I recently had a conversation with the family of a gentleman in his eighties. Sadly he had undergone surgery, contracted MRSA and suffered significant complications.

The family were concerned that recent swallowing difficlties had required the use of liquid based medicine, his multiple pathologies included various cardiac treatments that were only apparently available as "specials".

In the course of the conversation it transpired that the family were already well aware of the costs of such "specials" and even more surprisingly aware of the perverse incentive that some pharmacists use the most expensive route to obtain the drugs and maximise the profit.

When the son said "bit of a conflict of interest there Doc" I started to tactfully enquire as to their background- were they Lawyers, Teachers or God forbid- Medics?

Oddly no- she worked in IT, he worked in the Council. They were both aware of the cost pressures we all face and willing to consider any option which meant their Dad received good care.

After a while we reached an arrangement involving alternate treatments, delivery mechanisms and some PRN subcutaneous drugs.

There was no rancour, anger or demanding of "their rights". In effect they were acting as custodians of the NHS purse in much the same way as many GPs do.

Perhaps there is something in sharing care footprints with patients afterall.