A new report by Healthwatch England has recommended that GPs should offer over the counter (OTC) medications on prescription to those who cannot afford to pay for them.

But some community pharmacists have suggested that a minor ailments scheme delivered through community pharmacies would be a more accessible solution for patients.

Healthwatch England, which champions on matters within health and social care, also said that primary care staff should make sure patients taking lots of medication know about the annual pre-payment certificate option, where a year’s worth of prescriptions can be accessed with a one-off fee.

And it suggested that the Healthcare Travel Cost Scheme be extended to cover travel to primary care services including pharmacy.

Cost of healthcare particularly an issue for vulnerable groups

Based on surveys of adults in England conducted during March of this year, the report, which was published on Tuesday (30 May), found that people are increasingly avoiding vital health and care services, such as dentistry, over-the-counter medications and NHS prescriptions, due to the fear of extra costs.

It said that an increased number of people were avoiding booking an NHS appointment because they could not afford the associated costs, such as accessing the internet or the cost of a phone call.

One older patient had reportedly tried to book a GP appointment to get an audiologist appointment to address hearing loss, but gave up after waiting on hold for a long time due to the cost of the telephone bill.

In particular, it found that the cost of healthcare was a particular issue for people who accessed disability benefits, people on means-tested benefits, and younger people aged 18-24.

Healthwatch England said that 15% of people using disability benefits had avoided their usual OTC medication, compared to 7% of the general public.

It recommended that NHS guidance should encourage GPs to offer people over-the-counter medications on prescription based on socioeconomic grounds.

The report also found that 20% of people on means-tested benefits had avoided booking an NHS appointment due to associated costs, like using the telephone, compared to 6% of the general public.

Meanwhile, travel costs were a particular issue for people aged 18 to 24, with 14% of that age group having avoided an NHS appointment due to travel costs, compared to 6% of the general public.

In addition, an average of one in five people from each of these vulnerable groups avoided going to the dentist because of the cost.

Awareness and review of support schemes needed

Healthwatch England said that while it welcomes the support already in place, schemes like social tariffs for telephone and internet costs and other initiatives supporting patients on low incomes needed to be better communicated to those who needed them.

It also said that primary care teams should make people aware of pre-payment options, and suggested that dentistry teams could offer check-ups based on individual need, to free up more NHS slots.

More awareness was also needed of the Healthcare Travel Cost Scheme, which allows eligible patients, carers and escorts to claim reimbursement for travel costs to and from secondary care, it said.

In addition, Healthwatch England said that NHS England should re-open its review of the Healthcare Travel Cost Scheme, and introduce reimbursement for journeys to primary care services, including pharmacy, dentistry and general practice.

The report also called on the government to work with health and care services to go further to support people in the cost-of-living crisis. In particular, it said that government should ensure benefits, including Statutory Sick Pay (SSP), keep pace with inflation in real-terms.

Heidi Wright, practice and policy lead for the Royal Pharmaceutical Society (RPS) in England said that it was ‘very concerning that people are having to make choices about their health based on their ability to pay, which can result in poorer health, time off work and higher healthcare costs in the long run’.

She said that GP’s may use their clinical judgement to decide that a patient needed a prescription for an OTC medication, based on ‘understanding that a treatment may not be accessible if not prescribed’.

But she added that for patients in England that do not qualify for free prescriptions, it would often be cheaper for them to pay for OTC medications than pay the £9.65 prescription charge per item.

‘Primary care teams including pharmacists should actively ensure patients are aware of the help the NHS can provide to reduce costs, including the pre-payment certificate and low income scheme,’ she added.

Minor ailments schemes could support low income patients

Meanwhile, Shilpa Shah, chief executive of the North East London Local Pharmaceutical Committee (LPC), said that community pharmacies were seeing patients make a choice about which items they could afford on their prescription, with patients ‘sometimes only taking one item and leaving the rest’.

‘We are seeing people suffering from minor ailments which they need symptom relief for to avoid taking a day off work or their children need it so they can go to school, so a parent doesn’t have to take a day off to look after the child.

‘By not having this symptom relief or not getting an item that they need, their condition may worsen and then they may end up in urgent care or A&E which we know is a huge cost to the NHS,’ she added.

Ms Shah said that while she welcomed Healthwatch England’s recommendation that GPs offer OTC medication on prescription based on socio-economic grounds, she said that a minor ailments scheme ‘would be a better option’, to avoid adding to GP workload and to take advantage of the accessibility of community pharmacies outside of GP hours.

‘Community pharmacy welcomes the common conditions scheme that is due at the end of the year, but we need to be able to help patients with lower acuity minor ailments now,’ she said.

And she added that at a North East London NHS summit last week, there was a consensus in the room that a Minor Ailments Scheme (MAS) was much needed in the area, in particular to help with winter pressures, ‘as well as with the pressure that the NHS is now facing all year round’.

Amid increased reports of patients being unable to afford OTC medications, The Pharmacist investigated how a MAS delivered through community pharmacy could provide a solution for people on low incomes.

And our sister title Pulse reported that GPs would support a pharmacy-led MAS that would avoid patients needing a GP appointment for a prescription to get OTC medications on the NHS.

Following that, a national Pharmacy First service was announced to launch in England this winter, which will allow pharmacists to supply prescription-only medicines under a PGD, where clinically appropriate to treat seven common health conditions without the need for patients to visit a GP.

But it is not yet clear whether or how patients will pay for these services, nor how this will affect local schemes already in place, such as MAS that supply OTC medications free of charge.

Abolish prescription charge, says NPA

Helga Mangion, policy manager at the National Pharmacy Association (NPA) said that the most straightforward mechanism for maintaining access to medicines for people struggling with the cost of living would be to abolish prescription charges.

‘Prescription charges are illogical and unfair, and deter people from getting the medicines they need, especially those on low, fixed incomes,’ she said.

‘Scrapping prescription charges would also enable pharmacists to spend more time with their patients, instead of on paperwork,’ she added.

A recent Healthwatch England survey published in January found that one in 10 patients have avoided taking up an NHS prescription because of cost, while the same number avoided buying over-the-counter medication they normally rely on.

While an RPS survey of pharmacists, published in February, found that an increasing number of patients were failing to collect prescriptions, asking which medications they can ‘do without’ and asking for cheaper alternatives.

Health bodies have previously suggested the government pause prescription charges, as part of a call for targeted support for those most impacted by the cost-of-living crisis.

And there have been calls for the list of conditions exempt from the prescription charge to be updated, following a survey which found that patients with long-term health conditions were skipping medication due to cost.