While agreeing with DL Crosby's comments (letters, 16 September) that primary care groups should reduce commissioning of services that are not evidence-based, I do not agree that counselling services provided in primary care fall into this category.

There is a feeling nowadays that clinical effectiveness is the be all and end all in deciding which services should be purchased.

If only it were that simple. If PCGs were to purchase only services known to be clinically effective we could scrap half of the NHS providers witha pen stroke. The evidence is not there to make decisions based solely on this.

New treatments, drugs and procedures should be thoroughly scrutinised, but Mr Crosby ignores other measures of efficacy apart from clinical value.

More work must be done to determine the clinical effectiveness of counselling, but few would dispute itscost-effectiveness, particularly in primary care.

If it was not available the same patients would undoubtedly be taking valuable GP time instead.

So when waiting times in primary care increase because GPs are counselling patients, would Mr Crosby therefore advocate appointing more GPs or more counsellors at less cost?

PCGs need to balance all measures of effectiveness when providing services.

In the case of counselling, not only should current provision be assessed in this way, but more innovative solutions, which could potentially provide even more 'effective' services, should be considered, too.

Angela Knight

Chief executive

Eastbourne Downs PCG

East Sussex