A major change in UK health care has occurred, quite quietly, and overshadowed by all the goings on with the White Paper. There are no more pens. That's right, pharmaceutical companies will no longer be giving pens, and Post-it™ notes for that matter, to those of us who have come to see these items as part of the furniture of daily practice.

Some might call this a milestone, reflecting it as a positive step. Frustrated others may find it easier to describe it as a turning point. I know that in my practice it has had a profound effect on staff and I fear the repercussions on patient care. You see, staff have become very protective of ‘their’ pen, highlighted the other day when I asked to borrow one. Yes, there were none lying around – extraordinary, I know. Ordinarily I’d have pulled open a drawer and pens would have come flying out in all colours of the rainbow like a multicoloured ejaculation. Just as drug reps' homes were filled to bursting with pens, so were our …