Published: 04/03/2004, Volume II4, No. 5895 Page 25

Derek Wanless sensibly frames his recommendations in terms of direct interventions: a short chain of command that will get results.

It is surprising, then, that he has downplayed the significance of one of the most direct interactions between the public and the NHS - the clinician-patient relationship.

Achieving full engagement in the surgery and consulting room requires a fundamental shift in the way that healthcare professionals deliver services.

Action to achieve this needs to go far beyond Mr Wanless's recommendation that the capacity of the public health workforce be reviewed.

Stephen Thornton Chief executive Health Foundation