Intended for healthcare professionals

Views & Reviews If I Ruled the NHS

Ban management consultants

BMJ 2015; 350 doi: (Published 15 January 2015) Cite this as: BMJ 2015;350:h28

Re: Does anyone consider price and cost, other than the management consultants?

Max Pemberton suggests there should be a national campaign to inform the British public about the cost of the drugs they get, such as antibiotics. Did he pause to inform himself on the matter, first?
Dr Pemberton and his patients might be disconcerted to learn how little many of these drugs cost.

• A 7-day course of amoxicillin 500mg tds costs the taxpayer £1.68, or 8 pence per capsule
• A 100-tab pack of paracetamol 500mg costs £3.19, or 3 pence a tablet
• A beclometasone aerosol inhaler 50mcg costs £3.70, or 2 pence per inhalation
• A salbutamol aerosol inhaler 100mcg costs £1.50, or less than 1 pence per inhalation.

NHS patients of working age might start to ask why they are required to pay an £8.05 sales/prescription tax for these items, when they already cover the cost of their health care through income and other general taxes. Those who require antibiotics might ask why they should pay an extra charge for having the misfortune to succumb to infection.
They might start to ask why they can’t be issued a private prescription, for the price advantage this would offer. For those on long-term therapy, an extended 3 or 6 month private prescription could be attractively priced, compared to the 28-day course ordinarily available on NHS prescriptions. To say nothing of the convenience of an extended repeat.

The 28-day restriction on NHS repeat prescriptions is an added burden for those with long-term conditions because it increases the likelihood that they will run out of medication at some point, either through personal carelessness or administrative error across the chain of those involved in processing each request. For those who are steroid-dependent, death can rapidly follow.

To appreciate the true absurdity of prescription charge anomalies across the devolved UK, it is worth visiting the NHS England Frequently Asked Questions page about how patients on the Welsh borders can play the system:

Within England, anomalies in the application of the prescription charge are just as absurd as those between England, Wales and Scotland.

• Cancer drugs are exempt
• Certain long-term conditions, such as epilepsy or endocrine conditions, are exempt
• Other long-term conditions, such as asthma, are not exempt. Asthma is a frequent cause of emergency hospital admissions and sudden death, many attributed to poor treatment adherence. Thus, the indirect costs to the NHS of the £8.05 prescription charge may well outweigh the direct revenue return to the Treasury.

The prescription charge within England is an arbitrary, regressive form of sales tax. Coupled with a standard 28-day limit on NHS prescriptions, it gives the impression of a cynical ploy to extract revenue from the vulnerable, such as those with asthma. Both act to penalise the working poor, especially the self-employed, and deter treatment adherence among those with less than optimal budgeting or personal organisation skills. Yes, there is a Low Income Scheme, but have you seen the mind-boggling paperwork required to apply for it?

Around 60% of the population in England are exempt from prescription charges, on grounds of age (under 16 or 60+ years), medical condition or income. Nearly 90% of all prescription items are issued free, because the elderly tend to consume more drugs than the young. (Gilmore report 2009, ) So why does NHS England continue to impose an arbitrary, regressive £8.05 prescription charge on those aged 16 – 59?

I would strongly support Dr Pemberton’s wide-eyed suggestion, that patients and their doctors be educated about the true cost of prescribed drugs. Unless you want to leave that to the management consultants.

Competing interests: No competing interests

22 January 2015
Katherine G White
Addison's Disease Self-Help Group
PO Box 1083, Guildford GU1 9HX