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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Debate on NHS top-up fees

The British Medical Journal has published a head to head debate asking if patients should be able to pay top-up fees to get the treatment they want.

James Gubb, director of health unit, argues in favour of top-up fees stating that this practice already happens but is in need of some standardisation in terms of cost and availability. He sites the current situation with hearing aids and also how decisions over funding of NICE rejected anti-cancer drugs differ with location.

Karen Bloor, a researcher at the University of York, argues against top-up fees stating the treatment should be based on clinical need and not on ability to pay. It is also argued that allowing top-up fees could have a significant effect on market prices with emergence of top-up fee insurance and increasing drug costs due to the weaker price negotiating position of multiple purchasers.

This debate serves to highlight the continued tension of providing an enormous range of treatments with a limited resource. This debate is likely to continue, especially while individual patients, pharmaceutical companies and patient groups continue to contest national policy decisions to not fund treatment based upon want rather than need.

Action: Clinicians must ensure that they make optimal use of their allocated NHS resource by prescribing with due regard for cost-efficacy and clinical need.

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