ABLEnews World Desk [The following file may be freq'd as UK50301.* from 1:109/909 and other BBS's that carry the ABLEFiles Distribution Network (AFDN) and--for about one week-- ftp'd from FTP.FIDONET.ORG on the Internet. Please allow a few days for processing.] Taxing the Ill Following last week's rise in prescription charges in Great Britain, Christine Doyle reports on some surprising solutions to the high cost of drugs. How much you pay for a prescription is--like the hospital waiting list--an NHS barometer. So, predictably, the announcement last week that the new charge will break the sensitive 5-pound barrier, rising to 5.25 pounds from the current 4.75, led to howls of protests from patients, doctors and pharmacists. Four out of five prescriptions are free but, because many are repeats, this leaves about one in three people who must pay. If prescribed more than one item for their complaint, they could be charged more than 10 or 15 pounds because each item must be counted separately. Bronwen Morris, who was collecting a prescription at her local pharmacy in west London last week, sums up much recent criticism. "I am a pensioner, so I am exempt, but there are so many people--young and old--on low incomes. Many will now be too scared of the cost to go to their doctor." In her view the 300 million pounds raised from prescription charges is a selective "tax on being ill." Linda Lamont, director of the Patients' Association, agrees: "We have gone though the credibility barrier. Many patients now feel they can afford only one of the drugs prescribed by their GP." Zayd Mahfooth, pharmacist at the busy Spatetree Pharmacy in East Sheen, west London, says: "We are always being asked which is the most necessary medicine." Often cheaper to go private Few people, if they are realistic, expect prescription charges to be abolished. Yet, faced with a charge that seems set to keep rising, they might well ask if the present system is too rigid. Although some patients can get prescription "season tickets" and save costs, could others pay less by buying some drugs directly from the chemist or--extraordinary though it seems--by asking their NHS doctor for a private prescription? Bizarrely, hundreds of such common drugs as antibiotics, strong painkillers or asthma inhalers, which patients cannot obtain except by a doctor's prescription, cost much less than the prescription charge. Equally, large numbers of the drugs which can be bought over the counter for less than 4.75 pounds are often prescribed by doctors. Patients who are not exempt from charges could end up paying much more than some drugs are worth. If you are being prescribed medicine, ask your GP if you could pay less by buying the drug directly. Dr Ross Taylor, of the Royal College of General Practitioner's advisory prescribing committee, says: "I usually advise patients if this is the case." According to a Consumers' Association booklet, at least 700 medicines may be sold over the counter at less than 4.75 pounds. However, research by the Proprietary Association of Great Britain shows that some doctors think patients might feel they were getting inferior treatment if they were given advice on which medicines to buy, rather than receiving a prescription. Sheila Kelly, its director, urges patients to check. Pharmacists may not offer the information unless asked Pharmacists may not offer the information unless asked. "Quite a lot don't, even though it should not jeopardise their income," said one High Street pharmacist. Pharmacists buy in drugs at cost price and in addition to a monthly dispensing allowance receive a fee for each drug dispensed. But if they sell the same drug across the counter they are able to ask the full retail price. For antibiotics and other less expensive drugs which cannot be sold directly to patients, the second but much more controversial route to cutting costs is to ask the NHS doctor for a private prescription. Which? Way to Health reported last summer on Dr Stephen Bamber, a Norfolk GP who pioneered this approach. His local pharmacist agreed a fixed fee for dispensing a list of 20 medicines prescribed privately to NHS patients so that they could buy them below the 4.75-pound prescription charge By using both methods you could, for example, buy cough medicines advised by your doctor over the counter for around 2.60 ppunds and pay less than 2 pounds for a course of privately prescribed antibiotics, a total of less than half the present prescription costs. However, the British Medical Association warned doctors who followed suit that they could be breaking the law by being in breach of their NHS terms of service. The Health Department disputes the BMA's interpretation and has firmly said so in a letter to all Family Health Service Authorities (FHSA). So long as doctors write a private prescription at the request of--or with the consent of--their patients, they are not in breach of their NHS contracts. GPs cannot, however, ask their patients for a fee. No legal reason now why GPs should not write private prescriptions Dr. Patrick Hoyte, a medico-legal adviser to the Medical Defence Union, thinks the BMA is playing semantics while patients pay the cost. "Everyone knows that many common drugs are very cheap. I prescribed myself penicillin privately and paid only 50 pence. As I see it there is no legal reason now why GPs should not write private prescriptions." One solution might be for patients on repeated doses of cheap medicines to complain to their FHSA if their GP will not write a private prescription. However, Dr. Rhidian Morris, chairman of the National Association of Fund-Holding Doctors, believes many GPs are more concerned about saving time rather than breaches of contract. "If I have to look up the price of every drug I am prescribing, I could add three minutes or so to every consultation. We are already very stretched." Dr. Morris, like Dr. Taylor, tries to help patients save money "by prescribing, increased quantities, say two months' supply rather than one of cheaper drugs...But I have to feel sure this is safe." Water tablets for raised blood pressure, non-branded "generic" sleeping tablets or major painkillers might fall into this category. Be warned, however: pharmacists can set their fee for dispensing a private prescription. Some add on 1 pound or more. Some simply make up the cost to the current prescription charge. As a rule of thumb look for no more than a mark-up of 50 per cent. Looking ahead, Zayd Mahfooth says the present system could be simplified by treating each NHS prescription as if it were a private one for all drugs below the NHS charge. When medicines cost more, as most do, the prescription charge would apply. Last summer, a parliamentary select committee on health made a similar suggestion. The Government is attracted to the idea, not least because private prescriptions, like drugs bought across the counter, do not show up on the GPs' annual drugs bill of more than 2.4 million pounds. Critics, such as Tim Astill, director of the National Pharmaceutical Association which represents pharmacists, fear the move would lead to further blurring of the distinction between the NHS and the private sector. Some patients may feel that overall they get more from the NHS and do not mind charges. Yet, when the Government insists it is not trying to make money out of NHS patients, it seems absurd that, as things stand, it can be cheaper to go private. [Sometimes It Pays to Go Private, Christine Doyle, 3/1/95] A Fidonet-backbone echo featuring disability/medical news and information, ABLEnews is carried by more than 460 BBSs in the US, Canada, Australia, Great Britain, Greece, New Zealand, and Sweden. The echo, available from Fidonet and Planet Connect, is gated to the ADANet, FamilyNet, and World Message Exchange networks. ABLEnews text files--including our digests Of Note and MedNotes (suitable for bulletin use) are disseminated via the ABLEfile Distribution Network, available from the filebone, Planet Connect, and ftp. fidonet.org ...For further information, contact CURE, 812 Stephen St., Berkeley Springs, WV 25411. 304-258-LIFE/258-5433 (earl.appleby@deafworld.com)