Published: 02/09/2004, Volume II4, No. 5921 Page 21

Dr Mark Taylor's article exposed real problems in commissioning for paediatric renal services (Growing Pains, page 24, 29 July).

The weaknesses he refers to are mirrored across the whole range of specialised tertiary services.

In Nottingham, we have developed a relationship with our local specialised commissioning groups, which is helping us to get over many of these issues.

Commissioning groups have been developed involving up to three LSCGs including, where possible, public health input, acute service clinicians, parents/ patients and trust managers.

When there is a lack of understanding of the detailed services, commissioners have invited informal presentations from members of the multidisciplinary clinical teams demonstrating standards of best practice to describe the present level of service provision and thereby identify service gaps.

Also, in some instances, as with paediatric renal services, specialist management consultants with backgrounds in public health have been commissioned to undertake a service scoping exercise.

Both models have enabled the groups for these services to fasttrack their knowledge and create a positive atmosphere between commissioners and service providers.

Gill Martin Divisional service manager Family health division Nottingham City Hospital trust