Enfield and Haringey is an area that illustrates some of the geographical obstacles to setting primary care group boundaries. Ron Singer, chair of Enfield and Haringey commissioning executive, told a recent 'pan-London' conference that after 'meetings, meetings, meetings' the health authority produced an options document that included proposals for five PCGs based on parliamentary constituency boundaries.

The proposal for two PCGs in Haringey appears to have general support, although the local authority 'wants a whole-area solution'. But the HA's suggestion of three PCGs for Enfield has caused considerable debate. 'The A10 splits the area in two and that is a big problem because people who live on one side do not cross the road,' Dr Singer told the conference.

'So we looked at using the road as a boundary. That gives two PCGs with 150,000 people each, and puts all the deprivation on one side and the affluent areas on the other. There is a question about whether that is a good idea. Also, some GPs in west Enfield do not want to work with each other. So we looked at splitting it up, which takes us back to three PCGs. But one of them is very small, with only a 60,000 population.'

Christine Outram, chief executive of Enfield and Haringey HA, said that the issue 'still has to be resolved'.