Rationing

Editor—In the wake of the controversies surrounding the approval of sildenafil citrate¹,² and orlistat³ perhaps the time has come for the introduction of a new category of NHS prescription drugs, “full cost medicines.” Such medicines would be prescribed by the patient’s general practitioner, but the patient would pay the full cost plus the dispensing fee. This system would have many advantages, including maintaining the relationship between the general practitioner and the patient, suppressing misuse of expensive and possibly recreational drugs, keeping down the cost of such medicines because of the purchasing power of the NHS, and educating patients about the cost of pharmaceutical products and thus potentially opening up the debate on rationing of health care.

This proposal is not as radical as it sounds. We already have a model for such a system in the provision of NHS dentistry, with patients being expected to pay the full cost of their treatment up to a maximum of £340. If this charge is acceptable for the maintenance of dental health surely around £5 is acceptable for the maintenance of sexual health.