I welcome the article 'Labour exchange' (news focus, pages 11-12, 1 July) and the issues it raises regarding the transition of primary care groups to trusts. Many community health trusts are grappling with the very dilemmas highlighted by Barbara Kennedy at her conference.

However, as the article indicates, these issues need to be discussed locally with PCGs and health authorities - different solutions will certainly be applicable in different parts of the country.

What hit home was the need for transitional money, but I am not confident this will be available. If community health services start to move over time into PCTs, community trusts will become unviable at a certain point.

These trusts will either merge with others or remain as residual organisation for a time until PCTs are ready to take on the remaining services.

The alternative is for change to happen more quickly. Quick decisions may be necessary in these circumstances but my experience suggests that quick decisions lead to mistakes.

My plea - whichever path is taken - is for HAs, PCGs and their local community trust to be talking now, even if PCGs do not envisage going for trust status in the first wave.

Whatever decisions are made, the process needs to be a planned and managed one.

Annie Brough

Chief executive

Community Health South London trust