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PSNC: 15p prescription fee rise 'unwelcome'

Sue Sharpe: Many patients already find it "extremely difficult" to pay the charges

PSNC chief executive Sue Sharpe has labelled prescription charges a "tax on the sick" in response to government plans to increase the charge to £8.20

PSNC has branded a 15p prescription fee increase “unwelcome”.

 The increase of charges to £8.20 per prescription item in England, announced by the government yesterday (March 12), was a “tax on the sick” and many patients already found it “extremely difficult” to pay the charges, said PSNC chief executive Sue Sharpe.

 The Department of Health (DH) said the new charge would come into effect on April 1, although the cost of prescription prepayment certificates would remain frozen at £29.10 for a three-month certificate and £104 for an annual certificate.

 Health charges were an “important source of revenue” for the NHS and it was “crucial” prescription charges increased to keep up with rising healthcare costs, the DH said.

 “It's fair that those who can make a contribution do, so we can plough back precious resources into frontline services,” it added.

Pharmacy Voice chief executive Rob Darracott said the government had “missed the point yet again” by increasing charges.
“Prescription fees can deter patients from taking prescribed medicines, which may prevent them from getting the right care [and] result in higher healthcare costs further down the line. Collecting the fees also adds to a pharmacist’s workload without benefiting patient care,” he added.

 Charges rose by 20p in both 2013 and 2014, and this year’s 15p increase is 5p less than pharmacy minister Earl Howe predicted in 2014.


What do you think about the prescription charge increase?

We want to hear your views, but please express them in the spirit of a constructive, professional debate. For more information about what this means, please click here to see our community principles and information


Andy Burrells, Community pharmacist

Over 90.0 per cent of all prescription items were dispensed free of charge, with 59.5 percent dispensed free to patients claiming age exemption (aged 60 and over) and 4.7 per cent Prescriptions dispensed free to patients claiming age exemption (aged under 16 or 16 -18 and in full-time education) The leading BNF Section in terms of net ingredient cost, for the seventh year in succession,is BNF 6.1 Drugs used in Diabetes. Costs have increased for this section by 3.4 per cent (£25.9 million) since 2012, to £793.8 million in 2013. The number of prescription items dispensed has risen by 5.7 per cent (2.4 million) since 2012 to 44.6 million in 2013 (Source: HSCIC) 1) These facts say to me that the 10% that actually are paying the levy are funding the 90% that dont. How is that fair? 2)Type 2 diabetes is the single biggest threat to the future of the NHS. The diabetes demographic shows that the majority of patients are capable of paying, yet dont. This proves the exemptions are outdated and not fit for purpose 3)The Levy goes straight to the Exchequer and not directly reinvested back into the NHS so it's a pointless argument to say it's of great importance to stop the decline of the NHS The NHS has enough funding to carry out its role if the spending of public cash was under better direction

R Patel, Community pharmacist

Another reason to remove all the exemption categories and charge everyone just a £1. Will improve the wastage tremendously and improve 'polypharmacy' ! Why can't DoH see this?

Angela Channing, Community pharmacist

OK. But what about the man who I gave 18 items to today, and every month. What about him? Are we going to charge him £18 a month or does he get any help/rebate? Or should there be a cap on how much he has to pay? How would this work? There are so many questions and scenarios that no wonder no one since Harold Wilson has changed anything!

N O, Pharmaceutical Adviser

First and foremost do a MUR and check if he really needs that many items ? He should be in a hospital, which would workout cheaper for the NHS to treat him thoroughly to bring his list to below 10. The questions are bound to arise, that doesn't mean you don't attempt to try and implement a system which is in line with majority (not the minority) There can be cap to how much they pay, say 10 items max ?? Look at the big picture, the Govt. wants to get back some cost and many dont want to pay a heavy bill. So if all are charged a small amount then not only the Govt. recovers a part of the money spent on healthcare and we really get a control over how patients use their medication (no more wastages) Initially I proposed for the scrapping of the charge, but now I realise that given the size of population in England the wastage would go beyond control.

Leon The Apothecary, Student

Everyone, excluding age exempt could pay 77p per item and the NHS would be better off based on the latest statistics. Combine that with rigid monthly prescriptions rather then the three month shipping orders, and perhaps we can make some dents in the NHS deficit.

Angela Channing, Community pharmacist

Could you post your stats and calculations please?

SP Ph, Community pharmacist

For some quick stats. The NHSBSA stats for December 2014 for PCTs (now CCGs under Area Teams) show that in total 86.85 million items were dispensed. Taking this as an average monthly number for discussion sake, even if you charge 50p per item the Gvt would make £43.425mln or about £500mln per annum. If the target was £150mln then we only need to charge about 16.66pence per item and if we charge £1 per item then qe get £1.0 billion in 1 year. So friends can we discuss this now??

Bapi Patel, Work for a health/commissioning consultancy company

Well now that the UKIP party political broadcast has ended perhaps we can open the real debate. I guess the charge is interesting. Whilst the principalities have done the sums and worked out that, because of reduced costs, its a positive move to abolish then perhaps we should be clear and put this rise down to the cost of establishing the IT required to underpin the new fraud prevention scheme.

