Published: 05/12/2002, Volume112 No. 5834 Page 23The two polarised responses which you printed (letters, 21 November) to my letter of 24 October reveal just how diverse the position regarding practice managers and their development really is.

Alistair Mackintosh is, of course, correct in suggesting that the problems in practice management are also due, in significant part, to the mindset of GPs who seem to have been slow to recognise the potential that practice managers offer to the improved running of their clinical business. He is also spot-on in identifying the short-sighted unwillingness of GPs to fund both practice manager development and any concomitant higher salary from the practice budget.

I know of cases where highly motivated practice managers have funded their own postgraduate programmes only to leave for greener pastures when unable to command similar salary levels achieved by their fellow students.

Tracey Osbourne is wrong to paint such a universally glowing picture of practice manager development and to claim that my portrayal was '10 years out of date'. While such development programmes clearly exist in some parts of the country, in others there is a dearth of such opportunity. I am also dubious about how many community nurse managers have succumbed to the attractions of the Association of Medical Secretaries, Practice Managers, Administrators and Receptionists diploma.

Where development programmes do exist, it is most unusual to have them linked together into a 'seamless' progression to master level - not least due to the unwillingness of higher education institutions to recognise the credit rating of programmes delivered by their competitors. Only the NHS can knock heads together here.

Finally, while it is clear that some practice managers do work very closely with primary care trusts, in other places they seem to be estranged from them, with a negative 'themand-us' stereotyping developing.

The urgency to tackle issues remains - my concern is that it may fall between PCTs, strategic health authorities, workforce development confederations etc and that unacceptable status quo is allowed to continue.

John Edmonstone Director MTDS