The UK government’s promised public consultation on its review of prescription charges “must consider innovative ways to fund additional spending on the prescription budget in England,” according to a group of charity chief executives.

The current list of exemptions to the charges is more than 40 years old and around 800,000 people every year cannot afford their prescriptions, they claim in a letter published in The Times newspaper this week. “It is simply unacceptable in today’s health service to force people to select their medication based on what they can afford rather than what their doctor prescribes,” say the chief executives, who represent 14 healthcare and disability charities plus Citizens Advice and Help the Aged.

With government ministers having already made it clear that any changes to the system must be cost-neutral, the charity heads say they are “extremely concerned” that the public consultation will lead to “nothing more than a tinkering of an inherently unfair system.” They call on the government to consider options such as more effective use of generic medicines, which they say could save “hundreds of millions of pounds a year.”

Last month, prescription charges in England rose 25 pence to £7.10 and, while the government has promised the review, Ministers remain adamant that the funds raised for the National Health Service by the charge, which totalled £430 million in 2006-7, cannot be given up. Nevertheless, with Wales having abolished prescription charges altogether, Scotland planning to follow suit by 2011 and Northern Ireland considering options for the charge’s future, pressure is mounting for significant reform in England, at the very least.

The House of Commons Health Select Committee first called on the government for a review back in July 2006, and in February this year Citizens Advice condemned the Department of Health’s “extraordinary delay” in starting the consulting process. ‘It is essential that there is now urgent action to finally eliminate prescription poverty in England,” said the charity’s chief executive, David Harker. Moreover, after the latest increase in the charge was announced in March, the Royal Pharmaceutical Society of Great Britain said a review of the system was needed urgently, describing the present arrangements as “illogical and unfair.”

However, last week, Health Secretary Alan Johnson again emphasised the government’s determination that the charges should remain. They provide the NHS with a “large slug of money,” he told the Royal College of Nursing’s annual conference, and pointed out that 88% of prescriptions are actually free. People who cannot afford prescription charges generally do not have to pay them, he said, while people with jobs “like mine and yours” can afford the £7.10, he told reporters.