The move by public health directors to play a lead role in advising on new treatments puts primary care trusts squarely on territory that was previously dominated by NICE.

In a two-year pilot, the National Public Health Commissioning Network plans to offer quick assessments of new licensed drugs and treatments.

The idea is an innovative response to criticism levelled at the National Institute for Health and Clinical Excellence by the health select committee. MPs called for a quicker, less in-depth evaluation of new treatments to plug the gap until NICE is able to deliver its verdict.

Anchoring this venture in public health should encourage fresh thinking by placing treatment assessments in the context of the wider benefits to the community. The network is also in tune with the drive towards world class commissioning - developing analytical expertise, sharing information and giving primary care trusts a more central role in policy and delivery.

The riskiest aspect of the project is the onerous responsibilities it places on PCTs. By taking the national lead for a particular treatment, any weaknesses in a PCT's analysis will now be propagated across the country. On the other hand, PCTs will be able to drastically reduce the number of new treatments they have to assess - but only if they are prepared to hand over responsibility for providing the evidence to other trusts.

As far as the public is concerned, there will now be an added layer of complexity in the often ill-informed debate over access to new drugs. If the lead PCT comes to a different conclusion from NICE on a high-profile case, it will be portrayed as a reversal of national policy. So public engagement with PCTs will increase, but on difficult terrain.

However, the network is a pilot, so there is the time and willingness to meet these challenges. If it succeeds, it could be an important adjunct to the more rigorous procedures of NICE.

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