| Review of Prescription Charges |
 |
Exemption for people with long term conditions was announced by the Prime Minister in 2008.
The Department of Health are undertaking a review of
Prescription Charges to consider how to implement exemption from
prescription charges for people with long term conditions. | |
Patient Support Groups were approached with a request for a written
submission in response to a set of questions relating to the review
which will assist in the formulation of recommendations to Ministers
about how to exempt people with long term conditions from prescription
charges and how this exemption can be phased in. The closing date for
written submissions was 27 February 2009.
The response of the Gorlin Syndrome Group is included below:
Review of prescription charges
Response to consultation - Closing date 27th Feb 2009
The
Gorlin Syndrome executive group are responding on behalf of group
members. Gorlin syndrome is an autosomal dominant genetic condition;
major features include multiple basal cell carcinomas and recurrent jaw
cysts. Other features occur in the syndrome, although most are rare but
can include ophthalmic problems, cleft lip and palate, ovarian
fibromas, cardiac fibromas and medulloblastoma.
Patients are
at risk of skin cancer because of their genetic make up and are
included as a special group in NICE clinical guidelines 2006,
‘Improving outcomes for people with skin tumours including melanoma’.
There
is a prevalence of 1 in 55000 people affected by the condition.
Management includes the prevention of basal cell carcinoma by daily
application of sunscreens and treatment. Treatments vary according to
size of tumour and include repeated courses of topical 5 –
fluorouracil, imiquimod, oral reitinoids are recommended. Antibiotics
and dressings following surgical treatment for the symptoms are
essential to recovery. Additionally, skin camouflage products are used
where extensive facial scarring has occurred following surgical
treatment and the application of either Dermatix or Kelo-cote to
minimize scar damage.
Response to Question 1
What
are the guiding principles to bear in mind when seeking to extend
prescription charge exemption to people with long term conditions? For
example what consideration needs to be given to issues such as:
severity - Irrelevant as it is impossible to measure objectively
level of impairment - Irrelevant as it is impossible to measure objectively
duration – this is the only viable measure
time between having and not having symptoms – what does this mean?
amount of treatment required – varies from one person to another
the
potential to improve health outcomes - Will this mean that NICE will be
making QUALY judgments against the price of the drugs?
For
conditions such as Gorlin syndrome factors including severity, level of
impairment, duration, time between having and not having symptoms and
amount of treatment required varies from one person to another. There
is no set pattern. Some may have regular ongoing problems, others
infrequent but with more severity, others hospitalised and requiring
several weeks off work or school.
The potential to improve
health outcomes is to enable all patients’ access to free treatment
whatever the severity, duration, impairments, time between symptoms and
amount of treatment required to minimise the individual impact each
treatment package incurs and maximise the opportunity to heal both
physically and physiologically.
Free prescriptions needs to be driven by clinical need not income.
System should be straightforward.
The administrative burden on GP/Pharmacist should not be increased.
The system should have due regard to current health inequalities.
Free prescriptions should not be provided at the expense of other aspects of NHS funding and performance.
Response to Question 2
How
can these principles be applied to define the basis for exempting
people with long term conditions from prescription charges? For
example, should there be a revised list of medical exemptions? Or
should the approach be based on a broader definition of long term
conditions that takes account of the above principles? How do we ensure
that the approach is fair, transparent and, as far as possible, based
on objectivity?
Exemption on the basis of condition or disease is always going to be fraught with complications and inconsistencies.
[The principle should be abolition, failing that] exemption should be based on duration.
We
recommend that all patients with Gorlin syndrome for the reasons
discussed in question 1 are exempt from prescription charges for
treatment, management or prevention of the condition.
Response to Question 3
Taking
account of your views on questions 1 and 2, which conditions do you
think should definitely quality for exemption, and which conditions do
you consider should not qualify? Please give your reasons.
