As a GP working in a diverse part of Bristol, prescription charges are always a bone of contention with staff and patients. Every item of medication or appliance dispensed by a pharmacy costs £8.05, and this usually rises every year by about 20p.
I issue around 30 prescriptions a day, usually for items that would last a month, but sometimes for “acute” medicines for patients with infections or those who need pain relief.
Patients pay for prescriptions based on the number of items on the “script” and not the number of tablets dispensed. So it’s understandable that we get requests by patients on a daily basis to issue large batches of medication, as this can save considerable money.
There are no prescription charges in Scotland, Wales and Northern Ireland. In Northern Ireland prescriptions are free for English visitors as well. In England, patients under 16, between 16-18 and in full-time education and those over the age of 60 are exempt from paying. Certain long-term conditions are also exempt such as diabetes, cancer (or cancer-related problems) and epilepsy.
Patients can also qualify for exemption if they are on a low income, but this requires filling in a lengthy form (called HC1 form) every 12 months, which has administration costs nationally that run into millions of pounds.
I see a large number of university students. Many have significant health issues around long-term conditions like Crohn’s disease, migraines or depression and anxiety. Most are not aware of the HC1 forms, and of those who are, many choose not to fill them in as they are complex and require supporting evidence of low income.
Jason is a second-year architecture student who has moved into private accommodation and is experiencing financial hardship. His parents are not in a position to help him. His accommodation is cold and damp and his asthma has been particularly problematic. He is going through several inhalers a month and is asking for two or three on the same script (so that he does not have to pay repeatedly).
When he attends for his asthma review with our nurse, it is noted that he is often getting breathless after short bouts of exercise and waking up at night from coughing. We escalated his asthma treatment (which entails a second prescription of another inhaler as a preventer to be used alongside his reliever inhaler). We also gave him an asthma diary to record his symptoms. Two weeks later I received correspondence from A&E that Jason was admitted into hospital after a severe asthma attack. He never started his steroid preventer inhaler, as he had no money to buy two.
Many of my patients are selective in which medicines they purchase, and this can have a detrimental impact on their health and sometimes lead to unnecessary admissions to hospital. It is the working poor who bear the brunt of this cost. The £8.05 charge per item introduces financial anxiety and deters them from starting essential medications. It also introduces tension between the doctor and the patient through lack of compliance or resentment that the doctor is not prescribing items that would last for many months.
The King’s Fund has suggested that prescription charges should be introduced for everyone and limited to £2.50 per item dispensed. However this would introduce more health inequalities. Many of our elderly patients are on multiple medications and the costs would be prohibitive.
As GPs we are hesitant to prescribe large batches of medication on the same prescription as we are not able to monitor patients’ progress. It would certainly not be prudent for patients who may have depression or anxiety and are at risk of self-harm.
One way forward, which has been introduced in Scotland, is to issue a prescription for working patients for a longer duration that is dispensed at specified intervals. The HC1 form also needs to be simplified. In the meantime, there should be a freeze on the £8.05 charge for a prescription.
