Organisations reluctantly come out in support of top-up paymentsBMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a1685 (Published 16 September 2008) Cite this as: BMJ 2008;337:a1685
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The fundamental principles upon which the National Health Service
(NHS) is built over the last six decades, is providing the highest
standards of treatment and care, that is universal, tax-funded, free for
all at the point of need regardless of wealth or position (Department of
‘Co-payments’ or ‘Top-ups’ are payments made by the patients for drugs,
devices or procedures that are not funded by the NHS. Patients topping up
their treatment in the NHS is not a new phenomenon. Dentists providing NHS
as well as private treatment at their surgery , topping up in optical care
for those eligible for vouchers towards lenses or glasses,the use of
amenity beds in the hospitals, prescription charges and GP appointments
leading onto private appointments with specialists are few examples of
already existing top-ups in the NHS.
In the United Kingdom based on the cost effectiveness analysis the
NICE (National Institute of Health and Clinical Excellence) will decide
whether a drug or treatment to be funded free by the NHS. As far as the
cancer treatment is concerned the NICE has rejected 4 treatments out of 56
treatments assed since its establishment in 1999. The drugs are not
routinely funded by the NHS if they are rejected or not evaluated by the
NICE. In these situations patents can apply for funding from the local
Primary Health Care Trust (PCT) or Local Health Board (LHB) or got a
choice to privately fund their own treatment. The existing government
guidance suggests that the NHS should not provide free NHS treatment to a
patient who has made decision to top-up payment for a drug or device (The
Kings Fund, 2008).
Straughair K (2008) the Chair of North of England Cancer Network in a
letter to Professor Mike Richards, National Cancer Director for the
Department of Health has rightly explained the board’s decision to take up
a stance against the top-ups for the following reasons.
• The top-up system would create a two tier system of the NHS supplying
different cancer drugs to different cancer patients based on their ability
• The top-ups are likely to increase the burden to the NHS as a result of
using more resources to administer the top-up treatment thus depleting the
scarce and finite resources of the NHS.
• Top-ups eventually lead on to health inequalities among those who could
afford to pay and those could not.
The North of England Cancer Network believes that there are significant
practical, ethical and political implications in implementing the top-ups
needs addressing and debating.
We reciprocate the opinion of the North of England Cancer Network as
this top-ups / co-payments system is clearly against the principles up on
which the NHS is built. The Secretary of State for Health Alan Johnson in
June 2008 had commissioned Professor Mike Richard, National Cancer
Director to examine the current policy and ‘to make recommendations on
whether and how policy or guidance could be clarified or improved. The
report is due to be published in October 2008.
• Department of Health (2008) Sixty years of the National Health
Service: a proud past and a healthy futureLondon. Department of Health.
• The Kings Fund. (2008) Top-up payments for drugs in England.
London. The Kings Fund publication. Page 1-6.
• Straughair K. (2008) CO PAYMENTS FOR CANCER MEDICINES. [Internet]
Gateshead. Letter Available
-Itemforinfo-Co-paymentsforCancermeds.pdf> [Accessed on 16th of
Competing interests: No competing interests