Published: 01/09/2005, Volume II5, No. 5971 Page 3

Like the cast of the latest US TV blockbuster Lost, currently being screened on Channel 4, the 250,000strong primary care workforce face an uncertain future.

For many of them Commissioning a Patient-led NHS has had the same affect on their sense of security as the plane crash which deposited Lost's survivors on a mysterious desert island. The transfer of primary care trust-run services to 'alternative' providers is inducing the kind of fear inspired by the unfathomable and terrifying roars coming from the island's interior.

The Department of Health is clearly worried about the negative impact that Commissioning a Patient-led NHS is having.

Director of service delivery John Bacon has written to strategic health authority chief executives stressing that there is no rush to produce plans for the transfer of PCT-run services (news, page 5).

Mr Bacon's letter is welcome, but it does not address all the key concerns. The service transfer deadline is more than three years away, but given the range of issues that need to be tackled even this time frame will prove difficult to meet (news analysis, pages 10-11). Think of how long it has taken to get less than 10 per cent of elective care provision undertaken by non-NHS providers; in the case of PCT services we are looking at wholesale transfer.

Private sector suppliers, GPs, the voluntary sector and foundation trusts are all potential new providers. but there are significant question marks over all of them.

And even once the destination of the services is determined, what about the transfer of staff? Many have chosen to work in the NHS, value their pension, and would not want to lose the improvements in pay and conditions delivered through Agenda for Change.

However, perhaps the most pressing issue left untouched by Mr Bacon's letter is the connection between the structure and role of PCTs post-reconfiguration and provider services. Can anyone make sensible decisions about the structural reform of PCTs and the resulting changes in commissioning without first exploring the implications of such a major change in health service provision in more depth?