Gorlin syndrome – also known as Nevoid Basal Cell Carcinoma Syndrome (NBCCS) or Basal Cell Nevus Syndrome (BCNS)
Q Which conditions do you think should definitely quality for exemption?
A.
All those conditions which are judged by the attending physician as
‘Long Term’ (which expression should include genetic disorders and
proximately terminal conditions)
Q. Which conditions do you consider should not qualify?
A. Those outwith the definition above.
Response to Question 4
What
could be the anticipated health benefits of extending exemption to
patients with long term conditions? What other potential benefits could
be achieved by extending prescription charge exemption?
Exemption
would enable patients to afford the full range of treatment recommended
to control the disease, thus minimising the need for secondary referral
for surgical intervention.
Equally to enable patients to afford
the necessary sunscreen treatment recommended for daily application all
year round to prevent and control regrowth of basal cell carcinoma, and
to enable patients with facial scarring to afford skin camouflage and
silicone gel treatment to minimise the overwhelming psychological
effects.
Charges do not just deter unnecessary use of
medicines; they also deter essential use of medicines in people with
long term conditions. That has adverse consequences for their health
and for costs elsewhere in the Health System, such as unplanned and
avoidable hospital admissions.
Response to Question 5
What
impact could the widening of prescription charge exemption for people
with long-term conditions have on (a) prescribing practice (b)
medicines usage / wastage? (c) wider initiatives for people with long
term conditions – such as care planning? How can potentially positive
aspects be maximised and adverse impacts be mitigated?
Prescribing
practice may incur increase in request for repeat prescriptions where
those unable to afford paying for prescriptions take up the opportunity
of free prescriptions. With care planning the regular review of
medications could minimise the unnecessary issue of repeat
prescriptions where the medication is not currently required.
It
is also clear that there will be extra costs to both the NHS and the
benefits system if a patient’s recovery is delayed or their cancer
returns because they cannot access treatments.
The current arrangements mean that around 50% of the population are exempt from prescription charges.
Department
of Health figures show that people with Long-term conditions account
for 52% of all GP appointments. If we assume that each appointment
generates some fraction of a prescription then, in the absence of
definitive numbers, it follows that something between one third and two
thirds of prescriptions are issued to people with long term conditions.
If
income from prescription charges falls even lower, then the proportion
of the NHS drugs bill met by charges might require a complete overhaul
of funding.
Any additional costs resulting from a more radical
review could be funded by extending generic prescribing. The OFT report
on the Pharmaceutical Price Regulation Scheme (PPRS) identified
potential savings in the region of £500million from some major drug
categories. This is significantly more than the estimated £430m revenue
from prescription charges.
Latest figures show that, in 2007,
88.6% (707.6million ) - prescription items were dispensed
free-of-charge; 7.1% (56.7m) -) were paid for at the point of
dispensing and 4.3% (34.1m) were dispensed against a Prescription
Prepayment Certificate. In 2007/8 revenue from the prescription charge
was £538.323 million.
Response to Question 6
Taking
into account your responses to the previous question, what will be the
key practical considerations that determine how policy changes can be
phased in?
Each patient will need to attend their GP
for a consultation possibly in conjunction with secondary review to
ensure the correct medications are set up as repeat prescriptions
within primary care. This may take several months to implement.
For
example, if a condition is judged by the attending physician to be
likely, with reference to NHS guidelines, to persist more than say 12
months then an exemption certificate could be issued with the first
prescription after the legislation becomes effective.
Response to Question 7
What other issues would you wish to raise about exempting people from long term conditions from prescription charges?
Present structure is not logical, nor rooted in the principles of the NHS.
15%
of respondents to a 2006 Breast Cancer Care survey had decided not to
get their prescription dispensed because of the cost. Pharmacists also
report patients asking which drugs they can do without.
Reports
have been received by the Macmillan cancer charity of patients
selecting a different drug each week, thus rendering treatment plans
totally meaningless
On behalf of the executive members of the Gorlin Syndrome Group
|
|
