There are no plans to review the current list of people in England who are exempt from the prescription charge, MPs heard last week, despite concerns about the system among patients and doctors.
Patients’ groups representing people with conditions such as cystic fibrosis and Parkinson’s disease have told the Department of Health of their major concerns about exemptions, but no review is imminent.
MPs questioned department officials last week as part of the parliamentary health select committee’s inquiry into NHS charges, including prescription charges and dental and optical charges.
The witnesses were quizzed on a description of the current charging system as a “dog’s dinner lacking any basis in fairness or logic,” made by the independent think tank the Social Market Foundation.
When asked why the health department did not review the list of exemptions to the prescription charges to get rid of “anomalies,” Felicity Harvey, head of the department’s medicines, pharmacy, and industry group, said, “In terms of major reviews of the prescription cost system, this isn’t actually something that ministers have asked us to do at the moment.
“Clearly there are very many very serious chronic conditions, and these haven’t been reviewed for a while. The issue would always be: where do you draw the line? Therefore the approach has very much been around affordability and capping the costs of prescriptions for those that pay.
“We do understand that there are many patient groups that have major concerns about why indeed their condition is not exempt,” she said.
The current charging system for prescriptions and dental and optical services dates back to 1951, said Dr Harvey, and policy concerning exemptions from prescription charges had remained relatively unchanged since 1968.
When the health department witnesses were asked what it would cost to scrap charges, as proposed elsewhere in the United Kingdom (the Scottish parliament was due to vote on a bill to abolish prescription charges as the BMJ went to press), they said that the cost would be significant.
The prescription charge currently brings an income of around £427m ($760m; €620m) a year. Dropping dental charges would forgo income of around £600m, and providing free eye tests to everyone would cost around £92m.
Howard Stoate, Labour MP for Dartford and a GP, said, “I know of many occasions when a patient would say to me, ‘I simply can’t afford three prescriptions; which one can I afford not to take?' That can’t possibly be good for patient care.”
Dr Harvey said around 87% of prescriptions were currently exempt from payment. Since 1997 the prescription charge had risen by around 10 pence a year, which was, over that period, a decrease in real terms of 4.5%.
The NHS low income scheme, which allows financial help to people who are not automatically exempt from such charges, had been updated, she added, and information was now better targeted at people who need it.
The inquiry continues.