Published: 14/03/2002, Volume II2, No. 5796 Page 22 23

Tineke Bosma and Joan Higgins ('No can do', 21 February) rightly point out the main impediment to primary care trusts' success will be their inability to recruit, retain and train a primary care workforce.

One challenge for PCTs is to provide a supportive employment and professional environment for all staff.

They must take a strategic and long-term view of how best to meet the needs of smaller professional groups, such as physiotherapists. Little or no attention is being paid to supporting physiotherapy's longterm future in primary care.

Most PCTs focus only on employing their 'own' physiotherapists. This will result in fragmentation so good-quality services and professional support will become unsustainable.

Increasingly, community physiotherapists are working in small numbers, isolated from peer support. This limits opportunities to share good practice, skills or workload.

Time to develop innovative practice is restricted and limits career development.

This will hamper development of primary care-based physiotherapy specialists and consultants necessary for PCTs to achieve performance targets.

Introducing flexible hours while extending services to meet patient need and support Improving Working Lives depend on a 'critical mass' of staff. Allowing a physiotherapist to work flexible hours can be difficult if they are the only one available.

Bosma and Higgins highlight the importance to future recruitment of primary care providing good-quality undergraduate clinical placements. But too thin a spread of physiotherapists working unsupported in the community will destroy capacity for quality placements, doing little to attract newly qualified physiotherapists to PCTs.

Lack of a critical mass in a PCT is likely to exclude physiotherapists from making key decisions when the government is pushing for all staff to become involved in service delivery.

Involving the smaller professions can be difficult, but as NHS Alliance chair Dr Michael Dixon said ('Anxiety attack', 31 January), ensuring frontline staff involvement in service planning and design will be crucial to PCTs' success.

PCTs must ensure it is not just doctors and nurses who are empowered to move forward with the primary care agenda.

Penny Bromley Industrial relations research officer, primary care, Sue Skewis Professional adviser, primary care Chartered Society of Physiotherapy