The requirement to have secondary care nurse and consultant on the CCG board is a sensible, if late addition to the CCG Rules, so how are we going to ensure the secondary care board members add maximum value to the board decisions? For years secondary care journals largely ignored PBC and secondary care has only reluctantly "committed" to Clinical Commissioning once it was inevitable. Thus, while GP board members are likely to be confirmed believers, it is doubtful that the same can be said of secondary care candidates. There is a real risk of tokenism if Boards appoint secondary care members mainly to satisfy authorisation and then fail to fully engage them. Secondary care consultants and nurses undoubtedly have useful insights into the workings of hospital trusts and could play an invaluable role in collaborating with clinical senates. It is too soon for appraisal and PDPs but does anyone have a handle on what the secondary care members need? Prof Mike Chester Kingston CCG board member