'There is now an enthusiasm in the NHS for joint work with other agencies where at times in the past there was little more than trepidation and distrust'

As befits a policy which originated not in the political think- tanks, still less in the minds of ministers, but from within the NHS itself, the health action zone concept is proving popular among health authorities, trusts and social services departments (see News, page 3). There is now an enthusiasm in the NHS for joint work with other agencies where at times in the past there was little more than trepidation and distrust.

This enthusiasm is already manifesting itself in a number of other ways as managers get to grips with the post-white paper world: in Andover, what may be the first primary care trust is taking shape (See News Focus, page 11); in Aberdeen, a technical change in the rules governing the use of money from capital sales is enabling the health board and local trusts to build a new children's hospital (See News, page 8); in Norwich, the removal of the log-jam on private finance projects means construction of a new pounds214m hospital can begin in partnership with the private sector (See News, page 8). Why, even the National Association of Fundholding Practices is wondering whether it might be a good idea to co-operate more closely with other groups.

There can be few parts of the country where a pilot scheme of some kind is not in preparation or in progress, and for all the sense of panic in the GP press over practice management budgets and the 'threat' posed by new HA controls over primary care, there is a real sense of excitement among those involved in generating new ideas and new ways of working.

The worry must be, however, that enthusiasm will collapse into disappointment. Not everyone will be selected to pilot their project, and not every pilot will succeed. An essential task for ministers and the NHS Executive is to ensure that the managers, clinicians and others involved in unsuccessful initiatives are not left disillusioned. Experimentation and innovation are attributes to be encouraged and rewarded in their own right.