1 The attitudes of general practitioners and hospital physicians to the management of hypertension in the elderly, were examined by responses to a postal questionnaire distributed within the Northern Region, concerning the management of a healthy 75 year old male non-smoker with sustained diastolic or isolated systolic hypertension. 2 Two hundred and fourteen (64%) general practitioners and 127 (70%) hospital physicians responded to the questionnaire. General practitioners stated they would most commonly measure to the nearest 2 mm Hg (47%) as compared with nearest 5 mm Hg (61%) by physicians; P < 0.05. When measuring diastolic blood pressure 16% general practitioners and 31% physicians would use phase IV sounds; P < 0.01. 3 Median levels of hypertension, confirmed by repeated readings, at which antihypertensive therapy would be commenced were similar: 180 (150-230)/100(90-120) mm Hg vs 180 (150-200)/100 (90-120) mm Hg; median (range). The stated use of non-pharmacological methods to lower blood pressure before starting drug therapy was similar (74% vs 63%). General practitioners were more likely to prescribe a thiazide diuretic (70% vs 54%) and less likely to prescribe a calcium channel blocker (14% vs 28%) as first line therapy; data for diastolic hypertension, P < 0.001. 4 Considerable variation exists amongst both general practitioners and physicians in their stated assessment and management of a healthy elderly non-smoking male with sustained hypertension. General practitioners and physicians have similar stated thresholds for treating hypertension but differ in their choice of first line therapy. These results suggest that effective interventions in addition to guidelines need to be developed if hypertension in the elderly is to be consistently managed.

English health authorities are required to inspect pharmaceutical practice in registered nursing homes within their area. The inspection process provides opportunities to improve as well as monitor practice. An exploratory study is reported in which the verbal and non‐verbal behaviour of pharmaceutical inspectors was recorded. Brief questionnaires explored the views of the staff inspected on the inspection process. Marked differences between inspectors were found, and these were associated with different views on the process on the part of the nurses under inspection. The observation process was acceptable to the inspectors, and feedback was able to convey information which could guide them towards a style of inspection likely to improve practice in the homes in relation to medicines. The inspection process in this setting (and more widely in health care) should seek to provide constructive feedback so that improvement becomes a routine feature of inspection.

Pharmacy practice in the UK is in transition. Due to significant NHS changes by the current Government, pharmacists are experiencing a change in their work environment. Here we describe the challenges, obstacles and the effort needed to ensure that the profession contributes fully to the new agenda and to shaping the future of pharmacy practice.