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Published: 07/08/2003, Volume II3, No. 5867 Page 18

The prescriptions system is in need of urgent reform. Lyn Whitfield reports on a paper that proposes changes based on medication type

NHS charges are slowly making their way onto the political agenda. In July, the National Consumer Council published a report claiming that escalating prescription, optical and dental charges were 'eroding' the principle of free treatment.

It claimed 750,000 people a year in England and Wales are failing to collect all or part of their prescriptions because of the cost - now£6.30 per item in England and Wales and£6.00 in the rest of Britain. It also claimed people were missing out on optical and dental treatment because of fees for 'extras' not covered by the government.

The NCC is demanding a 'core services commission' to decide what should be paid for by the NHS - and to get this properly funded.

Its concerns have been supported in letters to national newspapers by a coalition of medical bodies, poverty groups and think tanks, including the Social Market Foundation, which - coincidentally or otherwise - recently published its own plans for radical reform.

In its report A Fairer Prescription for NHS Charges, SMF chair Lord Lipsey says 'the present system is a dog's dinner, lacking any basis in equity or logic and stuffed with anomalies and inconsistencies.'

He acknowledges that one solution would be to abolish charges, but says this is as simple as it sounds. Scrapping the prescription charge would cost£400m - assuming that people didn't clog up surgeries demanding free aspirin or complementary therapies.

Instead, the SMF wants a 'more rational system'with simpler exemptions and some link between cost and efficacy.

In essence, the report argues that anybody who can pay, should pay. Children and those on low income should be exempt and there should be a£90 cap on what anyone would have to pay in a year, to protect the chronically sick.

However, the report says: 'We see no reason why there should be automatic exemption for pregnant women, nursing mothers or older people.'

The SMF considers a number of options for making charges reflect the cost or efficacy of what is being prescribed. It is most attracted to a system in which government and patients share the cost of a drug, but what patients pay depends on its efficacy.

In France, drugs that are used to treat life-threatening illnesses, or that have major therapeutic benefits, are free - but patients must pay 35 per cent or 65 per cent of the cost of others. Belgium, Italy, Luxembourg and Portugal have similar systems.

The SMF proposes setting up four bands for medicines and attaching a nominal charge to each:

Band A: medicines vital to life or for chronic conditions - patients would get these free or cheap.

Band B: medicines that treat serious illnesses - patients would pay a lower charge for these than the current prescription charge.

Band C: medicines that are not such a high priority - patients would pay a charge at the level of the current prescription charge.

Band D: eg lifestyle treatments - patients would have to pay the full cost.

Optimistically, the report claims this could be done without holding up the introduction of its other reforms - even though these would inevitably be presented as charging mums and war heroes for drugs.

The SMF set up its health commission to 'go beyond Wanless' by looking at charges, alternatives to tax funding and private sector involvement in the NHS. Its main report should emerge later this year.

A Fairer Prescription for NHS Charges: the Social Market Foundation health commission report 1 Published by: The Social Market Foundation From: www. smf. co. uk/ health_commission. html