Leela Barham explores the costs that the new Labour Government could face if it decides to reform prescription charges. Whilst not on the priority list, reform has been on the Labour agenda in the past

Labour has been in favour of scrapping charging for prescriptions in England - which would bring the country in line with the other nations of the UK - in the past. Labour MPs more recently discussed reforming medical exemptions too, but what would be the cost?

Prescription charges

Cast your mind back to 2019 when prescription grabbed national media attention because of the case of Holly Warboys, who died aged 19 after an asthma attack. Paying prescription charges was a struggle for Holly because she was on a low income. Her mother told the BBC that she had just one puff left on her inhaler and couldn’t afford to buy another one. At the time, Labour’s shadow health secretary Jonathan Ashworth said that his party would scrap the charge.

In March this year, Labour MP Christina Rees (who left the House of Commons on 30 May) opened a debate on prescription charges for those with long-term conditions. In that debate, she called for the UK Government to “rethink their approach to prescription charges.”

Fellow Labour MP, Preet Kaur Gill, who retained her seat following the general election, suggested there should be a new look at the economic case for changing medical exemptions.

Income lost

Income from prescription charges was £490 million in 2023/24. It would have been higher, but most community prescriptions were dispensed at no charge to patients: 94.87 per cent in 2014/15 and 95.42 per cent in 2023/2024.

Income from prescription charges has been higher in the past, with a peak of £533m in 2015/16 – the most in the last ten years. That gives a ballpark for income that would be lost if the prescription charge was scrapped.

Income from pre-payment certificates is unknown, but NHSBA has released data in response to a freedom of information request that showed that over 2.8m pre-payment certificates were bought in 2022, the most recent year available.

People are able to buy three-month or 12-month certificates at different prices; the breakdown between these wasn’t in the data. 

Income would also be lost if the medical exemption was widened. There have been a host of petitions from people who want to see charges dropped across a number of conditions: cystic fibrosis, sickle cell anaemia and Crohn’s and colitis were cited in the March parliamentary debate.

Reduced administration

Prescription charging in England takes time and effort. That is borne by people who need to navigate whether they are exempt and/or if they could save by buying pre-payment certificates. It’s borne too by community pharmacy staff.

As an indicator of workload, just under 188,000 pre-payment certificates were bought in community pharmacies in 2022. This is the tip of the iceberg; just how much time is spent helping patients and others navigate the rules?

Work is created for NHSBSA too, for processing and in figuring out who is wrongly claiming for an exemption and issuing penalty charge notices. The most recent NHSBA data covers January to August 2023. It shows there were more than 520,000 enquiries resulting in close to 410,000 penalty charge notices.

But with a quarter of items dispensed without charge in 2023/24 with no declaration or non specific or unknown declarations, there could be even more people wrongly claiming.

It’s hard to know the pounds and pence, but it doesn’t look like it’s easy to administer the current system. It’s tough to know too if people are deliberately trying to cheat the system or are just finding it confusing.

Spend to save?

The indirect impact of changing policy on prescription charges needs factoring in too. When patients don’t pay, will they be prescribed more? The number of items dispensed without charge was 14 per cent higher in 2023/2024 than in 2014/2015, but perhaps this is a reflection of the health of those who have qualified for exemptions in the past.

Anyone worried about prescriptions spiralling should also consider that it should mean that those who aren’t getting their prescriptions dispensed due to cost would in the future be able to obtain their items. There could be downstream benefits for the NHS, as well as for these individuals’ health.

Rees cited evidence from Parkinson’s UK in her parliamentary speech that suggested that scrapping the charge for people with Parkinson’s would save money overall.

Welcome change

More work is needed to establish just how much a change to prescription charging policy would cost or if net benefits would be realised. It would likely be welcomed by those who are currently paying. It might ease the worry of those who have made a mistake in the past and wrongly claimed an exemption only to be charged later.

Community pharmacy would welcome it too; not only because many are against prescription charges in principle, but also because it would save time at the counter. A cheap and cheerful policy for the new Labour Government to implement perhaps?