29.10 from 1 April 2012. This will save people money if they need 4 or more items in 3 months.
A 12-month certificate will remain at £104 from 1 April 2012 and will save money if 14 items or more are needed in 12 months. A 12-month PPC is available by 10 monthly direct debit instalment payments.

NHS Dental Charges
Course of dental treatment – increase in charges from 1 April 2012

Band 1 £17.00 – new charge £17.50
Band 2 £47.00 – new charge £48.00
Band 3 £204.00  - new charge £209.00

Source: Department of Health – 2012

Quotes

"Since April 2009, people with cancer no longer have to pay for prescriptions.  This is wonderful news, but many more people in need are still waiting.  There is plenty of evidence that many people with long-term conditions currently struggle to afford their prescriptions, and often choose not to fill prescription because of the cost."

British Liver Trust - 2012

"In September 2010, the Government stated that they would not introduce free prescriptions but would look at ways to introduce 'more fairness' into the system.

"This is why we are now calling on the Government to freeze the cost of prescriptions until the end of the Parliament in 2015. If our petition reaches 100,000 signatures, this issue could be debated in Parliament.

"We want the Government to take this opportunity to do more to help people with long-term conditions who are struggling to afford their medicines in difficult economic times."

Asthma UK - 2012