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Time to reform NHS charge system?

Most prescription charges in England should be scrapped, say public health doctors. Equally, some treatments that are currently free, such as tonsil removal and varicose vein surgery, should be charged for, they say.

Dr Tim Crayford, President of The Association of Directors of Public Health (ADPH), said: "Medicine and treatment that people need for health reasons should be free. But things that people want, where there's little proof of clinical benefit, ought to have a price tag attached."

The NHS has always struggled financially to meet public expectations, and the ADPH feel that this proposal would help the NHS ensure that the people in most health need get the treatments they require.

Currently 89% of prescriptions are free, and, according to Dr Crayford, "there's no logic on health grounds to charge people for the remaining 11%, except for everyday medicines like aspirin and paracetamol, where charges should remain. It seems unfair to charge for highly effective drugs like statins to lower cholesterol and prevent heart attacks, while not charging for some treatments that offer much smaller benefits to people."

The ADPH considers that the following procedures are too widely used given their clinical effectiveness:

  • Surgery on minor skin lesions.
  • Tonsillectomy and adenoidectomy.
  • Varicose vein surgery.
  • Carpal tunnel surgery.
  • Hysterectomy for heavy menstrual bleeding.
  • Homoeopathy.

Dr Crayford explains: "Taking children's tonsils out, for example, makes very little difference to how many days they have off school or how many sore throats they suffer from. And there's strong evidence that, for many people, it's better to avoid surgery on uncomplicated varicose veins.

"If people had to contribute to the cost of these things, they would think twice before going ahead. There's often an alternative, which is much less costly. For heavy menstrual bleeding, for example, a coil can often be effective and, if so, it's far preferable to a hysterectomy. 

"There's no consistent approach to this across the country. Every primary care trust makes its own decisions. Let's have a public debate about what should be charged for and then apply a common framework across all 150 PCTs. 

"The savings to the NHS by charging for doubtful procedures could easily compensate for the revenue lost by making most prescriptions free."

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