The excellent Clare Gerada, Chair of the Royal College of GPs is calling for a brave and honest debate about rationing medicine. According to GP magasine two thirds of GPs think that the NHS should stop providing free prescriptions for drugs that are available over the counter. Generally stuff like Calpol which you can buy without a prescription is cheap, less than the £7.65 prescription charge we have to pay in England. So it seems unlikely that requests for this stuff are coming from the people who have to pay charges. Only a small minority of prescriptions attract a charge – and none at all in Scotland, Wales or Northern Ireland. So some of these requests may be coming from people who really have trouble finding small sums for medication.
Gordon Brown was talking about abolishing prescription charges in England in 2008, and we investigated the options. Prescription charges were imposed in 1952 as a rather primitive form of rationing. Apart from the free prescriptions for the poor, the old and the young there is a list of medical conditions which entitle a patient to free prescriptions – because in 1968 when prescriptions were reintroduced by the Wilson government there was life saving long term medication for those conditions. The list hasn’t been revised since. As the charges tend to deter people just above the level which qualifies them for free prescriptions from taking all their medication there is a downside. Some of those people will end up in hospital because they don’t take their medication.
Rationing healthcare is universal and inevitable. The only question is how it should be done. Asking people to pay at the time they need treatment is agreed to be the worst possible way of doing it.
Dr Gerada has often called for decisions about rationing to be made by politicians, not doctors. We haven’t seen a rush of politicians stepping up to make proposals about what should be rationed or how. The NHS reforms introduced by this government are designed to insulate politicians as far as possible from unpleasant decisions of this kind. In reality it’s probably better for most of these decisions to be made in the consulting room than in Whitehall. The introduction of Clinical Commissioning Groups does seem to have had beneficial effects in many areas, because it’s forcing GPs to look at each other’s practise and see where money could be saved.
Perhaps the price doctors should ask in return for taking responsibility for rationing decision is that prescription charges should be abolished in England. Then the discussions in the consulting room need not be complicated by considerations about charges.