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Welcome once again to a new bulletin.

Since the last edition we have had a general election and welcomed a new secretary of state and ministerial team. It has been an open secret that Patricia Hewitt would be considering some organisational changes and, like you, we have needed to work with the uncertainty. It was, therefore, with considerable interest that I read Sir Nigel Crisp's announcement at the end of July (see our lead story). Personally I think the move to strengthen commissioning is a sound one and long overdue, but I am still unclear about the precise role of PCTs in a world populated by practice-based commissioners. No doubt more details will emerge in due course.

I appreciate that for many of you on PCT boards the level of uncertainty has ratcheted up even higher. It will not be until November that we will know the eventual configurations, by which time I hope the scope of their new role will be clearer. I know that many of you will be hoping to continue with your NHS service post-reconfiguration and we have already had queries about possible recruitment processes for combined boards.

The commission hopes to publish firm guidance in the autumn but, from early conversations with the Department of Health, it seems likely that we will steer toward an open public competition for new boards on the grounds that they will have different functions and operate on a larger scale to the precursor bodies. Obviously chairs and non-executives with previous PCT expertise would be expected to be able to put up a good show at interview, however, this approach is not yet confirmed. What I can be sure of is that we will need absolute clarity about the role of the new PCTs so that we can be sure that the expertise and competencies of the people we recruit match the need. I want to avoid the situation we had when PCTs were first set up, when the functions changed dramatically with the introduction of commissioning in their first year of operation. Many of you have told me that the 'representative' task you were recruited for changed overnight, which isn't fair to you or sensible for your organisation.

We, like many of you, have to work out how we conduct our business in the meantime. The commission has opted for business as usual in our recruitment plans at least until October/November. However, since June I have warned all new appointees and those reappointed, in their appointment letters, that their term of office may be curtailed in the event of organisational change.

Before moving on from the change agenda I would like to add a personal thought. I have served the NHS in a non-executive capacity for nearly 40 years and in that time seen innumerable organisational changes. At the time there is always the tendency to think that changes are made because the organisations have failed. I don't think that is helpful. Looking back it is clear to me that the pathway from the monolithic, Whitehall-run, state institution of the seventies through to tomorrow's patient-led service with its plurality of providers and local commissioning needed the evolutionary steps in between.

Roy Griffiths did not know the end-game when he introduced general management to the NHS in the eighties; in the nineties we did not know where the purchaser/provider split would lead, but through the journey every organisation, every individual and every chair and non-executive has played a part in the successes of their day, helped patients and helped build the future. For that I thank you all past and present.