Successful stewardship of NHS budgets requires an impressive array of skills and knowledge, plus an ability to take a long-term view of what is in the best interests of patients and the health service. Understanding some of the more technical aspects of the primary care prescribing budget is crucial for making sensible prescribing decisions. For example, two issues relating to generic prescribing have a key impact on budget management in the short and long term, and clinicians and commissioners ignore them at their peril.

The first relates to the pricing of generic drugs (i.e. those “to which the manufacturer does not apply a brand name that enables the product to be identified without …