An important part of health resources are spent on prescriptions for acid suppression therapy each year in Cornwall. In 1996 the cost of prescriptions for these drugs amounted to £6.15 million [Prescription Pricing Authority. Prescription analysis and cost (PACT) data. Financial year 1996, unpublished data], which represents 14% of the total prescription cost for the district and 2% of the health authority budget. In addition there has been a continuing rise in the cost associated with acid suppression drugs, due mainly to an increasing use of proton pump inhibitors ( Figure 1). This is a national trend, but it is particularly relevant in Cornwall where the cost of acid suppression therapy is above the average for England.Studies have shown that a majority of acid suppression drugs are prescribed on a repeat basis and about 80% of the cost associated with these drugs is generated by repeat prescriptions; 1, 2 a repeat prescription has been de®ned as a prescription issued without a consultation. 1 The ®nancial burden of acid suppression drugs on health resources is therefore linked to repeat prescriptions.In previous studies repeat prescription rates varied between 1% 3±5 and 4.4%, 6 but these studies were based on a small sample of practices that were not representative of all English practices. There is evidence suggesting that repeat prescriptions may lead to an inappropriate use of acid suppression drugs, in turn leading to a waste of resources and possible damage to patients' health. A recent study carried out in seven practices in Dundee 6 has shown that 44% of patients with repeat prescriptions for acid SUMMARY Background: Repeat prescriptions for acid suppression therapy represent an important burden on health care resources. Aim: To determine the prevalence of acid suppression therapy and its indications by general practitioners (GPs) in a larger sample of practices than previous studies. Method: Practices in Cornwall and the Isles of Scilly were invited to identify the number of patients on repeat prescription for acid suppression drugs in their practice, to review the indication for treatment in a sample of 50 patients, and to indicate the mode of review of these patients.

Measures of deprivation are closely correlated one with another. However, by judicious choice of the deprivation measure used a ward can achieve a marked change in rank order. This may exert considerable influence on the decisions made by government departments, local authorities and health authorities when allocating resources.

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The day they give you the title, you become a manager. But becoming a leader may take a lot longer. If being a manager is about what you do, becoming a leader is about learning and trusting in who you are -the personal qualities and skills that inspire people to work with you.Good leaders -however different they are -seem to share certain qualities. Some of these are about intelligence and competence. Some are more difficult to define, and have been grouped under the heading of emotional intelligence. The emotionally intelligent leaderSo what is it? Roger Gill of the Leadership Trust Foundation defines emotional intelligence as ''. . . our ability to recognize and control our own feelings and needs, recognize those of other people and respond to them constructively and skillfully.'' These are innate abilities -some people seem to be naturally gifted in this way, other less so. Does this mean that effective leaders have to be found rather than developed?Well, in our experience, no. What it does mean is that developing leadership requires different approaches. Leadership needs to be developed and nourished in the day-to-day workplace, where relationships are under test and where complex issues of integrity and trust have to be worked through.'' If being a manager is about what you do, becoming a leader is about learning and trusting in who you are -the personal qualities and skills that inspire people to work with you. ''

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