Published: 16/05/2002, Volume II2, No. 5805 Page 22 23

Heather Ballard says proper GP and community nurse support will relieve pressure on hospital beds and begin to turn around long waiting lists (letters, 25 April).

Improving the management of continence is one area where primary care trust plans could make a difference.

In Leicestershire, PCTs have been assessing local need and developing a strategic framework for implementing the NHS target for integrated continence services.

We have concluded that around 400 admissions for constipation and 400 admissions a year for urinary catheterisation may be avoided with adequate district nursing capacity, skilled staff in nursing homes, common clinical guidelines and rapid-access outpatient facilities for patients with an enlarged prostate.

We will, of course, need to test our conclusions in practice, but ifcorrect this would have significant impact on helping achieve NHS targets for reducing avoidable hospital admission and readmissions of older people, as well as freeing hospital capacity to reduce waiting lists.

Consistency and access to appropriate continence assessment and management in primary care should result in other improvements.

Clinicians locally agree this should reduce referrals to secondary care for primary care assessments and management and help reduce outpatient waiting times.

In Leicestershire we have many examples of best practice for continence management. But interim findings from the Leicester University Medical Research Council continence study indicate that over 4,000 more people with incontinence could improve, given a consistent approach in primary care.

NHS Confederation chief executive Dr Gill Morgan (analysis, Budget special report, 25 April) suggests we need to build core capacity and not just invest in new initiatives.

Addressing capacity in community nursing to help deliver integrated continence services is one area where PCTs can make a difference for patients and aid the delivery of other NHS targets.

Wallace Pointon Strategic development manager for rehabilitation Melton, Rutland and Harborough primary care trust