Dear Mr Medawar

Thank you for your letter of 20 October to Frank Dobson about medicines considered to be less suitable for prescribing, which are now flagged more clearly in the British National Formulary.

The Department of Health welcomes and has taken an active role in the British National Formulary's initiative of highlighting drugs which are considered to be "generally less suitable for prescribing". The aim of this designation is to indicate to doctors that there are other drugs which in most cases may be more suitable. However, you rightly identify that depending on the individual circumstances of the patient, there may still be a legitimate role for the drugs. Only the doctor, in full knowledge of the patient and their condition, is in a position to decide on the most appropriate treatment for that patient.

Many of these drugs are already included in the performance management indicators for prescribing, notably that for drugs of limited clinical value. However, we will consider whether further changes to the PACT information system would be a useful addition for health authority advisers and practices.

The Government continues to encourage doctors to prescribe medicines which are clinically and cost-effective. We recognise the difficulties faced by doctors trying to keep up with increasingly complex developments in drug treatment and have implemented a number of mechanisms to support doctors in this quest. These include:

• funding the distribution of over 150,000 copies of the British National Formulary every six months to all doctors and pharmacists.

• the employment by all HAs of professional prescribing advisers and of pharmacists by some practices by some practices, to support General Practitioners (GPs).

• Prescribing advisers are well placed to address issues such as the suitability of prescribing decisions.

• the resource document, GP Prescribing Support - a resource document and guide to the new NHS, published jointly by the Department of Health and the National Prescribing Centre in September 1998. This is particularly timely in the light of the opportunities and challenges which the creation of Primary Care Groups will bring.

• the National Institute of Clinical Excellence (NICE). As outlined in the quality consultation document "A First Class Service", NICE will assess interventions for their clinical and cost-effectiveness and produce and disseminate guidance to support frontline staff.

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