While I agree with Simone Plaut's view (Letters, 4 June) that managerial, secretarial, financial and maintenance professionals in healthcare would not generally have a direct patient interaction role, I would point out that in the case of medical secretaries, it is highly likely that they will interact with patients frequently, using their communications skills to help ensure the effective delivery of care.

This is one of the reasons why so many highly skilled medical secretaries stay within the NHS family rather than transfer to a more lucrative commercial environment, despite an erratic career structure, low pay and less than ideal working conditions.

Jayne Pearce

Chief executive

Association of Medical Secretaries, Practice Managers, Administrators and Receptionists

London WC1