The Pharmaceutical Journal
Vol 279 No 7482 p679
15 December 2007

This article
Reprint   Photocopy

PDF 70K, Acrobat Reader

• NHS (2)
• Retention fees (5)
• Postgraduate education
• Independent prescribing
• Registration
• The profession (2)
• Pack sizes
• Retirement

Letters to the Editor

NHS

Aims of Drug and Therapeutics Bulletin misunderstood

From Dr A. Tarr and Dr I. Iheanacho

We write in response to a letter in The Journal (1 December 2007, p622), in which Noel Staunton criticised a recent Drug and Therapeutics Bulletin article about bath emollients for patients with eczema.

Mr Staunton appears to have misunderstood the aims of the DTB. These do not include looking for areas where the NHS might save money.

What the DTB does is to make recommendations about treatments based on relative efficacy, safety, convenience and cost. In particular, the publication aims to offer advice to health care professionals on areas where there is uncertainty. Indeed, the lack of consensus among specialists about the value of bath emollients was the basis for our article.

The reason for including the figure of £16m (the amount spent annually by the NHS in England on bath emollients) was to show how widely the products are used. As our article explains, we could find no convincing basis for using bath emollients.

Another thing that the DTB does is point out when data from randomised, controlled trials are needed. Such research is desperately needed to establish whether or not bath emollients are effective in eczema.

Patients and prescribers have a right to know if what they are using is effective and, until evidence on bath emollients is available, we think it is reasonable to question their use. We do not share Mr Staunton’s view that such issues are not worth raising.

It may appear that the DTB is always advocating spending less on treatments. This is probably because we often find that new treatments are more expensive than older, more well established therapy, but offer no compelling advantages.

Andrea Tarr
Associate Editor
Ike Iheanacho
Editor
Drug and Therapeutics Bulletin

Cost saving in the NHS, why put a limit on it?

From Ms M. Yassaie, MRPharmS

After reading the letter by Noel Staunton regarding cost saving in the NHS (PJ, 1 December 2007, p622), I find myself agreeing with him on the point that primary care trusts are still not good enough at commissioning. Commissioning colleagues in the past few years have come a long way but we are not there yet. We could indeed achieve so much more by better commissioning.

However, I would like to beg to differ from Mr Staunton on calling the Drug and Therapeutics Bulletin work on prescribing issues wasting time. The DTB is an independent publication that provides the clinician with evidence-based advice. The prescribing budget is about 19 per cent of a total PCT’s budget. I would not consider this a tiny spend.

So, we are not yet good enough at commissioning, but, we are good at providing evidence-based, effective, appropriate and cost-effective advice to clinicians and we are focused on doing so. We have the best expert bodies to support us, whether through the National Prescribing Centre or the DTB.

So why not build on our strength and carry on with the good work of evidence-based prescribing rather than wait for commissioning services to become perfect.

I strongly believe that £16m would have been good enough reason for pharmaceutical companies to do randomised, control trials if they thought that the outcomes would have been financially beneficial to them. I know of companies that have done clinical trials on less profitable areas because they were more certain of the outcome.

So let us not knock the excellent work of the DTB and let us celebrate it and support it; after all we are accountable for how we use public money in the NHS. Let us spend it according to evidence-based prescribing and let us stop it being wasted even if wastage is around or less than £16m.

Maha Yassaie
Chief Pharmacist,
Strategic Lead Medicine Management,
Berkshire West Primary Care Trust

Send your letter to The Editor

Next Topic (Retention fees)