Somehow, Scotland and Wales manage to give their prescriptions away for free. This has always been a bit of a mystery to me, a Welshman living in England, and seems very generous. I have to pay almost £8 for my Ventolin® inhaler that costs the NHS less than half that amount. Luckily for me, this is offset by a prescription for a Seretide® inhaler which, at about £30, could be considered a snip. I haven’t worked out who the winner is there but I suspect that, even despite my poor inhaler compliance, it is still me.
Why doesn’t the NHS in England also give out free prescriptions? Well, that’s actually a trick question, because it does. In fact in 2008, 88% of prescriptions were given out for free. Take diabetics, for example. We are desperate for people to control their diabetic numbers well, sometimes requiring multiple medications. Charging them for each individual item would be one more battle in the war on compliance, and a little bit unfair. Poor people would simply not be able to afford it. On the other hand, however, there are probably plenty of millionaires out there who are diabetics, and don’t need to save themselves £50 a month. Over 65s, people on thyroxine, even, dare I say, cancer patients. And what about rich parents with kids still in school? Free antihistamines, but skiing in Val d’Isère. It just doesn’t seem quite right.
Maybe we could do means testing. Rich people have to pay, and poor people don’t. It would be a bit like social care or pensions where those with the bigger needs get the bigger benefit. No. Wait. That doesn’t work. It turns out that the rich people get out of paying by finding some sort of loophole. After all, they didn’t get rich by giving away their money. Similarly, the usual lower end cut off will still penalise the not-quite-poor-enough people.
I propose an entirely different approach to our prescription charges. I, as a well-paid GP, am happy to pay for my scripts and, virtuously, am also happy to buy my son’s eczema cream over the counter. I’m sure my affluent friends and neighbours would too. I think prescriptions represent quite good value for money compared to, say, a cappuccino.
So here’s my plan. Why don’t we make prescription charges voluntary? A box on the back, inviting people to waiver the exemption. Also, halve the price of the prescription. Two more people paying half works out cost neutral. And if more people paid, then we would be quids in. It would be a sort of gentle, national philanthropy. We know that Brits are good at giving, you only need to watch Comic Relief. If you need a reward, there is the knowledge that the NHS will not be on its knees when you next need it.
Because lets face it, the NHS is a kind of membership scheme and we all have a vested interest. We expect good quality health care when we need it. But finances are tight and there is a risk that parts of it will be sold off to the highest bidders. When this happens it could be too late, and for the sake of a couple of family meals out a year, we could help avoid it becoming British Rail. And surely, volunteering to pay for prescriptions will be peanuts compared to ‘topping up’ one’s expensive cancer treatments.
But what about all the money we are paying already? National Insurance, speeding fines. Yes, that is a good point. But the answer lies in the US. Once you have had a heart attack over there, you will struggle to find someone to insure you against your next one, certainly without prohibitively expensive premiums. We don’t want that in the UK. Contributions to scripts are likely to be a drop in the ocean compared to what we would be paying in insurance premiums for even a vaguely equally comprehensive service.
So, everyone, what do you think? Are we up for mucking in together for the greater good? We could call it ‘the big society prescription scheme’. Or does that just sound a bit ridiculous?
- © British Journal of General Practice 2013
