Medicines management. A tension seeker.

Tensions exist across the primary-secondary care interface between GPs and hospital prescribing services. Repeat prescribing arrangements are a good focus for audit, as a patient started by the hospital on a treatment will tend to stay on it after discharge, with knock-on costs for primary care. Cost-effectiveness improvements in prescribing practice have included a significant reduction in hospital prescribing of 'loss-led' oral nitrates in favour of generic equivalents and the adoption as standard of the most cost-effective of the new proton pump inhibitors.