Four fifths of pharmacists want prescription payment exemptions to be replaced by a universal charge, a C+D poll has suggested.

But the Royal Pharmaceutical Society (RPS) warned that a "flat tax" for prescriptions would increase inequalities by disadvantaging those who needed the most medicines. "We would also fear a stealthy increase in costs through inflation as happens with the current prescription charge," said RPS spokesperson Neal Patel.

The C+D poll of 483 respondents, which ran from July 25 to August 7, sparked a heated debate on Twitter (August 10). Some pharmacists argued that a small prescription fee would increase medicines adherence, but others warned that any charge would act as a barrier to poorer patients accessing medicines.

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	Pharmacist Fiona Simpson said a charge of 20p per item would be enough to make patients consider whether they really needed a prescription. "I've lost count of the times I've had drugs returned as [patients] don't have room in [their] cupboard," Ms Simpson tweeted.

But other pharmacists criticised a universal charge for being disproportionate and said it would prevent patients on lower incomes from receiving care.

"[It] doesn't factor in the wider healthcare costs of not taking medicine because you don't want to pay," said pharmacist Paul Gimson from Cardiff. There was no evidence that a charge would encourage patients to be less wasteful, he added.

A universal charge would be "doubly penalising" for the poorest members of society as these patients living in deprived areas were likely to require more medicines, said Aston University pharmacy lecturer Joseph Bush.

"A £3 charge [is] inconsequential to someone on £100,000, but potentially unaffordable for someone on £5,000," he said.

PSNC head of NHS services Alastair Buxton said the current system of prescription charges and exemptions needed to be reviewed as it was a "tax on the sick".

"Any new system would need to be fair to all patients and sustainable for the NHS. Of course we would be keen to support changes that would also make life easier for pharmacies," he told C+D.

Pharmacists last month criticised the current system of prescription charges for being too time-consuming, in response to the Mail on Sunday claim that pharmacists are operating a "scandalously careless"  system.