Published: 03/02/2005, Volume II4, No. 5941 Page 22

Dr Tim Riley, chief executive, Trafford North and Trafford South PCTs and chair, Association of Greater Manchester PCTs; Will Blandamer, associate director, Association of Greater Manchester PCTs

We agree with the view (feature, pages 24-27, 13 January) that an optimum size for primary care trusts may not exist for all circumstances, particularly in relation to addressing health improvement at neighbourhood and locality level.

We also agree that the focus should be to use different ways of working to address specific need.

The article only mentioned in passing a further model of collaboration between PCTs that is emerging in some parts of the country, that of an 'association', 'federation' or 'alliance' of PCTS.

The Association of Greater Manchester PCTs exists to share information and best practice, to support PCTs to work collaboratively on issues of mutual interest, and to provide a constituted forum for PCT-wide decision-making in greater Manchester.

The association has developed its statement of strategic intent, articulating our collective ambition to improve provision of primary and community-based services. This collaborative approach is beginning to deliver improved commissioning and contracting, and work on maximising collective contracting opportunities is under development.

Comparable models are in place or under development in Hampshire and the Isle of Wight, Cheshire and Merseyside, Surrey and Sussex, North and East Yorkshire and North Lincolnshire, and West Yorkshire.

We believe that this association is a real solution to the 'big enough vs locally sensitive' debate that has characterised previous discussions on PCT effectiveness and reconfiguration.