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 (2010) basic NHS prescription charge in England is £7.20p. 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 £28.25 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 rules apply only to England. In the rest of the UK prescription charges are a matter for their devolved governments. In Wales prescriptions have been free for everyone since 1st April 2007; the Scottish Assembly plans to abolish all prescription charges by 2011 and the issue is currently under review in Northern Ireland.

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, as has already happened in Wales and will happen shortly in Northern Ireland and Scotland."

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

Statistics

In the year to June 2010 prescription volume increased by 5.3%. Growth in volume in
the month of June 2010 stood at 5%.
Prescription cost has increased by 3.8% in the year to June 2010 compared to the
same period in the previous year. Growth in cost in the month of June 2010 stood at
5.2%.
Growth in volume for the financial year 2010/11 is expected to be 6%.

Source: NHS Prescription Services report - September 2010

Quotes

"We are disappointed that the Coalition Government has announced free prescription charges for people with long-term conditions in England will not be taken forward at this time. We know that many people with asthma struggle to pay for their medicines, and some have to choose not to get some of their prescriptions because of the cost."

Asthma UK - 2010

"The present list of exempted conditions is outdated and arbitrary, and the approach in this respect has gained strong support from professional and patient groups alike. Furthermore, the report outlines a way in which exemptions could be phased in the fairest way possible when the financial landscape allows it."

Professor Ian Gilmore, president of the Royal College of Physicians, Prescription Charges Review - May 2010