In response to Simon Stevens' article on practice-based commissioning (opinion, page 17, 3 May), PBC has to be for all practices. If nothing else, PBC is about raising the eyes of GPs and practice management to understand the wider commissioning impact of their actions.

In response to Simon Stevens' article on practice-based commissioning (opinion, page 17, 3 May),.PBC has to be for all practices. If nothing else, PBC is about raising the eyes of GPs and practice management to understand the wider commissioning impact of their actions.

PBC is tasked with driving efficiency by engaging frontline GPs in reducing unnecessary admissions;.offering alternatives in primary care. The real PBC 'paradox' is that in small or large, rich or poor areas, the variability in use of resources is across the board..It's not really fair to say the bigger practices with well qualified GPs in an affluent area are good at PBC.

Demanding patients and lack of time and training for practice staff can lead to over-prescribing, over-referrals and less money for those in the worst areas and with the poorest health. How do you switch intelligent professionals on to taking a different approach to managing patients? It is not by taking the path of least resistance.

It's time PBC came of age in terms of its capacity to act as a key partner in delivery of health reform rather than a side show..This is not a short-term project to harness quick savings from better referral management, it must be a long-term partnership for continuing training and best practice development.

PBC needs to look ahead ten years at the sort of services and options for patients that will be available. Innovators and entrepreneurs are required to create a dynamic out-of-hospital market, GPs may be buddying up with consultants, but it's the semi-scheduled and long-term conditions management where the real future of PBC lies.

The point raised by Mr Stevens.about GPs offering poor value diagnostic and treatment services feels as much about accreditation and pricing policies as GPs 'milking' the system.

We are trying to harness PBC in a membership company offering benefits to those who join in terms of risk management, education opportunities, the the chance to work with innovative service solutions. All the GPs in Stockport are joining and this will provide a new sort of player, one founded on voluntary membership, common purpose and commissioning clout to work alongside the PCT. This will ensure standardisation and higher quality resource management in exchange for retained individuality and opportunity.

Call me an optimist, but we seem to have found a formula that just might work.

Alison Tonge is deputy chief executive of Stockport primary care trust and director of Stockport Managed Care

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