this week - Medical secretaries often feel undervalued and this makes them difficult to recruit. Kath Craig and Terry McLaughlin explain what happened when a trust decided to bolster their role and create a new, higher grade of business co-ordinator

Medical secretaries have a central role in ensuring the NHS delivers a personalised service and adopts improved ways of working. Yet they often feel overlooked and undervalued, in need of better pay and greater recognition.

We addressed this problem in the surgical directorate of this trust in 1992 when it was extremely difficult to recruit medical secretaries. We were often forced to use agency staff. The sense of frustration reached a peak when all the medical secretaries in the directorate applied for re-grading, claiming that they could earn more outside the NHS.

'No-one listens to us' and 'our technical skills are not recognised or appreciated'were frequent complaints.

This provoked a review of their role and a revised grading structure and benefits package which has produced significant gains. None of the nine secretaries has left since 1993 and they have expanded their role. They monitor contracts, maintain the short-notice waiting list and undertake pairing arrangements for annual leave.

The review was carried out by a working group comprising the general manager of the surgical directorate, the directorate manager, administration services co-ordinator (a former medical secretary) and two medical secretaries.

The medical secretaries prepared job descriptions identifying the range of duties covered by the various medical secretary posts. This enabled an analysis showing the percentage of the working week spent on the various activities.

The working party then reviewed the tasks with a view to prioritising them according to organisational need and the best use of skills.

This led to a recommendation for three levels of post for medical secretaries. Level 1 - clerical officer/ audio typist/ trainee secretary - and level 2 were refinements of two grades already operating within the trust. But level 3 - business co-ordinator - was a new level, encompassing extra work.

The working group decided to move away from a traditional proficiency payments system in favour of paying staff according to roles. The working party also recommended non-financial rewards such as fitness screening and opportunities for flexible working.

An external specialist was sought to evaluate the new post of business co-ordinator.

The current rates for the three grades are:

Grade 1 Up to£11,037 per year Grade 2£12,147 Grade 3£14,119-£16,667 All nine secretaries in the directorate are now on the top grade.

The working party also devised a system of standards and monitoring.

Standards for medical secretaries Consultants' letters to leave hospital, free of errors, within 48 hours of clinic.

GPs to receive discharge summary letter within 7 days of dictation by clinician and preferably within 10 days of discharge from hospital.

Callers requiring information via voice mail will be acknowledged within one hour or receipt of message. Inquires to be concluded within one working day.

Voice-mail message to indicate name of directorate, user's name, message retrieval details, office hours, alternative extensions and assurance of return call within an hour.

GPs' referral letters to be coded and forwarded to new appointments department within 48 hours.

Where there is suspicion of cancer, GP referrals to be faxed to appropriate departments the same working day.

Secretaries to constantly monitor details of patients on waiting list and their availability.

All departments to receive copies of the admission list 48 hours before first admission.

Business co-ordinator will ensure directorate follows guidelines on guaranteed access times for purchasers.

The review showed wide variation in the levels of responsibility and duties carried out by consultants' secretaries within the trust. It also found that the skill-mix within the secretarial function needed urgent attention.

Benefits for the directorate The medical secretaries now feel more valued and have greater authority to undertake a range of actions, such as profiling theatre lists and anticipating potential down time.

They believe their technical skills are valued and get involved in the business element of service provision.

Their increased skills have allowed some medical secretaries to undertake secondments for personal development. But all have returned to the directorate and expressed a wish to remain in their substantive posts.

Job enlargement has created more opportunities for medical secretaries, and more scope to plan and control their work. This, in turn, has led to a greater sense of involvement in the work of the directorate.

And carrying out the review reinforced their value to the trust.

The review was implemented with the full participation of consultants who were also involved in agreeing standards.

There is clearly a history of dissatisfaction among medical secretarial staffing in some areas relating to their status, pay and conditions of service. This has left many from this staff group feeling undervalued and under-resourced. The NHS plan, among other drivers, will require a fundamental review of pay and working methods for this staff group, to achieve plan targets relating to personalised services. Our work shows that a review of the medical secretary's role can bring significant benefits to the trust as well as to staff. Our experience suggests that medical secretaries can develop an enhanced view of their contribution to the organisation and to patients, and are eager to increase their contribution. A review of this kind promotes organisational aims as well as improving staff retention. It has the potential to create a better industrial relations climate, promote organisational growth and increase productivity.

Higher pay gives the medical secretaries a greater share in the success of the organisation.

Key points A review of the role of medical secretaries in a surgical directorate has reduced turnover among this group to zero.

Previously the directorate had difficulty with recruitment and often had to rely on agency staff.

The review led to the introduction of the new post of business co-ordinator, and all medical secretaries in the directorate have now achieved this level.

The review led to an expanded role for medical secretaries which has increased their job satisfaction.

Kath Craig is general manager, directorate of general surgery, Royal Hallamshire Hospital, Sheffield. Terry McLaughlin is directorate manager, Sheffield Teaching Hospitals trust.