Gill Malbon and colleagues ('Onus points', pages 28-29, 19 November) are right to say that GPs are only starting to recognise the implications of clinical governance.

But some GPs do recognise that clinical governance depends on building on what we already do through training networks, and co-ordinating work. If GPs can be enthused to take a 'bottom-up' approach, and primary healthcare teams can be encouraged to become involved, clinical governance might be established successfully.

Health minister Alan Milburn's recent remarks tell us this may be the profession's last chance at self-regulation. GPs must quickly take the initiative or have performance review and standard setting imposed upon them.

R A S Christie

The Portmill Surgery