Published: 31/10/2002, Volume II2, No. 5829 Page 20

While agreeing with part of your analysis of the problems besetting primary care within the NHS (comment, page 17, October 17) you will not be surprised to learn that the National Association of Primary Care disagrees with your conclusions.

As you rightly point out, 'there is widespread disengagement between primary care clinicians and the process of reform' and 'the NAPC represents a deepseated cultural trend within primary care'.

NAPC was the first primary care body to embrace the concept of primary care trusts and strongly advised its members to move to trust status at an early stage. It also actively embraced the personal medical services pilot scheme - a forerunner of the proposed new GP contract.

The successful primary care incentive fund and practice-based budgets, announced by the prime minister last year, were the result of active lobbying on the part of NAPC, which now supports the return to a plurality of providers.

At its autumn conference, however, NAPC is focusing on the re-engagement of frontline clinicians and managers. NHS Confederation policy director Nigel Edwards is included on our programme because, as you rightly point out, he is a top thinker and an enthusiast. The association has very successfully attracted the international speaker and motivator, Eddie Obeng, as well as Dr Raj Persaud and many others.

Choice for both patients and primary care is positive, and, of course, very much in line with government policy. Two organisations with different philosophies and approaches provide potential membership with choice.

NAPC does not share the NHS Alliance's view that reengagement of the front line will occur by giving clinicians an increased role in PCT decisionmaking alone, but rather through the return of practicebased decision-making, leading to real change and improvement.

Ten frontline workers with earned autonomy are worth 100 on a committee.

Valuable time has been lost, as you say, and practice-based services have stagnated, through lack of responsible decisionmaking about use of resources at local level. NAPC's judgement is that frontline engagement, including practice managers, is now the most urgent priority.

Dr Rod Smith president, Dr Rhidian Morris chair, GP contract committee, Dr Kenneth Scott chair, conference committee, Eric McCullough chief executive officer, Maggie Marum consultant National Association of Primary Care