NHS Prescriptions: Cost to Patients (Hansard, 15 June 1995)

§ The Minister of State, Scottish Office (Lord Fraser of Carmyllie)
My Lords, in the three years up to 31st March 1994 the total cost to the National Health Service in the United Kingdom of prescriptions for family health services was £3,626 million, £4,089 million and £4,491 million respectively. The income from the charges was 1893 £259 million, £290 million and £318 million and over 80 per cent. of prescription items were dispensed free of charge.

§ Baroness Gardner of Parkes
My Lords, I thank the Minister for that reply. He said that more than 80 per cent. of prescription items are free but today many prescription items cost more under the National Health Service than they cost to buy over the counter. Furthermore, prescription items are free for anyone over the official retiring age, which does not apply to dental charges. In view of those facts, is it not time that the whole question of who pays, and at what cost, should be looked at again? That would give us the benefit of prescribing new, improving and expensive drugs rather than seeing a great deal of public money spent on drugs which cost less than the money paid by the health service.

§ Lord Fraser of Carmyllie
My Lords, I do not believe that it would be appropriate to undertake such a review. It is important that some 80 per cent. of items are prescribed free of charge. Nevertheless, the money received from charges is substantial and the National Health Service can put it to good use. Particular items might cost less than the National Health Service prescription charge and it is open to the individual to acquire them by way of private prescriptions. However, I counsel those who consider taking that route to examine carefully whether at the end of the day it would be cheaper for them.

§ Lord Rea
My Lords, is the Minister aware of the anomaly whereby patients with certain medical conditions which require continuous replacement therapy—for example, diabetics and people with thyroid deficiency—but who are not exempt from prescription charges for any other condition can obtain free of charge not only the drugs that they require for their qualifying medical condition but tranquillisers and so forth, whereas other patients who are suffering from conditions which need continuous treatment—for example, those with high blood pressure—can obtain no drugs free of charge? Does not the Minister believe that it is time for a review of the whole system?

§ Lord Fraser of Carmyllie
My Lords, no. Clearly, the situation is not without its complications but I would not suggest that we should be extending the range of conditions to which exemption applies. Those who have a medical condition may wish to take advantage of the prescription prepayment certificates. Those in the United Kingdom who have done so have, on average, recouped their outlay approximately three times over. I am sure that the noble Lord will recognise that, if one tried to exempt those items required only for the treatment of the qualifying condition, an extremely complicated set of arrangements would follow, with whitelists and blacklists and doctors having to make difficult decisions about whether the particular prescription was attributable to the qualifying condition.

§ Baroness Robson of Kiddington
My Lords, we have heard that some drugs cost less to buy over the counter than on prescription and the fact that a patient can ask for a private prescription prepayment certificate. Would it not 1894 be easier for the pharmacist to be given the right to dispense the prescribed item at its correct price instead of charging the prescription price?

§ Lord Fraser of Carmyllie
My Lords, as I have indicated, that can be achieved by using the private prescription. One must look at the matter most carefully. There is an assumption that because the drug might be acquired at a cheaper rate by the National Health Service the price would necessarily be cheaper for the private individual going into the pharmacist. The situation is not as simple as is sometimes portrayed. I believe that it is important to continue with the system that we have. There may be casual circumstances in which people need a prescription but if they need it on a repeat basis they are probably better to use the prepayment arrangement, even if the required item costs less than the NHS prescription charge.

§ Baroness Jay of Paddington
My Lords, does the Minister agree that most GPs, under the terms of their service agreements, feel unable to issue the so-called private prescriptions? If the Government are anxious to see the increased use of that system, will they alter GPs' service agreements in order that they can issue prescriptions that are less costly than those of the NHS?

§ Lord Fraser of Carmyllie
My Lords, that arrangement is already in place. I have been anxious to establish the fact that this matter should be approached with caution. If the individual has repeat prescriptions, he might be better placed to take the opportunity of using the prescription prepayment arrangement, even if the individual item costs less than the current standing charge.

§ Baroness Jay of Paddington
My Lords, I am sorry to come back on this matter but the Minister may have misunderstood me. I understand the professional and legal advice to GPs to be that they should not issue the so-called private prescriptions within the terms of their service agreements. I consulted the BMA on the matter this morning and I believe that the understanding of GPs is that in order to do so legitimately their service agreements would have to be changed. Will the Government do that?

§ Lord Fraser of Carmyllie
My Lords, I was not aware of that view of the BMA. I understand that GPs can issue such private prescriptions hut it is certainly the case that they are under no obligation to do so.

§ The Countess of Mar
My Lords, is the Minister aware that I have had considerable correspondence with the department on that very subject and I have come to the same conclusion as he has? But there is a problem with dispensing doctors. Dispensing doctors can write a private prescription but they are not allowed to dispense that prescription to their patients. That puts the patients of such doctors on an unequal footing with other patients. Will the Minister ensure that something is done about that?

§ Lord Fraser of Carmyllie
My Lords, I am aware of that complication and I shall certainly look at the matter.

§ Baroness Gardner of Parkes
My Lords, perhaps I may—

§ Lord Graham of Edmonton
Next Question!

§ Baroness Gardner of Parkes
My Lords, there is not a next Question—this is the last Question on the Order Paper! I agree with the Minister that the matter should be approached with caution because it is an emotive subject. Nevertheless, I wish to press the point because he said that more than 80 per cent. of prescription items are dispensed free of charge. Even if the item you require costs only £1, if you have free prescriptions you would still like it on a National Health Service prescription because it would save whatever the amount may be. Can the system be reviewed so that, in the case of an item which is worth only £1 and is available over the counter for that amount, a patient entitled to a free prescription will still cost the NHS only £1 instead of the full dispensing amount of £5? Or does the Minister believe that such a system would so endanger the pharmacy industry that that factor should perhaps be taken into consideration? That is why I suggest that the matter should be investigated.

§ Lord Fraser of Carmyllie
My Lords, the assumption underlying the question is that the only cost to be considered is the cost of the drug. Clearly, administering the system of prescriptions throughout the United Kingdom is expensive. The cost to be considered is not only the cost of the drug but administration and other dispensing fees.