Angela Channing, Community pharmacist

If you reduce the charge like in the other home nations of the UK, you lose vital revenue. They chose to abolish the charge, and now must find savings to cover the revenue they have lost. I read recently that NI, I think, are considering re-introducing it. Basically if you pay nothing, you care nothing. This is the reason why we have carrier bags full of unused medicines returned. The person didn't pay for it, or make a small contribution so they care nothing. Somebody else's problem. The NHS is still running on the model that was set up in 1948 and the script exemptions apart from the addition of cancer, are still running pretty much as set up in the late 1960s under Harold Wilson. Can you imagine if any other area of life in 2015 was still running 50 years behind? ! Even Mrs Thatcher only tinkered at the edges of the NHS. In the early 80s she was presented with a paper setting out proposals to bring in charges to see a GP, she threw it back across the table, and said " they would never elect me ever again" However, even in socialist style countries like Sweden they pay to see a GP and for a hospital stay and for their medicines. As it was a Labour government that introduced the NHS, I think if we end up with a Lab/Lib/SNP coalition after the election, they need to start thinking hard about how to reform the NHS, particularly regarding script item charges and exemptions and access to GPs.

Dilip Shah, Community pharmacist

Total agree with Sue Sharp and I would even go further and get rid of this prescription charge as it cost a lot to administer this system and in the future total waste of pharmacists time to check exemption status. There are better ways of collecting payments from tax payer ie increase NI contribution by 0.1%-0.3% or increase in tax by 0.3% should make the system fairer. Pharmacist are not TAX COLLECTORS.

Mohamed Mohamed, Locum pharmacist

This high fee should be abolished and everybody, whether they are on benefits or not, should be made to pay at least 50p to £1 per item on a prescription. The current fee is quite high because most people do not pay for prescriptions for what ever reason and hence people who do pay for their prescriptions are made to pay to match the windfall,

SP Ph, Community pharmacist

A simple solution is to make a standard charge per item, in line with above poster. If the Govt. feels that they need to support the vulnerable group, then they can add that amount to their regular benefits. Same can also apply in abolishing the charge completely, with a small tax component added to either the NI or a separate charge to the higher tax slabs. If the Govt. or NHS is worried that people on multiple medicines and benefits will stop taking their medicines if a charge is applied to them, then same rule applies to those who pay for the medicines. Hence, we should stop playing the vote bank politics and make the NHS truly fit for the purpose. Unless we cut the red tape culture in the system, no point in imposing cuts on essential services like healthcare. I know these words will go on deaf ears, but worth a try !!

Gerry Diamond, Primary care pharmacist

Well it is unbelievable what is available on prescription, corn flakes, biscuits, sip feeds, baby food, for goodness sake sometime checking scripts I feel like I should be scanning the weekly trolley dash at Tesco. I think the whole NHS needs abolishing and a system similar to Canada that is semi private, where people get tax relief for paying for medicines, drug plans and pay a state health insurance plan for GP and hospital services. People on welfare and elderly are all looked after for free. Only then will the NHS get the extra money to deliver the services. Our system is broken and a sacred white cow that needs major review.

Angela Channing, Community pharmacist

I agree with Gerry. The Canadian model seems pretty fair. I've also heard the Singapore and French models are similar. This something for nothing has to stop. I'm sure Nye Bevan never ever thought we would be giving gluten free digestives on the NHS. He must be spinning in his grave.

Stephen Walsh, Community pharmacist

I believe our system has been deliberately run down and broken by the very people who would profit most from its demise. To read a list of the healthcare company directorships of politicians makes me rather cross.

N O, Pharmaceutical Adviser

Surprisingly, in a long long long time, most of us here are supporting the statement by Sue!!! Hope Sue takes the hint and continues similar stand (with affirmative) when she sits on the negotiation table with the NHSE/ DoH. No more nonsense from them please !!!

Hackney Drug Dealer, Community pharmacist

There is no money - the pot is 'dry'. This is for all Govt Depts. 1984 is here and has been for two decades, only the blind and baby-boomers (who ate all the pies) can't see this. So, diabetes, CHD & Lung diseases are on the up and there's no money... so what gives? From a book keeping viewpoint: if you can't pay for it then you cant have it. £1.00 per item/OP per month as a subsidy... Or pay privately. The pharmacy DOOP bins will now stay empty and we wont have to dispose of £000's each year up the chimney (in their original packs, unused, of course) Give someone something for free and they wont value it (until they loose it) Ah yes, the good old days...FORGET IT! THEYRE GONE!!!

I would love, love love to see a summary of a)how much prescription charges bring in b) how much it costs to process a two tier system and c) how much it costs to police prescription charges, and how this money stacks up compared to the whole drugs budget.

Dave Downham, Manager

a) Not a lot in the scheme of things b) Far too much c) See (b)

Clive Hodgson, Community pharmacist

Hi Hayley, perhaps there is also something symbolic in the charge? A reminder that NHS healthcare is not really free and that someone somewhere has to pay for it?

