Table 2

 Options for managing change

Option 1 Do nothingNo expenditure for commissioning authorities in the short termForgoes the opportunity to improve the quality of prescribing and management of asthma patients. Risk of the pharmaceutical industry managing the change throughout the transition period to meet its own agenda
Option 2 Independent local guidance on reviewing and switching patients between products using an evidence-based approachQuality issues addressed in both prescribing and managementDuplication of activity in different commissioning authorities with attendant costs. Risk of conflicting guidance between different authorities. The ability of purchasers to influence the behaviour of prescribers is impaired
Option 3 A co-ordinated national/regional transition guidelines products using an evidence-based approachThe scale of additional expenditure is contained. Effective prescribing and management is achieved. Conflicting recommendations and duplication of effort are minimised. There is improvement in the care of patients with asthma