Published: 03/06/2004, Volume II4, No. 5908 Page 23

Dr Mark Davis' article on care pathways provided a very useful summary of key steps in developing an integrated care pathway and identifying the potential benefits ('Way to go', pages 24-25, 13 May).

Unfortunately, there are examples of care pathway development across the NHS which has followed such an approach, but which has not proved beneficial. I wonder, therefore, whether an initial stage of development was missed out?

Close analysis of the success of pathways in the US highlights one additional and initial step which should be undertaken in identifying appropriate areas for development. In the US, pathways were developed in defined treatment paths where good evidence existed and where adverse variance or complications to treatment were similarly low.

The conclusion is that although pathways can provide significant benefits within the NHS, they are not a panacea for all treatment paths and areas for use should be selected carefully.

Peter Hughes Clinical governance manager Good Hope Hospital, Sutton Coldfield