As Richard Vize rightly points out, world class commissioning is an ambitious programme of change for primary care trusts. While we must be realistic about how they will perform on competencies at this early stage, the first year of the assurance system will establish the baseline for performance and reflect historical investment in commissioning.

The prediction that few PCTs will perform strongly in the first assessment should not be a surprise - even now, four years after the introduction of foundation trusts, fewer than half of trusts have reached foundation status. PCTs will have to show they are capable of strong improvement over the next few years and to commission services that can deliver world class care and outcomes.

David Stout, director, Primary Care Trust Network