CHAPTER ONE: INTRODUCTION
This report presents the findings of a public consultation to inform the Review of NHS Prescription Charges and Exemption Arrangements in Scotland. The consultation took place between January and June 2006 and comprised three main strands: an omnibus survey module, a written public consultation and focus groups with key patient groups.
This chapter of the report provides background information on the review and the consultation, highlighting some of the current issues relating to prescription charges and exemptions in Scotland and detailing the methodology for the three strands of the consultation.
BACKGROUND
NHS prescription charges and exemptions
Prescription charges were first introduced in 1952 and, except for a 3 year period between 1965 and 1968, have been levied ever since.
The current flat rate prescription charge in Scotland was raised from £6.50 to £6.65 per item dispensed in April 2006. Between 2000 and 2005, it had risen by increments of 10 pence. For patients who require many prescriptions, a more affordable option is to purchase a prescription pre-payment certificate ( PPC). PPCs can be cost effective where a patient needs more than 5 items in a 4 month period (for which the charge with a PPC is currently £34.65) and where the patient needs more than 14 items in a 12 month period (the current charge with a PPC is £95.30).
There are NHS prescription charge exemption arrangements designed to protect those who are most likely to have difficulty paying (see Figure 1.1 below). A person can qualify for exemption on 3 main grounds - age, financial status or medical condition. It is estimated that around 50% of the population qualifies for free prescriptions under the current exemption arrangements. However, because this group includes children, the elderly and people with chronic health conditions, all of whom are high users of medicines, over 90% of items dispensed in Scotland are supplied to the patient free of charge.
In 2004-05, the cost of pharmaceutical services provided by community pharmacists, dispensing doctors and appliance suppliers was £982 million. Of this, £859 million was the cost for medicines and appliances and £123 million was spent on remuneration for pharmacists, dispensing doctors and appliance suppliers. For the same period, income from prescription charges including the sale of PPCs, totalled £44.4 million, which was 4.5% of the cost of pharmaceutical services and around 1% of NHS Boards' total revenue budget.
Figure 1.1: Current exemption categories |
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Exemption categories as detailed in NHS Health Department Letter (2005) 10 (Scottish Executive 2005) The patient does not have to pay if he/she: 1. is under 16 or under 19 and in full-time education 2. is aged 60 or over 3. holds a current Health Board exemption certificate ( EC92) which are issued to: 3.1 expectant mothers 3.2 mothers who have a child under 1 year of age; 3.3 people suffering from the following medical conditions: - permanent fistula (including caecostomy, colostomy, laryngostomy or ileostomy) requiring continuous surgical dressing; - forms of hypoadrenalism (including Addison's disease) for which specific substitution therapy is essential;
- diabetes insipidus and other forms of hypopituitarism;
- diabetes mellitus except where treatment is by diet alone;
- hypoparathyroidism;
- myasthenia gravis;
- myxoedema (hypothyroidism);
- epilepsy requiring continuous anti-convulsive therapy;
- a continuing physical disability which prevents the patient from leaving his/her residence without the help of another person
4. has a valid War Pension exemption certificate 5. has a valid prescription pre-payment certificate 6. gets or has a partner who gets Income Support 7. has a partner who gets Pension Credit Guarantee Credit ( PCGC) 8. gets or has a partner who gets Income-based Jobseeker's Allowance 9. holds or is named on a valid NHS Tax Credit Exemption Certificate 10. is named on a current NHS Low Income Scheme HC2 'Help with health costs' certificate |
Policy background
The 2003 Partnership Agreement set out the Scottish Executive's commitment to set up a review of prescription charges for people with chronic health conditions and young people in full time education and training.
The Executive is supportive of prescription charging in principle on the grounds that the scheme places a value on the medicines that patients require, helps reduce the level of less urgent demands on GPs' time and provides a much needed source of revenue for the NHS.
However, the Executive has acknowledged that current exemption arrangements contain anomalies that require to be addressed. It was this recognition that led the Executive to make a commitment under the Partnership Agreement to a review of prescription charges for people with chronic medical conditions and young people in full time education.
As a first step towards delivering the Partnership Agreement, the Executive in 2005 undertook a review of prescription charging arrangements in other countries to provide an evidence base for future changes in Scotland. It examined and compared how much patients contribute to the cost of their medications and what exemptions and reduced payment policies are in place in Western Europe, North America and Australasia.
Secondly, January 2006 saw the launch of the public consultation, Review of NHS Prescription Charges and Exemption Arrangements in Scotland. The aim of this consultation was to encourage debate on a range of specified options for changing current prescription charging and exemption arrangements.
In parallel with this, a number of developments altered the context within which debates about prescription charges and exemptions have taken place. First, in October 2005, the Executive published Delivering for Health which set out a programme of action for NHSScotland to the end of the decade. In the report, the Executive reiterated its commitment to tackling health inequalities. The review of prescription charging and exemption arrangements is seen as one important step towards that latter goal. Second, in Wales, the Welsh Assembly Government has continued to pursue the phased abolition of prescription charges, initiated in 2001, and this has added to the momentum for change in Scotland. Thirdly, in January 2005, the Abolition of Prescription Charges (Scotland) Bill was introduced to the Scottish Parliament by Colin Fox of the Scottish Socialist Party. The Bill fell at its reading on 25th January 2006.
THE PUBLIC CONSULTATION
The public consultation comprised three main strands: a written consultation, an omnibus survey module, and focus groups with key patient groups. The written consultation document was designed and circulated by the Scottish Executive. The other elements of the consultation were undertaken by external research agencies. TNS System Three was commissioned to run the omnibus survey module. Ipsos MORI was commissioned to analyse the responses to the written consultation, conduct the focus groups and produce this factual report on the findings from all three strands of the consultation.
The following Chapter describes the three consultation strands in detail. Subsequent chapters comprise an in depth analysis of the findings.