Published: 26/05/2005, Volume II5, No. 5957 Page 3

'We are as interested in promoting networks as we are in promoting choice, NHS chief executive Sir Nigel Crisp told HSJ when he launched A Patient-Centred NHS in our pages (page 7, 17 March).

Was this 'apple pie and motherhood', an attempt to balance the drive to introduce contestability with a bit of old-fashioned NHS co-operation? No, networks have a potentially crucial role in the new choice/ payment by results-driven NHS.

This week's story on emergency care networks shows that much of the emphasis of the action plan is on smoothing access, but their development also touches on key financial and sustainability issues (news, page 12).

There is often a close relationship between the viability of accident and emergency services and that of elective care in an acute trust. If competition from other providers combined with patient choice means rationalisation of elective services, emergency departments may be affected.

Ensuring that emergency services continue to be cohesive and comprehensive will be one of the roles of emergency care networks.

Then there is the rise in emergency care admissions, a key target and an increasing headache for both commissioners, who face unexpected bills, and providers, for whom a volatile workload is another complicating factor in an increasingly uncertain world.

Many believe that the rise in admissions is closely related to changes to the provision of out-of-hours GP cover, and it is encouraging to see emergency care czar Professor Sir George Alberti stress that networks need to tackle the issues around 'urgent' care, too.

In short, networks need to be robust, willing and able to make tough decisions.

They will need senior management muscle and unambiguous clinical support if they are to operate effectively in the face of competing pressures created by the fragmenting NHS (foundation trusts, practice-based commissioning, independent treatment centres et al).

Managers involved in creating networks must ask themselves, 'do our plans pass that test?'.