Shifting the Balance (news focus, 2 August) provides an important frame for delivering the improvements to patient care outlined in the NHS plan.

However to be successful, this ambitious programme must ensure the full involvement of nursing staff.

It is vital that nurses both participate and have leadership roles in the new NHS structures.

Nurses are developing and running many of the most successful primary care initiatives. They are vital in delivering health promotion programmes and provide nursing expertise at a strategic level.

The NHS cannot afford to disregard this pool of talent, skill and knowledge.

We need to see cultural as well as structural changes in the NHS. Nurses participation would be real evidence of this.

Dr Beverly Malone General secretary Royal College of Nursing