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SECTION 1: INTRODUCTION AND CONSULTATION ARRANGEMENTS

Summary

1.1 This document has been prepared as part of the Executive's Partnership Agreement commitment to review prescription charges for people with chronic medical conditions, and for young people in full time education or training. This commitment recognised that the current exemption arrangements, which date back to 1968, contain anomalies and are no longer fit for purpose.

1.2 The Executive's Health Department undertook a literature search to gain an overview of prescription charge and exemption policies in other countries to help inform consideration and debate on the matter. The key facts from the overview are provided at Section 3 and a copy of the full Executive Summary is at Annex A.

1.3 This document:

• Sets out the background and policy context to NHS prescription charge and exemption arrangements in Scotland
• Discusses options for change to facilitate debate on possible system reforms

Consultation Objectives

1.4 The issue of prescription charges and exemptions is complicated. Changes to the current arrangements will have complex financial and social consequences. The best outcome is likely to involve a combination of changes implemented over a period of time.

1.5 The purpose of this consultation document is to encourage debate on a range of options. Thereafter, the preferred options will be subject to a regulatory impact assessment. The consequences of the proposed changes will be carefully considered and the Executive will then decide on the changes to be made, and how and when they might best be implemented.

1.6 The options, and way in which they are implemented, must:

• not deter patients from obtaining medication which is important for their health or to relieve suffering
• be affordable to patients at the time of need
• be practicable to deliver
• contribute to the efficient and effective provision and use of primary care services
• support the Executive's policies and priorities, which include:
• • promoting health
  • supporting self-care
  • tackling problems of poverty and low income

The Executive's Position

1.7 The Executive continues to believe that the principle of patient contribution to the cost of NHS prescriptions is right, provided it is underpinned by effective exemption arrangements. Such a scheme helps reduce the level of less urgent demands on GPs' time, places a value on medicines that patients require, and makes a valuable contribution to NHS finances.

1.8 However, it also believes that people should not be deterred from obtaining their medication because they cannot afford to pay for their prescription, and that those who have a substantial need for medication for which they pay a contribution should have access to an affordable system of payment.

1.9 As the Partnership Agreement recognises, the Executive also believes that we should widen access to full time education and training. Removing prescription charges from all full time students and people on Modern Apprenticeships could remove a potential financial barrier to participation.

Chronic conditions

1.10 There has been significant debate about the current exemption arrangements on medical grounds. Two anomalies are:

• The list of exempt conditions excludes common chronic conditions such as asthma but includes others, such as diabetes. It does not take any account of the volume of medicines that a patient may need.
• The exemption extends to all of the patient's prescriptions and, therefore, can include medication for other ailments completely unrelated to the chronic condition in question. For example, a patient with diabetes and asthma will obtain all their asthma medication free whereas someone with asthma alone will have to pay for the same medication.

1.11 Reform of the list of chronic conditions may be administratively complex and may not remove all of the perceived inconsistencies in the system. The key issue in this regard is that people who have substantial medication needs, including those who suffer from a chronic or life-threatening condition, should not face an open ended financial obligation, nor be deterred from obtaining their medication on the basis of affordability.

Options

1.12 This paper puts forward a range of options and possible variants. The Executive wishes an open consultation on these options and does not therefore specifically endorse or rule out options at this stage. The Executive's initial view is, however, that the best outcome is likely to involve a combination of changes managed in over a period of time.

1.13 Options which could be considered include:

• Extend the exemptions available under the NHS Low Income Scheme.
• Consider whether there are other proxy measures of low income which could be used to trigger exemption from prescription charges
• Review the current exemption list of chronic conditions
• Review the extent of any exemption for chronic conditions, such as restricting such exemptions only to prescriptions relating to the chronic condition
• Reform the current pre-payment system towards a monthly payment scheme so that participation need not require a large up-front payment.
• Provide exemption for all full time students and people on Modern Apprenticeships.

1.14 The focus of this consultation is on the Scottish Executive's Partnership Agreement commitment, against a background of ensuring consistency with the Executive's policies of promoting health, supporting self-care and reducing inequalities. However, as we have made clear, there are a number of interactions within the current regime of prescription charging and exemptions. The current rules include consideration of:

• Age-related exemptions
• Income or benefit related exemptions
• Condition related exemptions

1.15 The Executive recognises that it may be difficult to provide narrow responses to the consultation and will therefore be happy to consider replies which are not strictly limited to chronic conditions and young people in education and training.

Responses to this consultation

1.16 Written responses to this consultation paper are invited by 30 April 2006:

By e-mail to:

prescriptioncharges@scotland.gsi.gov.uk

or by post to:

1.17 If you have any queries please contact Mark Dorrian on 0131 244 2597.

1.18 We would be grateful if you could clearly indicate in your response which questions or parts of the consultation paper you are responding to (using the consultation questionnaire if appropriate) as this will aid our analysis of the responses received. We would also be grateful if, in responding, you would complete the Respondee Information Form that is attached to the covering letter or at the back of the electronic version of this document.

For future engagement:

1.19 If you wish to access this consultation online then please go to http://www.scotland.gov.uk/view/views.asp . You can telephone Freephone 0800 77 1234 to find out where your nearest public internet access point is, if you prefer to submit your response by e-mail to prescriptioncharges@scotland.gsi.gov.uk

SEConsult

1.20 An email alert system for SE consultations ( SEconsult) was launched in 2003. This system will allow stakeholder individuals and organisations to register and receive a weekly email containing details of all new SE consultations (including web links). SEconsult will complement, but in no way replace SE distribution lists, and is designed to allow stakeholders to 'keep an eye' on all SE consultation activity, and therefore be alerted at the earliest opportunity to those of most interest. We encourage you to register as soon as possible.

Access to consultation responses

1.21 We will make all responses available to the public in the Scottish Executive Library by 26 May 2006 and on the Scottish Executive consultation web pages by 5 June 2006, unless confidentiality is requested. All responses not marked confidential will be checked for any potentially defamatory material before being logged in the library or placed on the website.

SCOTTISH EXECUTIVE HEALTH DEPARTMENT
January 2006

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