Fresh calls have been made to review prescription charges in England as new NHS figures show a surge in the use of pre-payment certificates (PPCs).

The number of 12-month PPCs issued in 2023/24 reached 2.1 million – around 30% higher than before the pandemic, when 1.5 million PPCs were issued in 2018.

This type of certificate has seen a consistent year-on-year increase over the last five years, with the latest annual figures representing a 4% rise since 2022/23.

The number of medical exemption certificates also reached its highest level in recent years in 2023/24, with 475,000 medical exemption certificates issued last year, up from 453,000 in 2022/23, and following a dip in 2020/2021.

There were more medical exemption certificates issued in more deprived areas, excepting the 20% most deprived areas where people 'may be more likely to qualify for other income-related benefits that offer the same support as a medical exemption certificate', the NHS Business Services Authority, which published the figures, said.

Figures indicate HRT PPC renewals

The NHSBSA figures also showed that the hormone replacement therapy (HRT) PPC, which was introduced on 1 April 2023, had with 131,000 certificates issued in the first month.

This represented 23% of the 566,000 HRT PPCs issued in 2023/24, with the NHSBSA noting that a ‘notable jump’ in March 2024 was likely due to a ‘large number of these’ being ‘customers renewing expiring certificates’.

Integrated Care Boards (ICBs) in the South West of England had has some of the largest rates of HRT PPCs issued, while the highest issuer of HRT PPCs was South West London ICB, with 4,034 per 10,000 population, compared to the lowest issuer, Black Country ICB, that had 2,700 certificates per 10,000 population.

The number of HRT PPCs issued was higher in less deprived areas – consistent with prescribing rates, with an estimated 662,000 patients prescribed HRT medicines in the least deprived areas in England – more than double the 289,000 identified patients that were prescribed HRT in the more deprived areas.

The NHSBSA also noted that ‘in the most deprived areas, people may be more likely to qualify for other methods of help with health costs’.

Calls to abolish prescription charges in England

Both the Pharmacists’ Defence Association (PDA) and the Royal Pharmaceutical Society (RPS), along with other members of the Prescription Charges Coalition, are calling on the next government to abolish prescription charges in England.

Responding to the NHSBSA figures, Alison Jones, director of policy and communications at the PDA, said members saw patients ‘every day’ who ‘struggle to meet the financial burden of prescription medicines due to the cost of living, many of whom are self-rationing their medication to make it last longer’.

This not only results in poorer health outcomes for patients but could also have an impact on increased demands on NHS services if conditions are not managed effectively,’ she said.

‘There are no prescription charges in Scotland, Northern Ireland or Wales and pharmacists in England would also rather be focussed on providing care than having to check millions of certificates and undertake the other admin involved with the collection of what many call a “tax on health”,’ Ms Jones told The Pharmacist.

Tase Oputu, England board chair of the Royal Pharmaceutical Society (RPS), also said it was ‘high time’ the ‘stealth tax’ of prescription charges was abolished.

‘I would urge the next government to commit to reviewing this complex and unjust system,’ she said.

‘Prescription charges in England are a barrier to medicines adherence, which can lead to poor health, lost productivity and increases the risk of hospital admission, piling pressure on the NHS.

‘Nobody should face a financial barrier to accessing the medicines they need. Amid a cost-of-living crisis, the outdated and elaborate system of exemptions is confusing for patients and an overhaul is long overdue.’

The Prescription Charges Coalition has long called for the list of medical conditions exempted from prescription charges to be reviewed.

Nick Kaye, chair of the National Pharmacy Association (NPA), told The Pharmacist that the list of medical conditions included under prescription charge certificates was 'often arbitrary and does not take into account the complex range of conditions a patient may need medication for'.

'Many people already choose not to collect some or all their prescription medicines because of cost, with potentially dire health consequences,' he said.

'As pharmacists, we understand the healing power of medicines. So naturally we oppose arbitrary barriers to people getting the medicines they need.

'As community pharmacists, we are health care professionals and have no interest in being tax collectors.'