Work and Pensions Committee - Universal Credit implementation: meeting the needs of vulnerable claimantsWritten evidence submitted by Pharmacy Voice

1. Pharmacy Voice welcomes the opportunity to submit to this inquiry. Community pharmacists and their staff are in the frontline when it comes to the verification of entitlement to remission of prescription charges. We are therefore restricting our comments to Eligibility for and the operation of passported benefits.

Eligibility for Passported Benefits

2. The state invests heavily in maintaining and improving the health of the population through the National Health Service. Patients access clinicians free of charges at the point of contact, and enjoy quality care irrespective of their ability to pay. However, in England, patients receiving medicines dispensed or supplied within the NHS are required to pay a prescription charge1 (currently £7.65) for each item dispensed. Exemptions exist which entitle some patients groups, including those on low incomes, from the charges.

3. Although the number of paid prescriptions is low as a proportion of the total—some 5.4% of the 961.5 million prescriptions attracted a charge at the point of dispensing,2 we know that many people who present prescriptions for dispensing at the pharmacy ask which items are the most important, so that they can make a decision as to what to have dispensed. This may be because of unwillingness to pay for all items, or because the patient cannot afford to pay for all the items.

4. If a clinician issues a prescription, then this is because they have determined that the patient needs it for treatment or to maintain good health. Clinicians are acutely aware that prescribing decisions consume NHS resources; they do not prescribe medicines unless they are needed.

5. We therefore suggest that the passported benefit of remission of prescription charges is absolutely vital as without it, patients who are most at need (the health of those on low incomes is generally poorer than the population at large) might decide that they cannot pay for part or all of their medical treatment.

6. The failure to adhere to a prescribed course of treatment not only has an impact on a short term basis, it wastes clinician and scarce NHS resources, and can lead to long-term and perhaps irreversible deterioration in the health of the individual.

7. An instance of ill health may present at the same time that a person becomes entitled to the Universal Credit arrangements (for example, a sudden loss of income may cause a depressive illness; or an illness preventing someone working can lead to a loss of income). As treatment with medicines for those conditions will require payment of the prescription charge before the medicine can be supplied, it is imperative that the process for entering into the Universal Credit and passported benefits system can be completed quickly.

8. We strongly oppose any suggestion that the entitlement to remission from the prescription charges should be converted to a cash benefit. We know from what pharmacists tell us, that many patients decide not to have some prescriptions dispensed because they are unwilling or unable to pay the prescription charge. The fact that some patients already choose not to have prescriptions dispensed is evidence that financial considerations do impact on the use of medicines.

The Operation of Passported Benefits

9. The current list3 of persons entitled to remission from charges is complex. Any proposal to simplify this list is welcome. Patients seeking entitlement must find the range confusing, and when they seek to claim exemption from charges, they are required to complete an exemption claim, setting out under which heading they are entitled to remission from charges.

10. Pharmacists and their staff are required to ask for proof of entitlement, and can help patients identify whether they are entitled to remission from prescription charges from the type of benefit they receive. We understand that all those receiving Universal Credit will be sent a standard letter indicating which benefits they are entitled to. Unless all those on Universal Credit are entitled to remission from prescription charges, pharmacists will be placed in a very difficult situation. Not only will they be unable to determine entitlement to remission but they will have to spend more time explaining the changes to patients who are unwell, if they themselves understand them in the first place. If not everyone on Universal Credit is entitled to remission from prescription charges pharmacists and their staff will bear the brunt of the frustration of those people who do not know if they are entitled or not. Pharmacy staff time spent explaining complicated exemption arrangements represents a loss of opportunity for health-related discussions and for fulfilling the Department of Health’s objective of “making every contact count”.

11. We would propose that as well as consolidating the range of entitlements into one passported benefit, the opportunity is also taken to centralise the recording of such entitlement, and to automatically link this data into the National Health Service’s Electronic Prescription Service, so that pharmacists know through automatically when individuals are exempt from charges.

12. The Regulations were previously changed to allow prescriptions for age exempt patients to be processed without a patient declaration where this information is contained in the electronic prescription. We believe it is both practical and desirable for the Spine Personal Demographics Service to be updated to provide an indicator of exemptions and remission for all other purposes. This could be a simple Boolean flag indicating a currently valid exemption or remission (with no indication of the nature of the exemption or remission) set by batch update from the Department for Work and Pensions (DWP), NHS Prescription Services and other relevant Government systems at a frequency consistent with renewal of entitlement to the exemption or remission concerned. This flag could be used to update the eprescription as it is pulled down by a pharmacy or queried by a pharmacy at the point when any prescription charges due are collected.

Summary

13. The collection of prescription charges and the checking of exemptions are an administrative burden on pharmacies and present a barrier to health care for certain patients. We recognise that abolition of prescription charges is unlikely in the current political and economic climate; we therefore recommend some practical and administrative improvements:

That all people on universal credit are entitled to remission from prescription charges.

A new category should be created on the personal demographic service to identify whether a particular person pays for their prescriptions.

Organisation Descriptor

Pharmacy Voice (PV) represents community pharmacy owners. Its founder members are the Association of Independent Multiple pharmacies (AIMp), the Company Chemists’ Association (CCA) and the National Pharmacy Association (NPA). The principal aim of Pharmacy Voice is to enable community pharmacy to fulfil its potential and play an expanded role as a healthcare provider of choice in the new NHS, offering unrivalled accessibility, value and quality for patients and driving forward the medicines optimisation, public health and long term conditions agendas.

Pharmacy Voice wishes to acknowledge the support they have received from The Pharmaceutical Services Negotiating Committee in preparing this response.

17 August 2012

1 Prescription charges are set out in the National Health Service (Charges for Drugs and Appliances) Regulations 2000 (Number 620)

2 Prescriptions Dispensed in the Community: England, Statistics for 2001 to 2011. (2012) The Health and Social Care Information Centre

3 Part XVI, paragraph 6 of the Drug Tariff

Prepared 21st November 2012