NHS Confederation chief executive Stephen Thornton raises a timely warning about the potential failure of the current changes (letters, 25 October). Transforming an organisation means more than transferring services, functions, staff and estates.

There will be no real change if all that happens is the same as before, in differently configured organisations.

Opportunities exist at the time of change to develop new approaches. Processes used for planning, preparation and implementation provide opportunities to see what will and can be different.

Facilitation from outside can bring to these processes a fresh view and be used to check and challenge assumptions.

Work in the primary care trust preparatory period will begin to shape the future organisation and the attitudes of those who work in it.

The project planning and management used to guide the activities can provide opportunities to learn and develop the change. With facilitation, participants can explore their understanding of the new organisation and the potential it offers.

Similarly, business planning used to prepare personal medical services organisations can help GPs understand the implications of the change.

With facilitation it can provide a chance for reflection and assist them to develop targets and expectations that are realistic and achievable.

These are not quick-fix solutions, but without the preparatory work to build a deep understanding of the changes and expectations, no real change will occur - and even more time and resources will be lost.

Kate Wortham Consultant KWA Organisation Development Oxford