Select Committee on Health Third Report


8 February 2006

Meeting with Dr Brian Gibbons, Minister for Health and Social Services

The Minister discussed the abolition of the prescription charge in Wales and a number of areas of relevance to the NHS Charges inquiry.


Abolition of the prescription charge was a manifesto commitment, and was not backed up by a significant body of evidence.

A phased approach was taken to ensure affordability and allow health officials to identify and manage the effects of abolition on patient behaviour. The charge is currently £4 per item but is due to drop to £3 in April 2006. It will be abolished in 2007. No change in patient behaviour has been observed to date, but the Minister reported that modellers expect a change with the upcoming fall in price, such as increased demand for medicines, and patients seeking prescriptions for over-the-counter (OTC) drugs.

Changes to the exemption list had Lib-Dem support but it was decided to "keep it clean and simple" and abolish the charge altogether.

The First Minister was reportedly keen on abolishing the prescription charge in order to remove a disincentive for patients to return to work.


More people are registered with an NHS dentist in Wales (55-60%) compared to England (48%), with figures approaching 75% in Swansea.

The dental contract in Wales is similar to the English version, but the band levels are lower. A note subsequently provided by the Minister's office detailed the main differences between the new English and Welsh dental contracts:

The main differences are as follows:

  • Over the course of a year dentists will be expected to provide a certain number of courses of treatment weighted by their complexity. However, this will be 10% fewer (5% in England) than the courses of treatment carried out in the test period, while the dentist will still receive 100% value of the contract. There is also a tolerance level of 5% in Wales (4% in England) associated with the level of activity before this triggers a discussion between the dentist and the Local Health Board.
  • Additional differences in Wales are the way in which Vocational Training and Clinical Audit and Peer Review will be handled and it is the intention that it will remain centrally funded and administered in Wales and not form part of the new dental contract value as proposed in England. This has the full support of the Welsh Central Assessment Panel, the Welsh General Practitioner Committee, and the Department of Dental Postgraduate Education.

Dental Charges

The new dental charge band levels in Wales (English levels in brackets) are:

Band 1 - £12.00 (£15.50)

Band 2 - £39.00 (£42.40)

Band 3 - £177.00 (£189.00)

Current differences between Wales and England in the categories of patients' exempt from dental charges will continue as now i.e. those under 25 years of age and 60 and over are entitled to a free check up in Wales but not in England.

Eye tests

Some ophthalmic initiatives have been introduced in Wales:

  • Wales Eye Initiative—screening of at-risk groups, such as those with sight in only one eye, those with retinitis pigmentosa and people whose family origins are Black African, Black Caribbean, Indian, Pakistani and Bangladeshi
  • Primary Eye Acute Referral Scheme—this scheme allows rapid referral of specific patients by GPs.

Exemptions to the sight test charge are more generous than in England (under-25s are exempt, as for dental charges and the prescription charge), but there are no eye tests in schools.

Other considerations—parking, bedside telephones

A similar situation to that of England is in place for car parking, in that each Trust must make its own arrangements. There is also a similar situation for bedside telephones.

The Minister felt that additional help for people visiting patients in hospital was unlikely.

Meeting with ex-chairs of Health and Social Services Committee

The Chairman and Dr Taylor met with Kirsty Williams (Lib-Dem, Chair 2001-03), David Melding (Conservative, Chair 2003-05) and Rhodri Glyn Thomas (Plaid Cymru, Chair 2005-date)

The prescription charge

Revision of the list of medical exemptions for the prescription charge was suggested in a motion put forward by the Liberal Democrats. Ms Williams admitted that a revised list might significantly increase the number of exemptions. She thought that the Labour party had decided to trump her proposals for a revised list by proposing total abolition. Mr Morgan said Plaid Cymru supported extension of the list but not total abolition of the charge. Mr Melding stated that those with an adequate income should pay for their prescriptions, and that the exemption list should have been expanded. He did not believe that abolishing the prescription charge was worth the cost.

There was reportedly no debate on the funding needed to cover abolishing the prescription charge. The move was funded by the Welsh Assembly Government (WAG) as a whole. The move will cost £32 million, which represents 10-15% of the total drugs budget. A nominal charge per prescription was not considered.

Mr Morgan stressed that chronic illness impacts on earning ability and that individuals need to be protected from perverse incentives against returning to work after illness. The cost of prescriptions make a big difference to those on low incomes and workers have to pay the charge while the unemployed, or those unable to work due to incapacity, are more likely to receive free prescriptions. He added that levels of illnesses such as asthma and chronic obstructive pulmonary disease are much higher in Wales than elsewhere in the UK.

The current and ex-Chairs agreed that the evidence base for abolition of the prescription charge was very weak, and that little was known about the possible health benefits. Ms Williams, Mr Melding and Mr Morgan all expressed concerns relating to how the situation will be monitored, the possible increase in demand for prescriptions for OTC medicines, and the "hassle" that GPs may face as a result.

"Health tourism", whereby English patients try to have their prescriptions dispensed in Wales to avoid the prescription charge, is not a major problem yet.

Dental and ophthalmic issues

Both the Tory and Lib-Dem Members said they would rationalise those eligible for NHS dental care, to include older adults as well as children. The Lib-Dems would increase the number of patients exempt from paying dental charges and the fee for the NHS sight test to include greater numbers of at-risk patients.

The current and ex-Chairs reported that many dentists are not happy with the new contract, and some are leaving the NHS to work privately. There are problems of access to NHS dentists, as well as retention of dentists. However, the percentage of the population registered with an NHS dentist has changed very little in recent years.

Meeting with Ann Lloyd, Head of Health & Social Services Department, and John Sweeney, Director of Community, Primary Care & Health Services Policy Directorate

The Welsh health officials made three main points regarding the abolition of the prescription charge:

  • The evidence base for the move was not available at the time the decision was taken
  • It was too difficult to modernise the exemption list
  • Abolition supports the shift towards increased use of primary care.

The officials gave the Committee some background to the decision to abolish the prescription charge. The WAG agreed that unless they attacked ill-health, inequality and lack of access to care they would never "climb the mountain" of health problems in Wales. There was a feeling that unless something was done, health inequalities would never improve, and abolishing the prescription charge was seen as one way of addressing this problem. Previously, it was very common for patients not to fill their prescriptions.

The Health and Social Services Department expects the fall in the prescription charge to £3 in April 2006 to increase demand for medicines. There is to be a public education campaign to limit this demand, to appeal to individuals' better nature and encourage them not to abuse the system. The officials stated that abolishing the prescription charge was not at the top of their list of priorities at the time.

No studies were commissioned to the look at the problem before the bill to abolish the prescription charge was passed, however, the policy on prescriptions and charging is to be examined over the next 5 years by the All Wales Strategy Group. This research was commissioned by the Welsh Health and Social Services Department to evaluate any change in prescribing patterns and changes in uptake of medicines. The officials hope that this work will yield evidence that, in an ideal world, should have been available before it was decided to abolish the prescription charge.

The research described above will inform work on a reduced formulary that is also under way in Gwent. If doctors are only able to prescribe free of charge from a set list of medicines, this will limit expenditure on some (possibly expensive or OTC) medicines.

Ms Lloyd pointed out the connection between abolishing the prescription charge and the push towards increasing the availability of health services within primary care. Providing free prescriptions removes a barrier to patients being treated outside hospitals (where prescriptions are free already).

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Prepared 18 July 2006