Plans to expand the list of prescription charge exemptions – as promised by ex prime minister Gordon Brown in 2008 - have been shelved until a National Health Service spending review has been undertaken.

Health minister Simon Burns confirmed the delay last week after the government published of a report by Professor Ian Gilmore, completed in November last year, which makes recommendations on extending the groups of patients exempt from paying for prescriptions in England.

Under the current status quo, around 90% of the 843 million prescription items dispensed each year in England are already free, but prescription charges still generate a substantial stream of revenue - around £500 million - for the NHS every year.

Unlike its sister nations in the UK, the system in England has not been reformed for more than 40 years and has come under increasing criticism of late. For one, charges in Wales have already been scrapped altogether and those in Scotland and Northern Ireland are in the process of being phased out, while patients in England are shelling £7.20 per item.

Furthermore, apart from the recent addition of cancer to the list, exemptions have not been revised since their introduction in 1968, and have come under fire for being “out of date, inconsistent and arbitrary”, according to Gilmore.

Also, the current blanket ban on charges for patients aged over 60 has raised concerns over equity, seeing as the system allows for wealthy elderly patients to get free medicines while those younger and on low incomes must pay for theirs.

Broadly speaking, Gilmore recommends that patients with long-term health conditions lasting for at least six months should not have to pay for medication, substantially widening the scope of exemptions to include patients with disorders such as arthritis and asthma.

In a further potential change, under the current method direct input from a GP is not required for an exemption certificate, but any system relying on a broad_based definition for what constitutes a long-term condition needs a clinician to judge whether a patient meets the criteria and is therefore eligible for free treatment, Gilmore says.

He also recommends reducing the cost of the pre-pay certificate, and says the government should consider whether to introduce automatic exemption for patients on incapacity benefit without income support, or contribution based employment and support allowance, or disability living allowance.

However, Gilmore has estimated that putting his recommendations into practice will cost the NHS around £430 million year, and so suggests phasing in the new scheme over three years to help spread the impact.

Reducing cost?
According to the Prescription Charges Coalition, exempting people with long-term conditions from prescription charges “would directly improve drug compliance and health outcomes among those who are struggling to afford their medicines”, and it argues that it is likely that the NHS “would be able to treat long-term conditions more cost effectively as a result of prescription charge exemption, given the evidence that under-treatment of long-term conditions due to cost issues results in increased use of health services”.

Neil Churchill, Chair of the Coalition and Chief Executive of Asthma UK, welcomed the publication of the report, but, noting that patients will be “disappointed to hear that a timetable to abolish prescription charges has not yet been set”, he called on health secretary Andrew Lansley to outline how the recommendations made by Gilmore will be acted on by the new government.

Hamish Meldrum, Chairman of Council at the British Medical Association, said Gilmore’s recommendations “are a step in the right direction”, but stressed that “changes to the system short of abolition would still be unfair on the reduced number of patients who do not qualify for exemption”.

While recognising the financial pressures on the NHS and the revenue that prescription charges currently bring, the current system “is costly to administer, and as this review states, removing prescription charges could result in reduced hospital admissions, saving the NHS millions a year” he said.