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EDUCATION AND DEBATE: Judith Smith, Jennifer Dixon, Nicholas Mays, Hugh McLeod, Nick Goodwin, Siobhan McClelland, Richard Lewis, and Sally Wyke Practice based commissioning: applying the research evidence BMJ 2005; 331: 1397-1399 [Full text]

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Miles ahead

Steven Ford   (12 December 2005)

How not to operate

Roger H Armour   (2 January 2006)

Miles ahead 12 December 2005
Steven Ford, GP Haydon & Allen Valleys Medical Practice Send response to journal: Re: Miles ahead	Sir In the locality in which I work almost all of the practices have expressed interest in PBC (Primary Care Based Commissioning) and representatives have attended numerous meetings at which almost nothing but support for the general thrust of the policy has been expressed. Within the last week a broad agreement has been reached between the practices to suspend further progress until management/Trust/SHA/DoH/Ministers (take your pick) get their finger out and enable us to get on with it by providing the resources to undertake the project. We have specified the resources required in some detail and, with the ball now firmly in another court, we are twiddling our thumbs Yours sincerely Steven Ford Competing interests: I am waiting for PBC to be properly initiated.
How not to operate 2 January 2006
Roger H Armour, Honorary consultant surgeon Lister Hospital, Stevenage SG1 4AB Send response to journal: Re: How not to operate	The thoughtful and well researched paper on commissioning in the NHS (National Health Service) by Judith Smith and her colleagues is embellished by a photograph showing a surgeon removing a lesion on a patient's back. He is making a number of mistakes: 1. The patient is sitting up and could faint. 2. The scalpel in the surgeon's left hand is not in use, is a hazard, and should be on the theatre trolley. 3. The two streams of blood-stained fluid running down the patient's back are avoidable, will have stained her clothes and look unpleasant. 4. The surgeon's smart shirt and elegant tie may get splashed, possibly with methicillin resistant staphylococcus aureus (MRSA)- containing fluid; he should be in an operating theatre gown. I hasten to add that I had to learn the hard way from all these mistakes many years ago. Competing interests: None declared