Published: 03/02/2005, Volume II4, No. 5941 Page 23

James Fitton, director, Niche Healthcare Consulting I hope we have begun to move beyond the 'incessant conflict between expertise and procedure' portrayed by Raj Persaud (Working Lives, page 36, 13 January). Both individual and collective wisdom run the risk of becoming outdated or unduly conservative.

Surely what we need are procedures for making the best use of all available expertise - ie modern approaches to knowledge management that draw on the best managerial and clinical skills.

These require 24-hour access to up-to-date evidence about treatments, services and individual patients. Management procedures can then provide the context for high-quality clinical decisions.