We need to reform prescription charges


Over the last few years, we’ve seen rise after rise in English prescription charges.

Yet the list of illnesses giving you free prescriptions was set in the 1960s, with cancer being the only recent addition.  Shockingly, it excludes mental health outright.

At this autumn’s South Central Regional Conference, a motion by the author was passed calling for reforms to remove the inequities of the current charging regime.

Take two hypothetical examples.

Jon is 40 and has a weak thyroid. Although he has a well paid job, Jon does not have to pay for his thyroid medication, or for any other medication, no matter what it’s for.

25-year-old Samantha works part time, with an income of £17,000. This takes her over the financial thresholds for free prescriptions. She has asthma, but often cannot afford to fill her prescriptions. Samantha ends up in hospital with asthma several times a year, with frequent GP visits too.

As a doctor, I know that there are many real patients like this.

Samantha is one of an estimated 800,000 people for whom charges mean they who go without the medication they need, and end up not only risking their health but also costing the NHS more as they become more unwell.

A key reform should be widening exempt conditions to include all long-term physical and mental illnesses, as recommended by the 2009 Gilmore Prescription Charges Review. The Prescription Charges Coalition noted two thirds of GPs, community nurses and pharmacists surveyed think the current exemptions should be widened to include anyone with a long term condition.

Possible savings to help fund this could be achieved by only making certain medication free for specific conditions, rather than giving free prescriptions for all of the medications taken by patients with an exempted conditions.

Where medications are not exempt, a per-patient annual cost ‘cap’ should replace the current annual £104 pre-payment certificate.

The current certificate requires you to predict in advance how many prescriptions you will need over an entire year, and buy it first. If doctors can’t predict how many drugs you might need in a year, how can patients be expected to?

Lastly, there should be more user-friendly application process with simpler means-testing where necessary.

A petition calling for some of these recommendations can be signed here.

* Dr Mohsin Khan is the Chair of Lib Dem Campaign for Race Equality. He is also a directly elected member of Federal Policy Committee

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This entry was posted in Op-eds.


  • Peter Hayes 21st Nov '16 - 6:21pm

    The problem is the fixed charge makes some things more expensive. When I was working my pharmacy said it was cheaper to cross some items, such as aspirins for heart conditions, off the prescription. Even now after retirement I still buy some items rather than costing the NHS, for example surgical socks, because there are differing views between hospital and doctor. Perhaps the answer is retail price if less than standard charge and capped for higher (over) priced items.

  • Yes I agree with this: would go further in review of NHS funding but for now I shall simply say ‘here, here ‘.

  • Ed Shepherd 21st Nov '16 - 6:51pm

    A very welcome article. Healthcare should be free at the point of delivery funded by a progressive taxation system. There should be no prescription charges.

  • Some good points there. As much as I like the idea that someone with a chronic health issue, such as a thyroid problem, should be supported, they don’t deserve it more than someone with asthma, and definitely not more than a poorer person with asthma. I’m not averse to these ‘middle-class give-aways’, but not at the expense of those who genuinely struggle. There will always be something else for the NHS to spend money on, so for every give-away, there’s a take from someone else.

    I think there should be no GP prescriptions for the sort of medicines you can buy in a supermarket, such as paracetamol. It’s such a waste of time and effort. GP practices should hold stocks of the generic form of these to give to any patients they think might struggle.

    There could be exemptions for those that really do need large supplies, or in areas where there isn’t a supermarket selling paracetamol for 16p a packet.

  • Daniel Walker 21st Nov '16 - 9:50pm

    @Fiona “I think there should be no GP prescriptions for the sort of medicines you can buy in a supermarket, such as paracetamol.”

    I agree with your points, but I suspect in practice very few doctors issue a prescription for paracetamol, aspirin, and other OTC medicines. Mine only issues me with one for antihistamines because I already have a prepayment certificate because of my asthma.

