I agree with Michael Johnson's letter (28 October) about the value of properly trained medical secretaries and other practice staff.

Unfortunately, the availability of a qualification from the Association of Medical Secretaries, Practice Managers, Administrators and Receptionists depends on where you live.

Many local colleges no longer provide access to these courses.

There is a long way to go on the issue of medical secretaries' pay and grading, but this goes hand in hand with training. Unless remuneration is competitive with industry and commerce we will continue to fail to attract secretaries of the right calibre for training. Poorly trained staff leave departments open to risk, inefficiency and poor practice.

Hylda Whitehead Secretary British Society of Medical Secretaries Failsworth