With all the hype and hysteria associated with the year 2000 issue, it is refreshing to read that Andrew Cash, head of the millennium executive team, has identified the need for people to take some responsibility for their own healthcare needs (news focus, page 12, 8 July). Although extra provision does need to be made over the holiday period, it should not be the sole domain of public services to treat all ills.

The philosophy of our physiotherapy service in Cheltenham strongly advocates the importance of self-care.

Our aim is to avoid dependency and teach the patient or carer coping strategies to enable them to manage the problem themselves. In view of the recent DoH statistical bulletin on the prevalence of back pain in Britain in 1998, the need to adopt the same self-care approach for the 40 per cent of adults who suffer back pain is ever more pertinent.

To prevent further increases in the levels of disability reported in the workforce, we suggest that Andrew Cash's fridge magnets could be usefully employed to remind people to keep active and exercised. This will help to keep people 'back in work'.

Natalie Beswetherick

Julie Shepherd

Physiotherapy department

Cheltenham General Hospital