Published: 05/12/2002, Volume112 No. 5834 Page 23

Prescribing/pharmaceutical issues have featured heavily in recent issues of HSJ.As usual, fairly polarised views seem to be being taken with primary care trust spokespeople remaining focused on costs alone. This focus on medicine costs with no mention of the outcomes and health gain is a tired argument. A strategic approach to medicines management is needed, particularly now that PCTs are the main commissioners.

Perhaps what is needed is to:

Reappraise the role and value that medicines will play in the 21st century. The NHS currently spends 15 per cent of its budget on medicines. But is this the 'right' amount to spend? The constant focus on input costs needs to be re-evaluated with a move to focus on the use of medicines and the resultant health gain. Longer-term planning and commissioning needs to be factored into the implementation of the national service frameworks, with a focus on health outcomes.

Enhance the understanding and skills associated with health economics. Present evidence suggests that healthcare decision makers have a poor understanding of the economic evaluations of new technologies. As this new area enters mainstream NHS thinking as a result of National Institute for Clinical Excellence appraisals, competencies and capabilities will have to be increased. Health economic tools should be used 'honestly' to allow virement across budgets and this may well be into the prescribing 'pot'.

Clarify the use of nomenclature. More clarity is needed around the words being used within the prescribing arena - for example, what does costeffective and cost-ineffective actually mean? Is absence of evidence the same as evidence of absence?

Alan D Jones AJC Healthcare