Jaki Meekings' doubts about the level of management skill available in primary care (Letters, 8 October) are seriously misplaced. Are health authorities consistently successful in managing - or more correctly - in controlling NHS budgets?

Primary care operates predominantly in a small business environment. Like voluntary sector colleagues, those who cannot manage, do not survive.

In financial matters, the greater challenge lies in managing relatively small budgets well. I have it on the very best authority that those who are trustworthy with little prove themselves worthy to be trusted with much.

There is ample qualification, expertise and skill - in total purchasing pilots, multifunds, fundholder support agencies, good community trusts and the voluntary sector... even the rare, ex-family health services authority senior manager who survived the cull - to perform well at PCG board level.

The government's white paper is an unprecedented opportunity to integrate management skills from those in direct patient contact with the strategic overview of the NHS administration.

The 'iceberg of ignorance' would suggest that there is not just 'a place' for those in first-line patient care; rather, theirs is the key management role, in partnership with other health and associated professionals.

Brian Craven

Locality manager