I read with interest Jeremy Dale's article on telephone services, ('Wired for sound', pages 24-27, 29 January). His analysis quite correctly draws attention to the yet to be defined parameters for NHS Direct, and the yet to be answered questions on the likely outcome of its introduction. This is why the three pilot sites have been established, and as our trust is one of them we will be seeking to provide early evidence on such issues as future scope and demand.

Already our experience in Northumbria, before NHS Direct goes live, has shown a breaking down of professional barriers, improved collaboration and partnership towards a common goal, and an overriding desire to make the pilot a success.

The flaw in Jeremy Dale's hypothesis is his conclusion that GP co-ops or community trusts might be better placed to provide this service. He may be right, but the conclusion ignores history and the reason why the chief medical officer's study was established. Accident and emergency departments and ambulance services experienced unprecedented rises in annual demand in the 1990s. This coincided with a growing recruitment problem for GPs, particularly in remote rural areas and inner cities, based on the unsocial hours and the perceived abuse of the service by patients. This has lowered patient confidence that the GP will respond to their call, corresponding with a rising confidence that the ambulance service will always respond - and quickly.

Visit any ambulance service control centre, even today, and you will hear evidence of GPs' answering services, including co-operatives, advising telephone callers to dial '999' for an ambulance. The continual rise in 999 demand remains, therefore, even after out-of-hours GP co-operatives have been established.

The evidence thus far suggests that GPs quite understandably do not wish to be involved in what they regard as non-urgent calls and are content to rely on a nurse-type triage system.

Ambulance services are uniquely placed in the NHS to handle such a system given their continuous relationships with the public, acute and community- based trusts, and their established partnerships with GP co-operatives. A major benefit in using an ambulance service is if the caller to the 1-888 centre turns out to have an emergency need. Time is saved by re- routing the caller to another part of the same control room. This facility provides a fail-safe back-up for the NHS in an increasingly litigious society.

Let us wait and analyse the experience of the three sites. It is the patients' needs which matter, not the continuing competition for professional primacy.

Laurie Caple,

Chief executive,

Northumbria Ambulance Service trust.