Monday 18 July 2011

Paracetamol and millionaires

Given the high profile of the Welsh Government’s commitment to free prescriptions, I find it hard to believe that any Health Board in Wales would have decided to ban GPs from prescribing certain medicines without consulting the government.  And the calm response by “a spokesman” also suggests that the decision by the Hywel Dda Board did not exactly come as a surprise.
It amounts to the introduction of what Welsh politicians usually like to call a “post code lottery”; which items can be had for free will now vary from one part of Wales to another.  It touches on the long standing issue that there is a lack of consensus about which decisions should be taken nationally and which should be taken locally. 
As a general rule, I tend to favour local democracy rather than central imposition; but in this case, health boards are not subject to local democracy, and this looks like a case of local appointees trying to weaken or undermine a decision taken by electorally-accountable politicians.  Purely for that reason, I’m surprised at the calm response of the government – unless, of course, they are actually looking for a way of back-pedalling on their commitment.
From the figures included in the report, it appears that the introduction of free prescriptions has had no impact on ‘over-the-counter’ sales, which have remained static, but it has increased the number of prescriptions for those same medicines by a significant margin.  It therefore appears, at first sight, as though the extra prescriptions are not for people who would otherwise have purchased the same medicines.  And as far as I’m aware, there is not a single reported instance of a millionaire obtaining a prescription for paracetamol.
But I’d like to understand better where that increase has come from before coming to a conclusion.  Is it the case that people are now going to see the doctor when they wouldn’t have bothered before?  Is it that doctors are now issuing a prescription when they might previously have just said “take a couple of paracetamol”?  What’s the impact on health of removing that option?
From the reports so far, the decision appears to have been taken on purely financial grounds, without considering that health impact at all.


MH said...

It's an odd story. My first reaction is that it's unclear what Hywel Dda HB have actually done. At the start the report says "which GPs cannot prescribe", but later it says "advised GPs to reduce their prescribing", "putting pressure on GPs to conform", "inducing GPs" and "to encourage GPs and pharmacists to think".

So yes, it would be nice to know exactly what Hywel Dda have done, but my guess is that they have only issued advice, and that GPs will be able to carry on prescribing what they decide to ... because I'm sure all of them will have thought hard about it already. That probably also explains the relaxed attitude of the WG spokesman.


The second thing that is likely to be misleading in the story is the claim that:

"Official Welsh Government statistics indicate that removing the prescription charge has not increased the number of prescriptions dispensed."

The number of prescriptions issued goes up by about 5% each year. But this is true both in Wales and in England (where prescription charges have continued to rise) and the point they were trying to make was that the abolition of charges has not in itself resulted in an increase.

So I'm relaxed about the "almost a quarter" increase in paracetamol prescriptions over five years. It's in fact slightly under what we'd expect with a general 5% a year rise.

John Dixon said...

Thanks for that. I should have spotted that the increase in prescriptions for one type of drug was being presented out of context - my BS detector must have been temporarily switched off.

Given the amount of attention regularly being given to the question of prescription charges on the basis of so little substance, it's hard to avoid the conclusion that part of the media is pursuing an agenda rather than reporting news.

John Dixon said...


I haven't published your comment on this occasion. You're always welcome to engage in debate on this blog, but gratuitous abuse of the health board deosn't entirely fit the house style.

Unknown said...

Could it be that Paracetamol are being prescribed by way of Placebo?

GPs are not allowed to prescribe actual placebos, but they are effective in 30% of cases - especially for the worried well.

The hugely inflated costs that are charged back to the health service is of great concern, but the prescribing itself is not.

Boncath said...

The public perception is that prescriptions are free in Wales.
This has never been the case
There has been oversubsription
and it does seem ludicrous that aspirin and paracetamol should be available on prescription given their current price in shops
Recently there has been a movement to get patients on some drugs to accept cheaper options but this is not the same as refusing to dispense
for info Viagra or similar is dispensed in selected cases but on private prescription outside the NHS is currently £21 per tablet which makes it ideal for your millionaires or lottery winners

Glyndo said...

They'd better not touch my gluten free brandy snaps.