Published: 16/06/2005, Volume II5, No. 5960 Page 24

Barbara Kennedy, chief executive, Milton Keynes PCT; Janet Fitzgerald, chief executive, Reading PCT; Paul Bennett, chief executive, Wycombe PCT.

Recent initiatives by Manchester's primary care trusts have demonstrated one of the strengths of PCTs - developing flexible, adaptive means to meet the health challenges of their local environment (Good Management, pages 22-23, 2 June).

And there are a number of examples of this nationally. PCTs in Thames Valley are collaborating on practice-based commissioning - with a joint implementation framework and shared performance measures. Shared back-office functions will follow shortly, with the establishment of a Thames Valley data warehouse.

This, along with local planning to determine activity levels, will strengthen PCTs' ability to manage contracts in a pluralistic environment. PCTs have also agreed to share out leadership roles to ensure mutual support among chief executives.

There is strength in such collaboration - but it needs trust, mutual respect and a fair distribution of power. This is not easy. It requires serious consideration being given to governance arrangements. Formal agreements must be drawn up to ensure transparency about what organisations expect of each other.

Boards will need to sign over some of their independence - but also understand the benefits and risks of the collaboration.