I don't think symbolic should be enough to justify such a clunky system. Costs should always be scrutinised and assigned accordingly. There's no room for wooly ideals like symbolism.

Brian Austen, Senior Management

Is it £8.20 or £8.25. I thought it was £8.25, am I wrong?

N O, Pharmaceutical Adviser

£8.05 (current charge) + £0.15 (15p increase) = £8.20. Cheers

Clive Hodgson, Community pharmacist

It is not a ”tax on the sick”, it is a contribution to an extremely cash strapped NHS that needs all the financial help it can get. For those who are not exempt for whatever reason including the unemployed/low paid then a pre payment certificate works out at less than 30p/day. For those who claim they cannot afford that may I respectfully suggest that they need to reconsider their financial priorities?

I have a friend, 30 years old, wheelchair bound with EDS. She gets DLA (£81.30 per week), which barely pays for her heating bills (she has autonomic dysfunction so often requires heating, as well as it easing her constant pain slightly). She pays £80 per week for 17 hours of a personal assistant, to help her wash, dress, cook, clean etc. She already eats one meal a day (usually pasta) because its all she can just about afford. She east ice cubes to make herself feel less hungry. 30p/day could well tip her over the edge.

SP Ph, Community pharmacist

If she gets DLA then why she has to pay for the script?

Angela Channing, Community pharmacist

I don't want to seem cruel dear, but why do you keep telling us your sob stories? In this particular case, what about, family, and friends? and what do you do to help her? There are many charities and voluntary organisations that may be able to help her in practical ways, or help her in claiming the full amount of what she is entitled to due to her illness. This is the kind of person David Cameron talks about when he says "if you are old, or if you are ill or disabled, we will look after you" I don't think anyone on here would begrudge your friend what she claims and most would think she deserves more. I think what people on here are trying to say is the NHS is broken. The script charge in England brings in nearly half a billion a year in revenue. A pre-payment works out at £2 a week. That's the same as buying a lottery ticket on a Saturday night that most people don't think twice about. But as soon as we get to healthcare it's always someone else's problem isn't it? And regarding your friend's diet, I don't think pasta is the best option. Can she get to a market or a low cost supermarket like Aldi or Lidl? Could you take her? I don't want to sound cruel or heartless, yes, a lot, of people have difficult lives, but a lot of your posts always seem to be about all the problems and examples. You never suggest any viable solutions. We need to find a new way in England of looking after your friend and also protecting the system. I think moving the age exemption up will have to come in sooner or later. Most people in their 60s still work. I really do not think £2 a week or £10 a month by direct debit for full medicine coverage of what can be expensive drugs, e.g. xarelto £59 a box for a month's supply is such a hardship. One of the shops I work for sometimes has a lady from Eire. They are like the USA, there is no NHS, you pay to see the GP and you pay the pharmacist the price of the medicine. She tells me a trip to see both and go home with medicines won't give you a lot of change from a 100 euro note. Compared to the rest of the world we have a very generous welfare state. I think a lot of people in Britain forget this. PS . To help your friend, there is a book by GILL HOLCOMBE called 'How to feed your whole family a healthy balanced diet with very little money and hardly any time, even if you have a tiny kitchen, only three saucepans and no fancy gadgets' It has some lovely quick and easy recipes with very basic every day ingredients. I've just looked and there are lots on amazon.

Here's the thing: I actually do agree that a small daily charge would work. But what I don't agree with is anyone- particularly healthcare professionals- who accept this "undeserving poor" nonsense. I used to think, along with many others, that people on benefits had the life of riley, wiling away their days in a pubs while we all slaved away paying our taxes. Then I grew up a bit, looked behind the headlines, and started to realised the real suffering there is. What I object to is throwaway statements like "no one thinks twice about doing X,Y, an Z, it's only 30p, 80p, £2.50, £192, who cares? People live is very different circumstances, and its our duty to understand that, try and get our heads round it, and look for solutions that way. But to decide whether or not a global small charge would work, we need to look at costs. And no clear costings appear to be available. Without that, I, and no one else, can start coming up with solutions. The NHS isn't broken- the political system in charge of it is what's broken. Coming up with random solutions which will sound the most popular without first looking at the evidence- that's what is broken. How much of that "half a billion" actually ends up paying for medicines? Oh, and my friend? Yeah, she could get to a market. By taxi, which she can't afford. And she'd be in excruciating pain for days if not weeks afterwards. She has involvement from charities, foodbanks, her family and friends, as much as we can- not all folk are that lucky.

N O, Pharmaceutical Adviser

Good point Clive, may be, sitting in a comfortable chair in a all paid Home/ office. But there are numerous such 30p/ day essentials that people have to shell out make them think why should they pay this charge? They also seem to think that they work their a*** out day in day out to help the UK economy grow and yet they are the ones always taxed, whereas numerous others sit on their bum all day yet receive all sorts of freebies from the Govt. Don't you think it is a bit unfair?? Also, imagine if these people stop taking their meds and end up in secondary care (which is free), is it cost effective at all??

Clive Hodgson, Community pharmacist

……….Which would bring us back to the argument for a reduced charge for all.


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