Published:25/04/2002, Volume II2, No. 5802, Page 19

The Community and District Nursing Association has long campaigned for the provision of comprehensive 24-hour community nursing services ('Return to Sender', cover feature, 28 March). This report highlights the wider challenge for the newly formed primary care trusts.

PCTs need to use their new focus and responsibilities to co-ordinate out-of-hours services provided by GPs with community nursing, pharmacy and even ambulance services. Provision of proper support throughout 24 hours will relieve pressure on hospital beds and begin to turn around that seemingly insoluble problem of long waiting times and cancelled admissions.

Ifpeople are not admitted to hospital unnecessarily, then they will not develop all the side-effects of hospitalisation (infection, incontinence, confusion) which lead to blocked beds.

PCTs should assess the needs of their population not in terms of hospital bed days required but instead ensure that appropriate, effective healthcare is provided in the most appropriate place.

Heather Ballard National professional officer Community and District Nursing Association