When you go to an NHS prescription pharmacy in England ready to collect medication your doctor has prescribed, the systems, charges and processes are with few exceptions the same for each person.

You go to a pharmacy, pay the current prescription charge and receive a course of medication or up to a three-month supply depending on the treatment path.

This system was primarily brought in, as with most of the National Health Service, to stop a growing problem that happened in the unregulated health system prior to 1948, and one that is commonly seen in countries such as the United States.

However, the evolution of prescriptions in the UK to the fixed, affordable systems (either free in Wales, Scotland or Northern Ireland or with a nominal charge in England) was designed to avoid the exploitation of the unwell from the previous system.

Destruction Of The Citadel

Up until 1948, whether you had subsidised access to vital medication largely depended on where you lived. 

Whilst there had been a National Insurance system that provided medical care to working men since 1911, the system was fragmented, did not cover women or children, and did not always cover medication.

This meant that there were a lot of people who were not able to access the medical care they needed in the case of an accident or illness, and amidst the debates surrounding this, A. J. Cronin published The Citadel in 1937, a scathing and controversial novel about medical inequality and injustice.

It was very popular at the time, with a film adaptation being nominated for four Oscars. However, the impending Second World War delayed the conclusion of the debate for another decade, when the NHS was finally put into action.

Founded by the then-Minister of Health Aneurin “Nye” Bevan, its core principles were to provide health services that were free at the point of use, financed through taxes and available to everyone. This system was inspired by the Tredegar Medical Aid Society he had grown around.

This initially included prescriptions, which up until that point were not universally covered by National Insurance or other health insurance plans available at the time, but it was also something that would not exist for long.

The War On Free Prescriptions

By 1949, proposals were already being made to try and dilute the truly free notion of the NHS, fearing that the overspending seen in its first year would be permanent, a fear that would prove unfounded.

The then-Prime Minister Clement Atlee, under pressure from Chancellor of the Exchequer Stafford Cripps, introduced in the NHS Amendment Act 1949 a one-shilling charge for each prescription, but the opposition to its introduction was intense.

Its biggest critic, and the one that managed to block prescription charges, was Nye Bevan himself, who threatened to resign if they were brought in.

In 1951, in the wake of the Korean War, Hugh Gaitskell and Foreign Secretary Herbert Morrison brought in the first charges for prescription glasses and dentures, and true to his word, Mr Bevan resigned in protest.

The next year, Winston Churchill introduced a universal charge on prescriptions.