Consult: strictly not actually consult. What happens is they have to contact their surgery each month, each 4 weeks, then get the prescription paper to the Pharmacy, and then pick up the medicines. This can mean three trips, and can take 5 days. Getting that to happen, and managing to have a life as well, is a non-trivial task for many people. Many General Practices (Not Homefield Surgery) claim they are so busy with people contacting them to ask for things, and that asking for prescriptions by phone is so dangerous, that they won't do it.

When do people run into trouble?
That phrase has often been used to describe what happens to women who run out of their oral contraceptive pills. Providing 13 chances of unintended pregnancy per year would be monumentally dumb, and yet changes of Pill are quite common and the Pill is only fairly cheap.

Drugs for blood pressure are expected to be taken continuously. In practice we know that people often run out and miss a few doses, and usually don't have a heart attack or a stroke as a result. Usually. In other words we know they sometimes do. Giving 13 chances instead of 4 of heart attack or stroke in an effort to save small amounts of money seems to me to be a bad idea. In the early stages of treatment, before we have settled on a treatment to repeat, or if the medicine is hugely expensive, things are different. But in the early stages we don't give repeats, and the argument is about repeats, so that is a different matter.

Bendrofluazide, our first choice of blood pressure drug, costs around a penny a tablet. A year's supply costs around £3-4 pounds for the ingredients, and if it is dispensed monthly, would cost the patient £80 in prescription charges. But few people pay prescription charges. Whatever it costs to write a prescription, whatver it costs to dispense a package of tablets, and whatever it costs the patient to organise a request for it, and collect their tablets, doing it 13 times a year costs a load more than doing it once or twice a year. For the pharmacists and the doctor, that cost is mainly in time which many people would think could be used for a more beneficial purpose on another patient, or even on going home a minute earlier each day.

Aspirin costs a penny a tablet. Again, once someone is started on daily Aspirin, barring mishap we expect them to take it forever.

Thyroxine is a penny a tablet, it is taken lifelong, and we think that once a person is settled on a dose of it, checking their blood level of it once or perhaps twice a year is all the monitoring they should need (unless they notice something new and come to talk about it). How sensible is it to impress monthly upon them that they are ill, take up their time with trivial administration, and give them many many opportunities to forget and run low and slow down. Answer: it is monumentally dumb to do so.

Review: One of the points of repeat prescribing is that there is a minimum of checking and rarely any actual review. Doubling or tripling the number of items going across a GP's desk for signature halves or worse the amount of attention each can get. It is well-known that the number of mistakes made by people in any process is porportional to the number of actions they carry out. Multiplying actions multiplies mistakes.

Monthly prescribing is likely to cause people who believe their medicines are important to try to accumulate a spare month's supply. If their treatment is changed, this is lost, neither more nor less than it would be if the supply was larger.

Lesley Dunaway is CEO of the Mid-Devon PCT, rather than Exeter. Jill Ashton is the Exeter PCT Chair, Dr Vaughan Rosser is the Chairman of the Medical Executive Committee, and Mrs Ruth Airdrie is the Pharmacist who applies the pressure to reduce quantities of medicines to all GPs in the area.

In a week, the Practices in a PCT locally will prescribe (or more exactly, there will be dispensed against their prescriptions) around £zillions(fill in correct figure)