We were surprised at some of the findings in the feature 'Thin on the ground' (pages 26-27, 26 August). The results of the survey carried out, admittedly in London, do not square with our experience of the development and support of clinical governance in primary care groups.

York University has been involved with supporting PCGs in this vital part of their role, either through specially designed support programmes or with other universities' departments as part of a wider involvement in the overall development of PCGs in their formative months, including clinical governance. This support has concentrated on practical approaches and skills needed to implement change. We are helping over 40 PCGs in the Northern and Yorkshire region to develop their approach to clinical governance and other responsibilities. In addition, we have many individual members of PCGs attending our management and leadership programmes where this topic is well covered.

We agree with the authors that PCGs do need high-quality support to make effective arrangements. This should come from universities and other educational establishments with expertise in this area.

Ian Hargreaves

Centre for Leadership Development

Nick Nicholson

Centre for Health and Social Care Management

York University