Introduction

The existing prescription charge system in England, governed by the National Health Service (Charges for Drugs and Appliances) Regulations 2015, requires a patient to pay a set fee per prescription item, irrespective of the cost or duration of treatment. While prescription charges aim to mitigate unnecessary visits to general practitioners (GPs), this policy disproportionately impacts those with multiple prescriptions, chronic conditions, or those requiring ongoing treatment.

This paper proposes legislative reform to address inequities and to ensure prescription charges reflect fairer practice, in line with healthcare equality principles outlined by the NHS Constitution and the Health and Social Care Act 2012.

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Statement of Issues

Current prescription charges (£9.65 per item as of 2024) create inequitable scenarios:

• Patients requiring multiple, inexpensive medications (e.g., eye drops and antibiotics) incur significantly higher costs compared to those prescribed a single, more expensive medication.
• Medication selection frequently involves trial-and-error approaches. Patients should not bear additional costs resulting from clinical necessity.
• Patients with chronic or lifelong medical conditions face continuous financial burdens, effectively imposing a “tax on the sick.”
• The cumulative cost of ongoing prescriptions disproportionately affects those with low incomes, deterring adherence to necessary medication regimes and ultimately leading to increased NHS expenditure through preventable hospital admissions or complications.

Legislative and Policy Context

Prescription charges fall under the scope of the National Health Service Act 2006, specifically Sections 172 to 174, empowering the Secretary of State to regulate charges. The existing regulatory framework (National Health Service (Charges for Drugs and Appliances) Regulations 2015) stipulates charges per prescribed item.

Healthcare equity is emphasised within:

• NHS Constitution (2021), highlighting equitable access to healthcare irrespective of socio-economic conditions.
• Equality Act 2010, obliging public bodies to reduce inequality, including financial barriers to healthcare.
• Health and Social Care Act 2012, mandating efficiency and equity within healthcare provision.

Proposal for Reform

The proposed reform introduces charging based on episodes or conditions rather than per item, determined by GP discretion, aligning charges to treatment rather than quantity:

• Condition-based Charging: Prescriptions issued by GPs would indicate whether the medication is for an ongoing condition or a new condition, at their discretion.
• Charge Application: Only prescriptions for new conditions would incur charges at pharmacies. Prescriptions designated as ongoing treatment for chronic or lifelong conditions would be exempt from recurring charges.

Implementation Framework

To operationalise this policy:

• Amend the National Health Service (Charges for Drugs and Appliances) Regulations 2015 to introduce a new prescription categorisation.
• Provide GPs with clear guidance and training developed by NHS England and NICE (National Institute for Health and Care Excellence) to ensure consistent application of clinical discretion.
• Incorporate monitoring and evaluation mechanisms to assess the impact on patient adherence, health outcomes, and NHS expenditure, in accordance with standards set by NHS Improvement and Public Health England.

Anticipated Impact

The reform aims to:

• Alleviate financial burdens on patients with multiple prescriptions or chronic conditions.
• Enhance adherence to prescribed treatments, reducing complications and associated NHS costs.
• Strengthen fairness and equity in healthcare provision, aligning with statutory equality duties.

Consultation and Next Steps

Stakeholders including healthcare professionals, patient advocacy groups, and pharmacy associations will be consulted to refine implementation details. Following consultation, legislative proposals will be submitted to Parliament for scrutiny and approval.

Conclusion

This green paper recommends transitioning to condition-based prescription charges to promote equity, improve patient outcomes, and enhance efficiency within the NHS. It calls for parliamentary action to enact necessary legislative changes and ensure fairer prescription charges for all.

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