Strategies used by general practitioners to minimise the impact of the prescription charge

Objectives: To determine the strategies used by GPs to make medicines, both prescribed and over-the-counter (OTC), cheaper for patients when deciding whether, and what, to prescribe. Method: Five focus groups were conducted in three Health Authorities in the Northwest of England. Between 10 and 11 GPs participated in each group. Results: GPs used a wide range of strategies to try to make medicines either cheaper for patients or to increase their perceived value for money. These strategies included using the prescription charge system to the patient's best advantage, by recommending the purchase of an OTC medicine or increasing the amount of medicine supplied. They could also prescribe more effectively by reducing the number of prescribed items or prescribing a medicine perceived to be more efficacious and more expensive to the healthcare system, to paying patients. Respondents also mentioned questionable practices such as re-using returned medication and prescribing more for a family member that was exempt from prescription charges. Conclusions: The UK's fixed charge prescription system, where patients pay a relatively high rate per prescribed item, may facilitate the development of a wide range of strategies to make medicines cheaper for patients. These strategies, and their diversity across EU member states, is an area that merits further investigation as an influence on patient management decisions at both the GP and patient level.