Published: 06/02/2003, Volume II3, No. 5841 Page 25

I agree with National Association of Primary Care chair Dr Peter Smith's ideas regarding commissioning and primary care (HSJ interview, pages 22-23, 16 January). Establishing a clear link between GPs' management decisions and the subsequent effect on secondary care is a prerequisite to the process. But putting the rhetoric into practice is the challenge. It will take more than Oscar - the online system for comparison analysis or reporting - to make this happen.

How do you inform a busy GP of the impact of his referrals, investigations, prescriptions and admissions on the local health economy? Yes, there is plenty of information available - but it needs to be accessible now, not in three months' time. Someone needs to collate and interpret this data at practice level and feed it back to GPs in bite-sized chunks.

We should be able to compare ourselves with colleagues locally and across primary care trusts.

So who will do this job? We need a new breed of practice manager. They could analyse the effects of GPs' management decisions and feed it back to the doctors. GPs need time to assimilate and act on the information. Changing patterns of behaviour among doctors is not an easy process. GPs need to take decisions in a corporate way, collaborating with local colleagues and the PCT. From the PCT perspective, information must flow much quicker to primary care. PCTs need staff that can communicate the information clearly and concisely.

Getting research into practice, using evidence-based management and guidelines needs to happen quicker. Nurses are integral to this process and must be allowed to develop their skills. The patients' voice is also key to the commissioning process.

If we can support primary care with this information and establish a clear link between our management decisions - and the impact on secondary care - we could make better use of finite resources.

Murray Freeman GP Rock Ferry Wirral