The challenges facing the prevention and inequalities modernisation action team are immense and urgent ('Once bitten. . .', news focus, pages 18-19, 15 June).

The notion of a health promotion 'czar' and an earmarked budget is not, of course, novel. But the realisation that questions need to be raised about the boundaries and expectations of the NHS in promoting health is interesting.

Those in the clinical domain may find difficulty working with modifiable determinants of health rather than of disease.

In a recent study I did of health promotion academic literature, the contribution of medicine to the theoretical debates was minimal.

Unless there is real opportunity for health professionals to develop health promotion competencies and explore theoretical concepts via validated courses, it will be futile to expect the NHS to have a significant influence in promoting health.

In undergraduate medical education the rhetorical call for health promotion in curricula is not easily matched by action. Third-year students in this medical school can choose a special study module in health promotion, though places are limited to four. But in Berkshire, an advanced certificate in health promotion by open learning provides places to qualified NHS staff, and is funded by the local NHS consortium.

If the NHS is to be a key player in health promotion, more opportunities will be needed for relevant training. Future health professionals will benefit from health promotion being an integral but assessed aspect of their undergraduate programme. The prevention team's infectious enthusiasm needs to be harnessed - a workforce skilled not only in healthcare but in health promotion would be a pragmatic option.

Ann Wylie Development co-ordinator Department of general practice Guy's, King's & St Thomas' School of Medicine