There's also a real risk that people's health is suffering because they have difficulty in affording the fees charged

Health Which?

It added many were taking smaller amounts of their prescribed medicine than they should.

One of the major problems highlighted by Health Which? is the increase in the frequency prescriptions are issued.

Some patients are being given one-month prescriptions, instead of two or three-month prescriptions.

This means double or triple the charges, and the need for more frequent visits to the GP and pharmacy.

The National Prescribing Centre encourages doctors to prescribe for shorter periods, to reduce waste, but says that is not national policy, according to Health Which?

Season ticket cost

A survey of over 100 prescribing advisors to primary care groups and trusts found half had a policy limiting the amount of medicine supplied each time, usually giving out only one or two months worth.

Many others said they were introducing repeat prescribing policies.

The survey also found:-

• 43% thought income-related exemptions should be reviewed
• 35% said more conditions should be exempt from charges
• 40% thought charges should be lower

Health Which? also criticised the annual 'season ticket' scheme.

Under this system, aimed at those on low incomes, patients can buy pre-payment certificates to limit costs.

The certificates cost �87.60 for 12 months, a lump sum Health Which? said those on low incomes were least likely to be able to afford.

Kaye McIntosh, editor of Health Which?, said: "The confusing exemption system is full of anomalies: someone with diabetes could get free medicine while people with asthma have to pay, for instance."

She added: "There's also a real risk that people's health is suffering because they have difficulty in affording the fees charged, especially when they are paying for several items on the same prescription form."

Time for change

Dr George Rae, a member of the British Medical Association's GPs' committee prescribing group, said he was "delighted" Health Which? was backing what the BMA had been saying for many years.

"The system does need a radical review, particularly in regard to chronic diseases. It really is time."

He agreed pre-payment certificates also needed to be rethought. "Eight to ninety pounds as a lump-sum is beyond the ability of many people in the UK."

A Department of Health spokeswoman said 85% of NHS prescriptions were dispensed free, with a further 5% going to pre-payment certificate holders.

She said the department was currently looking at the pre-payment certificates scheme.

She added schemes due to begin next year would allow prescriptions to be dispensed in instalments so patients do not have to go back to their GP each time.

But she added: "Evidence from pilots has shown that many patients with chronic conditions find repeat dispensing more convenient."