Sir - It may not be widely known that the Nuffield Orthopaedic Centre routinely provides services to a much wider area than Oxford city and Oxfordshire.

There are out-reach clinics in Berkshire, Buckinghamshire and Northamptonshire.

I am extremely concerned that the changes proposed by the South Central Strategic Health Authority will have a devastating effect both on these routine services, but even more important than that, also on the highly specialised services, such as the treatment of bone infection and bone cancer, that can only be provided by a tiny number of specialised orthopaedic hospitals. Some of these specialist services can in fact only be provided in the UK by the Nuffield Orthopaedic Centre. It appears that it is these services, which are expensive and complicated, that jeopardise the financial security of the NOC. Unless the process for paying for them is addressed there is no realistic chance that any organisation would be able to provide a financially viable plan. If they are properly funded, then the NOC would be viable.

The expertise concentrated at the NOC must not be allowed to wither away. This is an internationally recognised centre of excellence and we need to do everything possible to keep its unique identity.

As a retired GP who regularly referred patients from the Newbury area, and as a long-standing patient myself, I have a great deal of experience of the very high quality of care that is provided by the NOC.

Dr E Heitzman, Newbury