PDA signs joint letter to government on prescription charge increase proposal

The PDA has joined with health charities, the Royal College of General Practitioners, the Royal Pharmaceutical Society and the British Geriatrics Society to issue an open letter, urging the Government to rethink its proposal to raise the qualifying age for free prescriptions in England from 60 to 66.

Thu 2nd September 2021 The PDA

The letter highlights the organisations’ deep shared concern that scrapping free prescription charges for 60–65 year-olds is likely to intensify existing health inequalities and have a devastating impact on some older people’s health.  With many older people already struggling to meet basic living costs, this additional levy on poor health could prevent them from managing their health conditions, especially if they are on a modest income but still above the benefits line.

The letter continues by highlighting how the Government’s proposal will have a lasting adverse impact on the half (52%) of 60-64yr olds with one or more long term conditions.  While some patients will find the change affordable, significant numbers will not.  The DHSC impact analysis highlights that these patients will find it harder to proactively manage their conditions, presenting in their local health service as their conditions deteriorate.  New analysis by Age UK reveals that each year, tens of thousands of people may require hospital treatment (1), having cut back on their medication due to no longer being eligible for free prescriptions

The DHSC itself has estimated savings of £198-£257m p.a. for the NHS as a whole, which is a tiny fraction of the NHS £212.1bn budget (2) What’s more, this estimate does not take into account the extra costs to local health services from addressing the more complex issues that will arise for the patients who feel unable to afford their medication.  These patients are more likely to live in more deprived communities, with services that are more overstretched and under-resourced than in more affluent areas.  There are no specific measures in place to direct the money saved by this proposal to less favoured localities, and the change seriously risks widening health inequalities at a time when the Government and the NHS are committed to narrowing them.

Mark Koziol, PDA Chairman, said: “The PDA has several concerns around this proposal. It fails to consider the real impact it would have on the most vulnerable members of society. If the prescription price becomes a barrier to accessing prescription medicines, the poorest most vulnerable members of society will be faced with the hard choice of having to decide which medication to purchase and which one/s they could “go without”. They may also try to ration items such as inhalers, rather than take them as prescribed.

Whilst the introduction of charges for people between 60 and State pension age may lead to short-term increases in income, in the long-term there would be an increased burden both financially and in terms of workload on the NHS as a result of complications arising from poor compliance with their prescribed medications.

 

Caroline Abrahams, Charity Director at Age UK, said:The money the Government raises if it goes ahead with this proposal will be easily outweighed by the additional costs to the NHS if, as is predictable, some people fail to take their medication and become sicker, more quickly.  Tens of thousands may require hospital treatment due to rationing what they take, so this really is a bad idea that will hit people who are poorly and on modest incomes hardest of all.

“Once we reach our early to mid-sixties many of us are advised by our doctors to take medicines that are proven to keep potentially serious health conditions safely under control. If the Government goes ahead with its proposal, it is clear that some people will be reluctant to act on symptoms or get a diagnosis, for fear they will be unable to afford long term, symptom relieving or even in some cases lifesaving medication. The Government should definitely think again.”

 

Professor Martin Marshall, Chair of Council of Royal College of General Practitioners, said: “We have always been supportive of any safe and sensible measures to reduce medication costs for patients and ensure equitable access to necessary medication for all patients.

“Introducing an additional cost for over 60s managing long term health conditions will, albeit unintentionally, disproportionately affect a large group of patients who are on low incomes but just above the threshold for financial help with the costs of their medication. Many patients are already waiting longer for treatment or will have seen their health deteriorate as a result of the challenges of the last 18 months.  This change will discourage patients who are financially less well-off from managing their health proactively, and could mean that they present to general practice when their problems are far worse and at a time when general practice is already at breaking point. We urge government to reconsider these proposals.”


Thorrun Govind, Royal Pharmaceutical Society English Pharmacy Board Chair, said:
“The proposal to raise the age at which people can access free prescriptions from 60 to 66 means that many more people will be affected by this tax on the sick at exactly the time at which they may be needing more medicines.

“It is unacceptable to raise the cost of prescriptions in the current economic situation when many have been disadvantaged by the pandemic. Such proposals will only further drive the health inequalities that have been highlighted by Covid-19.

“RPS would like to see the complete abolishment of prescription charges in England, whatever the age group, as is the case in Scotland and Wales.”

 

Dr Jennifer Burns, President, British Geriatrics Society said: We are dismayed to hear that the Government is considering increasing the age at which people in England become eligible for free prescriptions. It is essential that older people with multiple long-term conditions are able to access to the medications they need to effectively manage their health.

 

The letter says:

Dear Secretary of State,

We are writing to you to express our deep, shared concerns about the proposal to raise the qualifying age for free prescriptions from 60 to 66.

There is no doubt that it will have a lasting adverse impact on the 52% of 60-64 year olds with one or more long term conditions. Some will find the change affordable but significant numbers will not. The DHSC impact analysis highlights that these patients will find it harder to proactively manage their conditions, presenting in their local health service as they deteriorate.

