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GPs are contractually obliged to offer FP10 NHS prescriptions to patients. As long as this obligation remains any guidance will be ineffective. It will result in more variation as one GP may deem certain patients ineligible, where another GP may continue to provide the medications.
The Department of Health can simply remove the offending items from the approved NHS list (Compendium) and take the responsibility of the consequences of their policy.
Instead of prescribing paracetamol, GPs will now be obliged to offer less appropriate prescription medication, for instance paracetamol with codeine.
For patients exempt from prescription charges, no medication is going to be cheaper to buy over the counter, irrespective whether it costs the NHS four times as much to provide it than the cost of the medication. Abandon the archaic nonsensical system of exemptions, for instance patients with hypothyroidism receive all medications for free, but patients with asthma or hypertension are charged.
Forcing patients to buy certain medications is equivalent to introducing a flat fee. A fairer way to levy additional charges would be to introduce a co-pay to all NHS prescriptions according to income, this way lower income families will not be carrying most of the burden of the proposed additional charges.