Go-ahead for free prescriptions in Wales despite warnings
pharmafile | February 9, 2007 | News story | Sales and Marketing |Â Â NHS, WalesÂ
Wales is set to abolish all NHS prescription charges to patients in a move intended to allow fairer access to medicines for people on low incomes.
Abolishing charges has been a long-held ambition of the Welsh Assembly and serves to underline the different approach to the NHS in Wales compared to that of England
Welsh Health Minister Dr Brian Gibbons said: “The main reason for providing free prescriptions was to ensure people are not put off getting medication they need due to cost.”
The changes are not, however, supported by the pharmaceutical industry in Wales. ABPI Wales has opposed the plans from the beginning and says the abolition of charges will lead to medicines going to waste and an increased demand thus placing a drain on the resources available for newer treatments.
Industry concerned
Dr Richard Greville, Director of ABPI Wales said: “Our concern is that a further squeeze on the medicines budget may reduce access to the range of treatments, especially new innovative medicines, available to patients in Wales, or reduce prescribing which clinicians believe is appropriate and cost- effective.”
The present system dates from 1968 and critics of it say it contains inconsistencies, such as free prescriptions for diabetes patients but not for sufferers of cystic fibrosis or asthma.
The new policy is aimed at helping the less well-off individuals or those suffering from chronic illnesses, who previously may not have been eligible for free prescriptions.
To qualify for free prescriptions from April, patients must be registered with a Welsh GP. Some people who live in Wales are registered with GPs across the border in England, and these patients must first obtain an entitlement card in order to claim their free prescriptions.
The NHS in Wales is used by some three million people and faces a number of challenges – including some of the highest rates of cancer and heart disease in Europe and a high proportion of elderly people.
NHS policy in Wales began to diverge from England with the creation of the National Assembly in 1998, but the process is now gathering pace.
A number of very significant reforms introduced in England over the last couple of years have not been replicated in Wales, including practice-based commissioning, payment by results and foundation trusts.
The Welsh Assembly froze prescription charges at £6 in 2001 and then cut them in 2004, 2005 and again in 2006, when they reached their current level of £3 per item. In contrast, the charge for patients in England and Scotland has been rising yearly and now stands at £6.65.
Even as it announced the changes, the Welsh Assembly was warning its new policy could cause problems for the NHS in Wales if patients abuse the system.
Dr Gibbons stressed the free prescription policy would only cover prescription-only medicines and not treatments that patients would normally pay for themselves. GPs would continue to decide a patient’s need for prescription medicines on clinical grounds, he said.
“Where patients already buy non-prescription medication over the counter, they should continue to do so in the normal way. If patients change their behaviour radically, this could have a detrimental impact on the NHS as a whole and indirectly on those patients who are in most need of the free prescriptions,” he said.
Support for change in England
Meanwhile, there has been a call for England to follow Wales example. The Association of Directors of Public Health, which represents NHS public health directors, says most prescriptions should be free and charges should instead be levied for a limited number of surgical procedures.
Association president Dr Tim Crayford said: “Medicine and treatment that people need for health reasons should be free. But things that people want, where there’s little proof of clinical benefit, ought to have a price tag attached.
“The NHS has always struggled financially to meet public expectations, and this proposal would help the NHS ensure that the most people in most health need get the treatments they require.”
Dr Crayford criticised the lack of a consistent approach when it came to deciding on the efficacy of surgical procedures and called for a public debate about what should be subject to a charge.
The savings to the NHS by charging for doubtful procedures, such as tonsillectomies, would compensate for the losing of revenue from prescription charges, he said.
Dr Crayford, who is also director of public health and medical director at Croydon PCT, added: “89% of prescriptions are free as it is, and there’s no logic on health grounds to charge people for the remaining 11%, except for everyday medicines like aspirin and paracetamol, where charges should remain.
“It seems unfair to charge for highly effective drugs, such as statins to lower cholesterol and prevent heart attacks, while not charging for some treatments that offer much smaller benefits to people.”
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