It's a progression, it's a promotion, it's a priority ('Dobson pushes for rehabilitation', News, page 7, 29 October). But if the goal of new rehabilitation services is to prevent 'permanent disablement' by an early response to 'illness or injury', services will need to intervene early in the history of a disabling condition. In most cases the early stages are picked up in primary care.

The logical policy is to concentrate rehabilitation skills in primary care. Traditional hospital-focused services will miss the best chances of avoiding disablement.

Not only would better access to rehabilitation within primary care services allow professionals to anticipate patients' (and carers') needs more effectively, but one of the best-kept secrets in rehab might escape out into the wide- open NHS. People might see that it is easier to apply remedial activity to everyday life if it is actually introduced in the home, the school or even the workplace...

Woody Caan

Cambridge (NHS) Research and Development Consortium