Until April 1, Northern Ireland’s health service had observed the care of those in the cradle and approaching the grave. However, now those who were formerly obliged to pay prescription charges will no longer be burdened by the ‘tax on illness’.

Health Minister Michael McGimpsey made political and social history last month by announcing that his Department would be scrapping all prescription charges, which had been initially lowered to £3 per single item in January last year. 

Ulster Chemists’ Association president Paula McDaid and contractors Paul Cooper, Michael Guerin and Paul McDonagh were among the delegates attending the policy launch at Belfast’s Grove Wellbeing Centre to listen to the Minister’s address.

The evidence and findings from the other parts of the UK has helped to inform the DHSSPS review. In Wales, prescription charges were abolished in April last year while the Scottish Executive has decided to introduce a phased abolition of prescription charges so that by 2011, there will be no charges for prescriptions. England has abolished charges for cancer patients.

While both PSNC and NPA have indicated that there has been a “limited impact” upon any increase in volume of prescriptions dispensed in Wales since charges were scrapped, the estimated 5 per cent increase in the first year equated to 2.9 million items. 

Anecdotally there was a noticeable increase shortly after the announcement although this generally settled down for Welsh contractors. However, the Minister insisted that prescription charges are a disincentive for patients to pay for and obtain their medicines. “I believe that charging people for vital medication is totally against the principles of a health service that is free at the point of use,” he added. “Prescription charges have been called a tax on illness. The fact is that within our community there are ill people who do not have enough money to pay for their prescriptions. They are being forced to choose between their medicine and food, which is totally unacceptable.

“Why should the health service fund the cost of operations, outpatient appointments and diagnostic tests and expect people with asthma, diabetes and other lifelong conditions to pay for the medication they desperately need? When I carried out my review of prescription charging I looked at a number of different options. One option was to extend the list of conditions that would be exempt – but that would mean trying to rank one illness against another, this goes against the principles of equality."

The issues surrounding the cost of introducing such policy, despite how beneficial it may be to Northern Ireland communities, are recurring ones. “The cost of abolishing prescription charges will be accommodated from within my existing budget,” the Minister vowed. “No existing services will be affected by this decision.” 

He added: “I have a lot of money to spend, despite the fact it’s not enough. But I have to prioritise and this is a priority. There is a group of people in the middle who have to pay for their drugs but can’t. While 50 per cent of the population are entitled to free prescriptions, 89 per cent of prescriptions which are dispensed are done so free of charge. This indicates a number of people who do not take their prescriptions to be dispensed because of the cost. They are folks with serious conditions that are not exempt from the charge.”

Speaking on his very last official day as chief executive of the Pharmaceutical Contractors’ Committee, Terry Hannawin welcomed the move. “We felt that the previous system was unfair and inconsistent,” he said. “As community pharmacists we saw many examples of patients with chronic or long-terms conditions having to pay charges, while others were exempt. We believe that having a uniform system whereby no one is charged will make the system fairer, less bureaucratic and easier to manage. Aside from being unfair to people with illnesses, administering the prescription charge was also time-consuming and bureaucratic for pharmacists, so we fully support its abolition.”

However, the timing certainly has not escaped the negotiating body. “Community pharmacists are all too aware however that the funding climate in Health & Social Care has changed considerably from when the Minister first announced this move in 2008. While PCC NI fully supports the principle of free prescriptions, it is essential that other front line community pharmacy services are not affected by the need to find resources to fund this initiative.” 

No suggestion of hesitation or scepticism from the Pharmaceutical Society of Northern Ireland however. Following the announcement president Ms Ann Bowen, said the Society “fully supports this move” describing it as “tremendous news” for all patients. “Evidence and research has repeatedly shown that prescription charges are linked to many patients skimping on their medication on the grounds of cost,” she added. 

Past UCA president James McKay also welcomed the move. “The UCA wishes to place on record our congratulations to Health Minister Michael McGimpsey for his bold initiative of introducing free prescriptions,” he said.

 

“This is a very positive development and means in essence that patients will no longer have to pay a 'tax' for being ill. From an equality perspective the government already funds an extensive range of acute service episodes and it is only right that patients with asthma, diabetes and other lifelong conditions should not have to pay for essential medication requirements. It is our considered view that this initiative will help and facilitate the primary care strategy of caring for patients in community settings. Community pharmacy remains ideally placed to further enhance and support the management of patients with chronic disease in local communities.” 

 

 

So what happens next? What can be learned from elsewhere? Prescription charge abolition in Wales was phased in over a three year period, leaving both patients and pharmacy contractors with plenty of advance warning about the change. “There was only a small uplift in volume for a couple of months after the final removal of the charges but volume quickly returned to normal,” a spokesperson for the negotiating body told NIPinF. “The process was relatively smooth for pharmacy contractors as the same forms continued to be used. The only problem was in border areas where Welsh patients of English doctors had to be issued with a card to show that they were entitled to free prescriptions as they were resident in Wales.

  

“CPW and contractors were broadly in favour of the change because it removed some of the hassle over checking exemptions under the previous system. If contractors in Northern Ireland collect a significant amount of charges then removal will produce a cash flow disadvantage.”

Turning policy back into figures, here is the Department’s summarised analysis.

A cost and benefit review group was established following an Assembly debate on prescription charging in May 2007. The review group included pharmacists, doctors and, most importantly, patient representatives. 

In 2006/07 there were over 16 million prescription forms issued to patients which resulted in almost 30 million prescription items being dispensed. This equates to an average of 17 prescription items per person.

Currently, the income from prescription charges amounts to around £13 million net each year. The gross cost of £14 million is offset by £1 million administration costs. That must be set in relief against the £360 million that is spent on medicines prescribed by GPs. Of that £360 million, only a small proportion - around 3•5 per cent - is recovered.

Additionally, each year, hospital consultants prescribe approximately £109 million worth of drugs, all of which are free to patients.