Rapid responses are electronic letters to the editor. They enable our users to debate issues raised in articles published on thebmj.com. Although a selection of rapid responses will be included online and in print as readers' letters, their first appearance online means that they are published articles. If you need the url (web address) of an individual response, perhaps for citation purposes, simply click on the response headline and copy the url from the browser window. Letters are indexed in PubMed.
Sirs: Reasonable and sensible enough, of course, but Nigel doesn't seem to deal with Aligned Incentive Contracts. These replace activity based contracts - the system known as Payment by Results, which was a misnomer - and allow commissioners and providers to work jointly to reduce demand where appropriate. Nigel's final point about post-operative follow-up is valid in this context, though perhaps an 'opt-in' would be even better. John