The Pharmaceutical Journal
Vol 269 No 7226 p782-783
30 November 2002

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Letters to the Editor

Alzheimer's disease

Missing the point

From Mr M. Campbell, MRPharmS

The report (PDF 50K) by Shubrha Mace and David Taylor (PJ, 9 November, p680) makes for interesting reading but I suspect tells us little about the quality of care for people with Alzheimer's disease, of which a key prerequisite is the availability of old-age psychiatry services. The Royal College of Psychiatry's annual workforce census shows that, for 2001, 72 out of 512 old-age psychiatrist posts (14 per cent) in England were filled by locums or were vacant. Even including these, this is less than one whole time equivalent old-age psychiatrist per 1,000 people with dementia (based on 412 whole time equivalents and an estimated 700,000 people with dementia [National Institute for Clinical Excellence guidance]). Although other specialties are involved in the management of dementia, most services are led by old-age psychiatrists and I suggest that the shortage of trained specialists rather than drug funding arrangements, is the rate-limiting step in access to treatment for Alzheimer's disease.

Moreover, the title of the paper is misleading. Only a detailed clinical audit would tell us whether clinical practice is in line with NICE guidance and no such data are presented. Unfortunately, similar surveys of prescribing advisers and directors of public health are commonly used to determine if health authorities and primary care trusts are funding a particular drug and therefore "complying" with guidance. The crudeness of such app-roaches misunderstands the complex nature of the National Health Service and its commissioning processes in particular. As commissioners of services, PCTs might, for example, provide additional investment for cost pressures arising from NICE guidance but it would rightly be for hospital trusts to prioritise and allocate these extra resources.

Mark Campbell
Programme Director — Clinical Governance
Bury Primary Care Trust

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