Private prescribing in the NHS: what is the future of the NHS?

Is socialist healthcare dead? #MSBlog #MSResearch 

“The NHS was founded on two principles that underpin socialist healthcare in the UK. (1) Healthcare will be free at point of service and (2) there will be equity. The coalition has undermined these principles by allowing private prescriptions in the NHS. In the past private prescribing was the remit of the private sector and you needed to have all your care covered privately. Doctors were not allowed to look after the same patient in the private sector and the NHS. Now you can pick and choose. As a neurologist who sees people with MS from all walks of life I am deeply uncomfortable with this change in policy. Why should one patient be denied access to a licensed drug in the NHS simply because they can’t afford it, when another can?”

“Is private prescribing the thin edge of the wedge? Is it the end of the NHS as we know it? We tried to set-up a debate on this last year, but could not get any politicians, from any of the parties, to participate. Why? I am beginning to suspect that there is a cross-party consensus on private prescribing in the NHS and that they would rather not put their heads above the parapet as they have too much to lose. I am very keen to get to the bottom of how, and who, was responsible for this change in NHS policy? I need to know if this is the shape of things to come. Will the NHS increasingly provide a two-tiered system? Should we prepare ourselves for a future of NHS haves and have-nots? I don’t know the answer to these questions, but it needs a public debate. In a world of austerity in which soaring health costs need to be addressed there are no right and wrong answers. Allowing private prescriptions in the NHS may be a subtle way of the government telling the British electorate that we can’t afford the NHS in its current form and we need to top it up with private contributions. If that is the case the Government, or the Whitehall mandarins who thought up this change in policy, should tell us their plans for the future of the NHS.”

“I need to know how to deal with issue of private prescribing. I need to rationalise how I am going to deal with this issue in my clinic. At the moment I am referring patients who make a request for a private prescription to my colleagues who don’t have a moral problem with this issue.”

“To get more information on this topic we are going to task an intern, or work-experience student, with the job of investigating this issue. As part of his/her job I will ask them to periodically update you on this issue via the blog. If any of you can help please feel free to contact us. The primary objective of this exercise is to get a genuine public debate on this issue that will hopefully lead to some clarity.”

“If you are interested in this issue please read some of our previous posts on the topic.”

13 May 2013
Fampridine is not being funded by the NHS, but we are allowed to give private prescriptions to individuals who can pay for the medication themselves.” “What this practice signifies is the end of socialist medicine in the UK as 
15 May 2013
“Our post on ‘Topping-up the NHS with private prescribing’ has generated a healthy debate. In response to a query yesterday I thought I would highlight an example of private prescribing within the NHS in relation to the 
10 Jul 2013
I have already highlighted the pernicious influence that private prescribing is having on the NHS. Private prescribing has undermined the two founding principles of the NHS: free at point of access and equity. We are planning 

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.


  • Apathy is allowing the destruction of the NHS throught the back door, the coalition are hell bent on destroying all of the welfare state and doing it by massaging the egos of the population who think if they shop at Sainsbury and can afford a Holiday abroad they are now some how middle class and private health care is another status symbol to be waved in front of the so called benefit scroungers.
    Be careful what you wish for because when it's gone it's gone.

  • I am with you on this one, Don Giovannoni . The Americanisation of British culture will be to the detriment of the universal values we enshrine and abide by. Under this heinous coalition party we now exist in a Britain where it is more acceptable to tax the disabled woman with an extra bedroom rather than tax the rich man in his mansion who has now received a five per cent tax cut. It is almost Dickensian in its contempt of the most vulnerable in society.

    Private prescriptions, to my knowledge, have been usually issued through NHS doctors for things like finasteride whereby prematurely balding blokes can try and salvage their fading looks. (Good luck with that one.) To think that essential medicines that can make the difference between life and death may make its way to private prescribing is a scary concept.

    If multiple sclerosis can be effectively treated via DMTs then I am all for its availability for free through the NHS. However, I remain unconvinced of the efficacy of any of the drugs you’re promoting lately. It seems that many formidable health authorities back me in that opinion.

    My fear is that highly impressionable and vulnerable sufferers of MS will pay fortunes for toxic crap like alemtuzumab, and then suffer potential consequences and disappointment further down the line. You know as well as I do that alemtuzumab is not a panacea and may not deliver hope for all who take it.

    Nonetheless, I abhor the privatisation of the NHS and hope we come together in a form of cultural nationalism and fight to protect it. The NHS is bigger and more valuable to us than even God.

  • Britain is coming apart at the seams. The very same things that almost destroyed this nation five years ago is happening again with over inflated house markets and a economic recovery led by consumer debt. We are so addicted to spending money and told that we must pay through the nose for nice things. Now we are told that good health care is something strictly the province of the rich.

    My own brother, while smoking his third cigarette of the morning, said he pays for expensive private health care because you can't afford to be cheap with your health. This is what modern Britain looks like.

  • Unless we are willing to pay more in taxes or radically change the way the NHS works eg you pay for your food and laundry in hospitals, we won't be able to afford it in the future. Most people retired from work and were dead within 10 years. Now we have an aging population who may have 30 years post retirement who will need health care (not taking into account the enormous amount in pensions that will be paid out to NHS workers out of the NHS pot ).

    This is such a political issue, but you are dealing with people's lives. How can you say it is morally right to refuse a patient a drug they are willing to pay for that would improve their health on the basis that you can't prescribe it for someone else. Therefore, you would be willing to see that patient's health deteriorate to prove a point. Also if they pay for their drug, surely it is leaving more money in the NHS pot for the other users of the NHS.

    We are not talking about the rich here either. A lot of people work very hard for their money, and if they choose to spend it on drugs or healthcare rather than expensive holidays it should be up to them. A dog in the manger attitude helps no one.

  • My wife receives private prescriptions for LDN because our PCT will not fund, some of course will. I agree with the principal you are concerned about but the reality is if she had to pay for private prescriptions as well she would be even worse of. Unless the NHS seriously investigates treatments other than expensive often dangerous licensed drugs then the cost is s not findable. Those who do not do there own research and find some treatment that works for them likely also impact on care costs which again is not sustainable. Truth is no individual government seems to want to address these cost issues so the system will crash. Maybe indeed no individual government has the power to take on multinationals in any field not just medicine

By Prof G



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