letters :

The author of 'Second helpings' (news focus, pages 13-14, 7 June) lives in a fantasy world if she believes 'postcode prescribing may have disappeared as primary care trusts are forced to adopt National Institute for Clinical Excellence guidance'.

Anyone involved in the changes proceeding from health authority to PCT will know this assumption to be factually incorrect. NICE guidance is not compulsory, and many authorities and individuals are avoiding or rejecting it for various reasons, including the perception of external influence on NICE by politicians and pharmaceutical bodies. The 'evidence' NICE presents is often weak.

Very little extra funding has been put towards implementing the guidance to date, and GPs are not employed by PCTs so are not compelled to follow NICE guidelines. This is already in some areas leading to postcode prescribing at a PCT level, as some PCTs have obtained better working agreements with primary care colleagues than others. Within a small town it is possible to find people in adjacent streets subjected to postcoding - a more ridiculous state of affairs than when district prescribing groups laid down policy for the much larger populations of HAs.

It is time you researched facts on the ground before making sweeping statements in support of a viewpoint - or is it a case of managers closing their eyes to the reality of clinical judgement and circumstances?

Dr P Emerson Derby