Intended for healthcare professionals

Letters Free prescriptions in Wales

Have dispensed items really risen with free prescriptions?

BMJ 2008; 337 doi: (Published 10 September 2008) Cite this as: BMJ 2008;337:a1581
  1. Tony Jewell, chief medical officer Wales1
  1. 1Welsh Assembly Government, Cardiff CF10 3NQ
  1. tony.jewell{at}

    The headline in the print issue, “Free prescriptions in Wales lead to 5% rise in dispensed items,” is misleading.1

    Prescription charges were finally abolished fully from April 2007. I cannot detect any step changes that might have been expected and thus associated with the policy change. For example, although figures over the past year show a 5% increase in prescriptions dispensed, since 2000 the yearly increase has fluctuated between 4% and 6%, so it would be wrong to deduce that free prescriptions alone were responsible for the increase.

    For some time, Wales has had a high rate of items dispensed per head of population. The cardiovascular system accounts for the largest proportion of prescriptions, increasing from 22% to 33% of items dispensed between 1997-8 and 2007-8. We have a high burden of coronary heart disease in Wales, and our national service framework encourages ascertaining and treating cardiovascular risk factors, which has had an impact on, for example, the prescription of statins.

    Your headline could have referred to the fact that Wales has the lowest net ingredient cost per prescription in the UK (£9.51 v £12.65 in Northern Ireland) or a comparatively high rate of generic prescribing (84%) in 2006-7.

    With no prescription dispensing fee, the responsibility for the appropriate use of finite resources resides with the Welsh population and prescribers. We continue to analyse this relationship but have no evidence of an adverse impact. The ultimate test for NHS Wales, clinicians, and patients should be whether we are meeting needs and prescribing effective treatments.


    Cite this as: BMJ 2008;337:a1581


    • Competing interests: None declared.


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