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The prescription charge has had its day

If NHS care is to be “free at the point of delivery” then it should be and funded through central taxation, says Numark's John D'Arcy

The government’s plans for pharmacists to check electronically if patients are eligible for prescription exemptions have gone down like the proverbial lead balloon. A recent survey carried out by C+D has indicated that two thirds of pharmacists are opposed to the plans, and soundings we have taken among Numark members show a similar pattern.

I am not at all surprised. Pharmacists are healthcare professionals and, while the relationship between pharmacists and their patients is complex, it relies heavily on trust. The notion of pharmacists being tax collectors and exemption policeman can only serve to undermine this trust and harm the relationship with patients.

But there are other concerns associated with this proposed new role. Pharmacists are already required to monitor declarations on prescriptions and have the first-hand experience of financial penalty when they are inadvertently filed in the wrong bundle or declarations are incorrectly completed. The new arrangements will apparently require pharmacists to interrogate an online system to verify whether patients are entitled to free prescriptions “at the click of the button”, according to the Department of Health.

Pharmacists will be forgiven for lacking confidence in all things NHS IT, given the delays and problems associated with the lengthy roll out of the electronic prescription service and the recent problems associated with prescription payments. There is also a question mark around why it is left down to pharmacists to police the process. Why, for example, could we not have a system where the exemption status is checked and confirmed prior to the prescription being issued by a GP?

Of course, none of this would be an issue if we did not have the prescription charge in the first instance. True, it provides revenue for an already cash-strapped NHS, but the process for determining how it operates in practice is cumbersome and anachronistic. It is also riddled with anomalies: diabetics do not pay for any prescriptions, but those with coronary heart disease or COPD pay for all of them. Where is the logic in that?

The prescription charge is a tax on the sick. We are continually being told that the NHS is free at the point of delivery. If any of us – heaven forbid – had a serious accident, we would be transported to a nearby hospital and given every test, procedure and medicine needed to bring us back to full health. There is no direct bill for that care.

But, unless we are exempt from prescription charges (and around half of us are not), if we were issued with an FP10 at the end of the process, we would incur a charge of £8.05 in respect of every item. This puts a real strain on those with low incomes and, for multi-item prescriptions, puts pharmacists in the impossible position of being asked to advise on which items can be left out.

The prescription charge has had its day. If NHS care is to be “free at the point of delivery” then it should be and funded through central taxation. The prescription charge has been abolished in Scotland, Wales and Northern Ireland. The time has come for England to follow suit.


John D'Arcy is managing director of Numark


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