  • Morwen Millson 21st Nov '16 - 10:32pm

    I think there are probably lots of GPs that give prescriptions for paracetamol and aspirin – my mother gets them, as does my sister’s mother in law; one in West Sussex, the other in Kent. They get at least 100 at a time too, which seems dangerous, given that I am only allowed to buy 32 at a time!

    There is also the issue that free prescriptions start at age 60, regardless of need.

  • I was shocked recently to find out that HRT (as a combined therapy) counts as two prescriptions this seems unfair as it is, in effect, one treatment.

  • grahame lamb 22nd Nov '16 - 8:43am

    Abolish prescription charges.

    The three founding principles of the National Health Service are that it is universal, comprehensive and free at the point of use. Prescription charges (which, incidentally, have nothing to do with the cost of the medication) are contrary to these principles. Nye Bevan and Harold Wilson resigned from the Government when prescription charges were introduced.

    I do not understand why no leading Liberal Democrat member of Parliament has ever spoken out against prescription charges. Or Labour. Or Conservative.

    For the avoidance of doubt I do not have to pay now. But I have all my life been against this charge.

    Isn’t it about time that this iniquitous impost were abolished?

    Is there a Liberal Democrat policy on prescription charges may I ask? Mr Farron – over to you.

  • Daniel Walker 22nd Nov '16 - 9:15am

    @Morwen You’re right, of course. I was referring to short-term painkiller use, but I didn’t specify. Although I note at 20p for 16 (for example, from Wilkinson’s) you can still get 672 for the cost of a prescription charge, or you could if you could buy more than 16 at once.

    Is it legal to buy 100 paracetamol in small packets if you have a prescription? Presumably you’d have to be at the chemist.

    But I agree the prescription charge should be abolished. Dr Kahn’s example of “Suzanne” is the reason why.

  • Hi everyone
    Just 3 points to add to the discussion really:
    1. Some would argue that looking at prescription charges in isolation is not the best approach. Surely the debate should be looking at a realistic joined up strategy for funding the NHS in 2016. Think Social and Mental health costs for instance. Some may argue in the context of these enormous issues, looking at Prescription coast (some would argue the whole drugs budget actually which is less than 10% of NHS spend) is tinkering at the edges?
    2. For me, the unfairness of Scotland and Wales having free prescription costs whilst England pays is another example of the “postcode lottery'” that some would see as a major source of unfairness with the present system
    3. Although not a solution it’s worth mentioning that at £104 for an annual certificate is a partial solution to those requiring more than 2 medications a month.
    4. Foe me the real issue here is that the NHS in 2016 is simply not sustainable with the present funding model (reasons well documented elsewhere with demographics, the cost of chronic long term hospital care – which of course private companies don’t want to know about, much easier to make a profit on the acute stuff and mental health being major drains on resources).
    5. Basically it comes down to *how* we are willing to pay for our healthcare going forward, not should we. For me this can only be achieved either by increased taxation or the introduction of a contributory model, such as the one Ed Miliband was talking about but then shelved.
    6. Some may say that actually baring in mind all the above points that a simple prescription cost especially going the annual route, is nothing compared to what we’ll all have to pay in the future through either of the above long term funding solutions

  • Got carried away – 3 points became 6. Note to self: check before posting!

  • I’m with Simon. I don’t pay for my prescriptions. I can afford to and Heart Disease, Diabetes and Kidney Disease are all my own stupid fault…

  • grahame lamb 23rd Nov '16 - 8:13am

    To all of you will you forgive me if I repeat:

    The National health Service is .




    Isn’t it?

    If I were Chancellor of the Exchequer it would give me great pleasure today to announce the abolition of prescription charges.

  • Ruth Bright 23rd Nov '16 - 2:36pm

    Simon Shaw is right to raise dentistry as a major breach of the supposed universality of the NHS – more worrying in many ways than the unfair effects of prescription charges. Slowly and quietly many services have stopped being free at the point of delivery. For example, though NICE say that podiatry/chiropody should be available on the NHS, in my area it is only available if you are diabetic or elderly. Children wait nine months to see an occupational therapist and only those with very high levels of need get any help. And don’t get me started on ante-natal care……………………..

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