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Whilst hospital trusts have a lot of managerial and administrative, and clinical staff, their experience is in the care of a subsection of their local population. In particular those with 'clinical ' conditions, that is people who have been filtered and sifted based on biomedical criteria. This equally applies to 'community' care organisations which have criteria for referral.

The expertise in managing the biomedical and some holistic aspects of the whole population lies elsewhere. There are specialists in the system who are trained in managing this much broader population.

Another useful group are those who are engaged in managing social aspects of biomedical health on a community footprint.

This suggests the need for a partnership approach which incorporates each of these areas of biomedical knowledge with some administrative and managerial expertise aimed at enhancing the offer from each group.

These groups need to be at a system level which is small enough to be responsive, but which doesn't trigger the centre's aversion to 'too many' providers, with its corollary of variability (usually reflecting the real variability in our local communities and their health needs).