Published: 10/01/2001, Volume 112, No. 5787 Page 22 23

The academic approach taken to analysing why NHS recorded activity is decreasing despite massive injections of cash is as na´ve as the government's failure to understand where all the money has gone ('Short measure', pages 24-27, 13 December 2001).

The only way most trusts can meet the challenging waitingtime targets is by finding new ways to deliver: modernising the NHS. But those of us who have been engaged in this for years (surprisingly it wasn't a New Labour invention) have had to accept the failure of central recording systems to reflect the amount of work transferred to non-consultants - for example, GPs and nurse practitioners - none of which is counted because it falls outside the definition of 'consultant activity':

that is, it neither constitutes a consultant referral nor a finished consultant episode.

Add to this that consultants are increasingly left with the more complex work, and a picture emerges of the NHS doing less, when we are working harder than ever. The answer is not to redirect money into activitygenerating areas, but to recognise that as a basis for counting, consultant activity is no longer a valid measure.

Brian James Director of planning and operations South Durham Healthcare trust