Beenstock and Walsh ('Going through the change', 3 September) identify many problems that newly commissioned primary care groups will encounter during their formative period. But PCGs' biggest challenge will be to build themselves into effective teams.

They need to do this to use their skills, knowledge and experience efficiently. In many cases, members will be unaware of each other's strengths and weaknesses, and should make an inventory of them. Members must be aware of each other's professional guidelines, which may influence their reasons for membership and their objectives. The inventory is also necessary to enable role identification and allocation.

The group may use any model it is comfortable with, but many will naturally fall into the 'forming, storming and norming' process commonly seen during the transformation of new groups into teams.

The first stage is identifying the current state. This is essential to establish a baseline from which to progress to the third stage - the desired state. At the second stage it is important to identify waypoints to enable progress to be measured, discussed and adjusted as necessary. This three- stage process is often described as a 'Where are we now?', 'Where do we want to be?' and 'How do we get there?' process. The essence is identifying the current state, which must generate the desire to change, to achieve a perceived better state, otherwise the process will be resented and opposed. If team-building is effective, members will feel valued and hopefully experience greater control of patient processes and outcomes. It may feel at first, especially during 'storming', that the new process is inferior to the status quo, but multi-agency co-operation should ensure a smoother patient process than before, with shared responsibility for outcomes.

Patients should experience rapid, single assessment of their needs and more efficient use of assessment and treatment resources. 'Grey area' patient groups - such as long-term community care, disabled and mental health clients - should also experience better access to a wider range of services, with a louder voice to express their needs. Success in 'grey areas' will generate the need for improved cross-cultural team-working in other areas.

Team-building is vital for change, and must precede it, otherwise members may lose the opportunity to influence the desired outcome. This may cause resentment and mean that initial ventures may not be revisited for a long time.

David Stelmach

Pontefract