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It goes down very well with voters, but are free NHS prescriptions such an obvious boon?

I ask because this week it became clear that, within a couple of years, only patients in England will have to pay for their medicines after Northern Ireland's decision to follow Wales and Scotland and abolish prescription charges altogether

I can already hear the objections of English patients, furious at the unfairness of a supposedly national health service that is in UK terms, of course, nothing of the sort. But my question is not about British health equality. It is about the most effective use of limited public funds which, ultimately perhaps, should amount to the same thing.

Ask someone whether they would rather pay £7.10 or get something free and they will think it must be a trick question. But the problem with free stuff is that people don't value it. And the 'stuff' we are talking about in England alone is valued at £8.2 billion.

Let's look what has happened in Wales.They went first and abolished prescription charges in April 2007. A year on, an enterprising Liberal Democrat wrote to GPs to ask what they thought. It was a straw poll rather than anything you could hang your hat on, but almost two-thirds of 133 family doctors said they opposed free prescriptions.

Here are some of the responses;

"I think that patients frequently fail to value that which they receive cost free and I suspect this contributes to high levels of wastage of medicines."

"I'd much rather the money was used to reduce waiting list times which causes needless suffering and often worsening of conditions."

GPs revealed that patients were demanding prescriptions for what would normally be over-the-counter treatments. Among items they were asked to prescribe were "nit combs, vitamins, honey, aspirins, paracetamol, cough and cold remedies, antihistamines".

One respondent revealed how they were "inundated with requests for head lice preparations for whole families".

I am sure there are some people who are put off going to their GP for beneficial medicines because they are worried about the cost. But not many. Eighty-eight percent of prescriptions in England are free already. And that's before Gordon Brown's recent announcement that all cancer patients won't have to pay for their prescription drugs.

Income from prescriptions in England is expected to be about £435m this year - hardly peanuts but equally not a huge sum in the grand scheme of NHS finance.

The cost of administering the whole prescription system is only ten million quid so the bureaucracy is not really a factor.

You see, I wonder if it is the money that matters here. Is the relationship people have with their NHS more important? People abuse ambulance crews and A&E staff because they see themselves as disgruntled consumers rather than citizens with a shared responsibility for the system. They waste the valuable time of doctors and nurses by not bothering to turn up for appointments because there are no consequences.

As I was having a tooth drilled this morning, my NHS dentist told me that the patients who are most likely to miss their appointment are those who don't have to pay. Further journalistic inquiry was limited to dribbling I'm afraid, but she was convinced that if a service is free people don't respect it.

The NHS in England reckons patients waste prescriptions worth "at least £100m" a year. I suspect it is much more given Merseyside health trusts alone calculated the cost at £12 million.

Managers speculated as to whether putting the real prices of drugs on the packets would reduce wastage, make people think twice before they threw away valuable drugs. A focus group suggested this would have unintended consequences.

"If the cost of the medicine was very high, some people thought that they should not take it, because it was too expensive. If the cost was very low, people thought that they should have had a slightly more expensive drug" the .

Prescription drugs have never been part of the "free at the point of delivery" contract that underpins the NHS, but one can see why abolishing charges appears to strengthen this principle. To some, the health service ideals are seen as a bulwark against the power of capitalist markets - a model for benign and universal state provision.

However, the NHS increasingly encourages patients to behave like customers. Internal markets designed to improve standards are driven by "patient choice".

The arguments over prescription charges quickly go to the heart of the relationship between citizen and state, patient and NHS. Would free medicines for all protect the health service? Or expose its weaknesses?

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