Stuart Smalley ('No kidding', feature, pages 24-25, 22 June) rightly points to the desperate need for careful deliberation about the future organisation of children's health services.

He also picks out a critical issue which bears not just on paediatric surgery but on many secondary care services for children: the tension between clinical quality and local accessibility of services. His solution - to develop partnerships which ensure services are structured to meet the needs of children and their families - carries real weight.

Partners in Paediatrics is a provider network which includes nine local (district general hospital based) children's acute health services serving the population between Birmingham and Manchester. Over the past 12 months, with colleagues from surgery and anaesthetics, PiP has been exploring how planned, cooperative changes in practice might be achieved. Most important, changes would ensure greater specialisation and a concentration of care - too many surgeons and anaesthetists conduct operations on an occasional basis.

While a networked approach must include the tertiary centres, the aim is to ensure that this is not at the expense of local access to surgical services: local outreach day-case surgery is one possibility to consider.

As Stuart Smalley's article hints, the task is to find an appropriate balance of provision which assures quality without losing the local accessibility to services which users of children's services need.

PiP has looked hard at the way services are currently provided and is organising a workshop for 9 October which will bring surgeons and paediatricians from nine DGHs and from the specialist centres to explore how, working together, it may be possible to address the issues in paediatric surgery provision which are now becoming clear. A briefing paper for the workshop is available from the partnership manager.

Angela Hopper Manager Partners in Paediatrics Royal Infirmary site North Staffordshire Hospital trust Hartshill Stoke on Trent