Published: 21/11/2002, Volume II2, No. 5832 Page 20

HSJ 's very public challenge to merge the NHS Alliance and National Association of Primary Care ('Two many advocates, too little time, 17 October) deserves a public reply. Both organisations are built on premises for which they been strong (indeed sole) advocates and which are an essential part of modernisation.

The first, that NHS decisions and funding should start rather than end in primary care, sets the pace for the rest of the NHS.

Ninety per cent of patient contacts are dealt with entirely in primary care, while the remaining 10 per cent determine the nature and quantity of secondary services. Redesign must therefore start in primary care.

The second is that there should be strong clinician involvement in local decision-making. The alliance supports a populationbased, multiprofessional approach, re-involving clinicians in commissioning and provision at primary care trust and sublocality level. NAPC is focused at practice level, but there should be proper engagement at all levels, down to the individual patient, and these views need not be mutually exclusive.

We still have much work to do in getting both messages across.

Investment in primary care over the past few years has been minimal - hence our recent dramatic but true headline, 'Lack of investment in primary care costs lives'. Too many primary care clinicians are disengaged.

The NHS is still being equated with hospitals, and the not-somodern Modernisation Board has no independent representative of PCTs at all.

Currently, the alliance's star is rising, with a rapidly increasing membership. But there is no room for complacency. The alliance has always been an organisation committed to partnership. We comprised equal numbers of fundholding GPs from the beginning and have embraced the working relationship between clinician, manager and lay leaders within PCTs. The National Association of Lay People in Primary Care merged with us this year and it would be logical for us to have a closer relationship with NAPC.

Rhidian Morris et al (letters, 31 October) argued there should be two organisations in the interest of choice.

I suspect, however, that most people would agree that the division is unhelpful. Today, the danger of having two primary care organisations may be less about creating a division between PCTs (most of whom are alliance members) and more about a potential rift between the PCT agenda and individual practice.

But that is not healthy either.

There are a number of ways of creating a single voice, from joint-working to full merger. We should all act in the interests of primary care as a whole. As far as the two organisations are concerned, ultimately it must be the membership that decides.

Dr Michael Dixon Chair NHS Alliance