There is a local medicines initiative in Essex, started by the former PCT and continuing under the new Commissioning Board, where Doctors are only allowed to prescribe the cheapest medication for a patient despite the Doctor knowing that they are aware of other medication that would suit the patients needs better. I think this puts patients quality of life in jeopardy but most of all this practice reduces the Doctors years of training and qualifications to just ‘ticking boxes’ and that the practice is both dangerous and immoral. Patients who have been very successfully on a medication regime for a number of years are being put at risk and discomfort by this practice and patients new to a medication are not being treated with the best available drugs. NICE states that the patients needs must be considered and the most suitable medication prescribed but this direction is not being followed. Patients are having to return to their GPs as medications fail and this must be having an impact on the pressure for appointments that all GP practices seem to be having. Useless medications are having to be discarded causing more waste of money.