I support Brenda Sawyer's comments (letters, page 21, 10 August) on the need to include all appropriate organisations in the debate about developing practice management.

The feature 'All change' (pages 24-27, 27 July) would have benefited from the Institute of Healthcare Management's view.

However, she describes the Association of Medical Secretaries, Practice Managers, Administrators and Receptionists as 'supporting receptionists and secretaries', which of course it does. But it has also been a management association for many years, and is the only organisation to provide a qualification unique to practice managers - one which IHM deputy chief executive Rosey Foster has often promoted. AMSPAR's advantage is that it is made up of receptionists and secretaries as well as managers. It helps develop individuals and encourages their promotion within general practice.

Having members from both primary and secondary care, it promotes the idea that skills learnt in one sector can be transferred throughout the health service.

It is important receptionists and secretarial staff can feel valued and supported.

Pauline Young Vice-chair AMSPAR Hove East Sussex