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With the impending loss of patents, it's no surprise that the drug bill will go down over the next few years - just as they did from December 2004. The drugs market is not subject to the same inflationary forces as other items of commerce, and hence it's a bit spurious to compare it to the rate of inflation, and for prescribers to expect "growth" whilst there are stll painless efficiencies to be made. Credit should be shared with medicines management teams: pharmacists are amognst the few professionals that have to prove their direct economic value in addition to their managerial ability.

A good medicines management team should ensure robust and proactive processes are in place for managing the entry of new drugs - what they cannot do however, is materialise a clinical champion if there is little interest in adopting a new technology within the local health economy. If the wider system costs were considered, fully auditable, and an appropriate investment was re-directed into primary and secondary care drug budgets perhaps the drugs spend will finally stop being considered in isolation and recognised to be the valuable invest to save strategy it can be. We're doing things right, but as with everything, it's a case of "prove it" - so why not put some additional resource into counting the right things?