Sunday, December 10, 2023

Myles’ Blog: Free Prescription Up For Grabs

It is always a good idea to sign up to as many groups as possible as you never know what you are going to get sent to you. I don’t know how I found myself on the mailing list for the campaign to change the exemption rules on prescription charges but I am certainly glad I did sign up for it as on May 28th I received possibly the most important PDF file I have ever received – The Prescription Charges Review.

As is common knowledge, there are a number of groups of people based on age, medical condition or certain benefits who already receive prescriptions free of charge. There are, however, many people who would benefit from an exemption from prescription charges who cannot and whose health is suffering because they cannot afford to pay for the medications they need or are suffering financially trying to pay for an increasing number of prescriptions due to a long-term condition. In October 2008, the then Minister for Health commissioned Professor Ian Gilmore to lead a review to consider implementing an exemption from prescription charges for people with a long-term condition who were still being forced to pay. Just over a year later, in November 2009, Professor Gilmore published his report and it makes for fascinating reading.

In his report, Professor Gilmore outlines ten recommendations that not only allow for a gradual phasing in of the new exemption but also changes the definition of a long-term condition and allows certain benefits to be used as a proxy in determining whether someone has an eligibility for exemption. The Prescription Charges Review report, however, does not just have implications for the targeted group as, if all the recommendations are taken on board and acted upon by the current Government, everyone in the country who are, at present, liable for prescription charges may also benefit.

Professor Gilmore’s recommendations are:
The definition of long-term conditions should be a broad definition based upon the duration of the condition and the need for continuing management. The public and most professional and voluntary sector stakeholders favour this approach as a general principle.
Duration should be at least six months to be considered long term.

Continuing management includes:
Regular medication
Periodic monitoring and review
Psychological therapies

The person best place to make a determination on eligibility against the broad definition is the patient’s GP, however, they may be supported in this role by other practice staff, such as nurse practitioners, who have some clinical responsibility with patients with long term conditions.

Any detailed plans for the implementation of this exemption should be made by Government in partnership with primary care and patient group stakeholders. The move towards a broad definition of long-term conditions means that some patients with less clear-cut diagnoses may potentially qualify for exemption.

A number of proxies will be used to define long-term conditions on the basis that people on the benefits listed below are more likely to be suffering with a long-term condition. It will also include those on low incomes and will reduce the number of cases that require a clinical decision on eligibility.

Incapacity Benefit without Income Support
Contribution based Employment and Support Allowance
Disability Living Allowance

The exemption should continue to relate to the person rather than a specific condition due to the difficulty in some cases of determining whether a treatment is related to the condition for which exemption has been granted.

If a patient disagrees with their GP’s determination for exemption from prescription charges there is currently no appeals mechanism in place and, because of the potential increase in bureaucracy and the possible creation of an adversarial environment between GP and patient, it is recommended that no appeals mechanism should be created. The system should rely on good clinical judgement with effective guidance.

Exemption should last for three years and it should be made possible to renewal to be confirmed at any point in the final year of exemption if it is clear that the patient will continue to meet the conditions under which exemption was granted. This should mean that renewal could be made during an existing consultation or review so as not to burden the GP with extra unnecessary appointments.

The phasing in of the new exemption category should be achieved by a step-by-step reduction in the price of the prescription pre-payment certificate (PPC).

This phased approach is simple, targeted to those with the greatest need for prescriptions and will allow time to implement the new arrangements. Improving uptake of PPCs could be achieved by:

Wider availability at pharmacies.

The ability to qualify for a PPC through accumulated individual charges by using a loyalty card mechanism or by registration with a pharmacist.
Patients who are already exempt should retain their exemption.

The Government should consider bring in the proposed changes as soon as possible. As the extension of the exemption to people with long-term conditions may have the effect of making it economically more sense to abolish the prescription charges altogether or reform the system due to the administration costs outweighing the income from the charges.

As you can see this could change the way the National Health Service tackles health problems before a condition becomes so bad that it requires lengthy and expensive hospital stays and operations. The question becomes – will the new Coalition Government act on this report? That, of course, all depends on whether they are planning to play a long game rather than go for a quick and, perhaps, necessary fix through the planned cuts in public spending made necessary by the former Government.

If the long game is the way the Coalition Government wants to play it then acting on this report is of paramount importance because in the long run it will save the country money at a time when we desperately need to be saving it.

In my opinion, taking these recommendations as they stand is the only sensible way to approach the health of the nation but then who am I to offer such opinions to the Government?


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