The DHSC has estimated savings of £198-£257m p.a. for the NHS as a whole, a tiny fraction of the NHS £212.1bn budget for 2020/21. What’s more, this estimate does not take into account the additional costs to local health services of having to address the more complex issues that will arise for people in this age group who will no longer feel able to afford their medication.

These patients are more likely to live in more deprived communities, with services that are more overstretched and underresourced than in more affluent areas. There are no specific measures suggested to direct the money saved by this proposal to support health systems in less favoured places. The proposed change seriously risks widening health inequalities at a time when the Government and the NHS are committed to narrowing them.

The age for exemption from prescription charges may have its origins in the State Pension age but its rationale today is that it meets a known health need. Most of us will live with one or more health conditions as we age and for many in their sixties this can mean needing to take medicines into the longer term, to preserve and protect their health for the future. The fact that the existing exemption helps to remove any potential barriers to achieving this is really important – just as significant, in fact, as the exemptions that help people on low incomes to afford their medicines.

This is also why, in the longer term, we believe that prescriptions should be free for all. At a time when it is inevitable that millions are going to be waiting long periods for elective surgery and other treatments, these changes risk compounding the NHS backlog by putting new barriers in the way of 60-65 year olds with lower incomes taking the medication they need to manage their conditions in the meantime. For all these reasons we urge you to commit to retaining the prescription fee exemption for patients aged over 60.

We would be very happy to discuss these matters with you or with your advisers.

Yours sincerely,

Caroline Abrahams, Charity Director, Age UK
Carla Jones, Chief Executive, Allergy UK
Sarah Baker, Interim CEO, Anaphylaxis Campaign
Sarah Woolnough, CEO, Asthma UK and the British Lung Foundation
Tony Thornburn OBE, Chairman, Behçet’s UK
Sarah Mistry, Chief Executive, British Geriatrics Society
David Phizackerley, Deputy Editor, Drug and Therapeutics Bulletin, BMJ
Des Quinn, Chair, Fibromyalgia Action UK
John Hibbs, Founder and Chairman, The Hibbs Lupus Trust
Dr Susan Walsh, CEO, Immunodeficiency UK
John Palmer, Director of Policy and Communications, Independent Age
Paul Howard, Chief Executive, LUPUS UK
Angie Davidson, Campaign Director, Lupus Trust
Karen Walker, Chief Executive, Multiple System Atrophy Trust
Laura Cockram, Chair of Prescription Charges Coalition and Head of Policy and
Campaigns at Parkinson’s UK
Martyn Hooper MBE, Chair, Pernicious Anaemia Society
Martine Walmsley, Chair of Trustees, PSC Support
Mark Koziol, Chairman, Pharmacists’ Defence Association
Professor Martin Marshall, Chair of Council, Royal College of General Practitioners
Thorrun Govind, Chair of the English Pharmacy Board, Royal Pharmaceutical
Society
Sue Farrington, Chief Executive, Scleroderma & Raynaud’s UK
Shwachman Diamond Syndrome UK
John James OBE, Chief Executive, Sickle Cell Society
Romaine Maharaj, Executive Director United Kingdom, Thalassaemia Society
Arlene Smith, Executive Officer, Turner Syndrome Support Society UK

Download the letter:

thumbnail of Prescription charges open letter

Notes:

Age UK’s ‘Save Free Prescriptions’ campaign which was launched in response to the consultation has already generated over 32K responses to the proposal. The consultation, pushed out by the Government last month closes today.

The Government says that those affected by the proposal could buy a certificate to cut their costs, at £108.10 a year. However, this ‘Prescription Pre-payment Certificate’ (PPC) requires either up-front payment or setting up a direct debit, something which many older people may not be able to afford. Age UK is concerned that awareness of the PPC is already low with 27 per cent of ‘high users’ aged 55-59 – those who need more than 12 prescriptions a year – currently not using a PPC. If the same percentage is assumed for the 60-65 age group, this equates to 240,000 people who would be paying too much for their prescriptions

References:

1, Source: Age UK analysis based on assumptions from the Department for Health & Social Care (DHSC) document “Impact assessment: increasing the upper age exemption for prescription charges in line with the state pension age” and the Office for National Statistic (ONS) 2020 mid-year population estimates. The ONS estimate there are 3,767,959 million people aged 60 to 65 in the UK. The DHSC estimate that 66% of people aged 60 to 65 will not qualify for free prescriptions if the age at which free prescriptions is available is raised immediately from 60 to 66. The DHSC assume as their central scenario that 15% these people will not fully adhere to taking their prescribed medicine. This means that 354,376 people (3,767,959*66%*15%) will not fully adhere to taking their prescribed medicine if the age at which free prescriptions is available is raised immediately from 60 to 66. The DHSC document notes that a survey by Asthma UK found 13% of respondents who said that they were cutting back on their medicine due to the cost required hospital treatment as a result of skipping their medicine. Assuming this figure applies across the board, it will means that on a central scenario 46,069 people (354,376*13%) could require hospital treatment from having to cut back on taking prescribed medicines because of the cost increase from the age at which free prescriptions are available is raised immediately from 60 to 66.

2, The NHS £212.1bn budget includes approximately £60 billion of additional COVID spending.

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