The Primary Care Trust must ensure patients are treated within the maximum waiting times set by the Government and increasingly we must offer patients a choice of hospitals including in the independent sector.

Setting maximum waiting times may seem a blunt instrument but they have produced a startling improvement in access to care. It is not so long ago that the wait for an orthopaedic operation would have been measured in years, the maximum wait will now be six months by the end of this year.

Hereford Hospitals NHS Trust has been very explicit, it wants to be the hospital of first choice for the people of Herefordshire.

Ultimately, local people will make their own choice about their hospital care and to an extent it will depend whether the hospital can treat patients within the required waiting time and to the right quality.

From time to time every hospital encounters difficulties in matching capacity to demand. In the past these problems might be masked by allowing waiting lists and waiting times to grow but this is no longer acceptable. The decision to limit orthopaedic referrals to the County Hospital is a temporary one and Hereford Hospitals Trust is planning to expand its orthopaedic capacity as soon as possible.

Dr Henry Connor makes an interesting contribution to the debate about the future of small General Hospitals but it is dangerous to make a giant leap from a temporary problem in orthopaedics to casting doubts about the future of the County Hospital.

Hereford Hospitals Trust sees over 30,000 new outpatients a year and less than 1,000 orthopaedic patients will be redirected elsewhere this year. We need to keep the problem in context.

Dr Connor claims Hereford Hospitals Trust is underfunded in comparison with primary care and community services. Over 90% of all patient contacts are with GPs and community health staff and without strong primary care general hospitals would be overwhelmed.

In making comparisons about hospital funding it is important to remember that in Herefordshire we also have five community hospitals and when these are taken into account comparisons with other districts' spending on hospital care become much more similar. The introduction of "payment by results" into the NHS will in any event soon render arguments about fair funding irrelevant.

Finally, I want to reassure your readers the temporary redirection of orthopaedic referrals is most certainly not a ploy to appear to be meeting waiting times. The whole point in taking this difficult decision was to ensure that real waiting times do not exceed the targets we have been set.

PAUL BATES,

Chief Executive, Herefordshire Primary Care Trust.