GPs have dominated discussion of the NHS reforms, with less attention paid to the views of non-medical members of the primary health team. In our shadow primary care group - which covers 87,000 patients and 15 practices - anecdotal evidence suggested that staff felt uninformed about PCGs and were anxious about their implications for patient care. We therefore undertook practice visits targeted at all employed and attached staff except GPs.

These consisted of a brief introduction by the health authority's PCG development manager and a presentation by the lead GP. After questions and answers, staff were asked to explore their hopes and fears for PCGs in break-out groups. Sixty-one attended, including receptionists, practice managers, school nurses, chiropodists, secretaries, midwives, community nurses, health visitors and practice nurses.

Apart from the status of fundholding staff, concerns included patient confidentiality, the impact on small practices, patient attitudes and demands and the adequacy of practice budgets.

Receptionists reported common problems with repeat-prescribing systems, managing appointment requests, chasing hospital letters, results and appointments, queries about ambulance bookings and patients who did not attend appointments. Discussion was vigorous and good ideas were shared.

Among opportunities highlighted were health and social services working together, scope for reviewing the skill-mix of community and school nurses, clinical governance and professional development, more use of protocols for more consistent and structured care, and emphasis on health needs assessment.

Practice staff's views will be invaluable to PCGs. Though non-clinical staff have no formal role on PCG boards, PCGs should consider setting up a database of primary care managers and other staff. Such networks may be valuable in helping to implement PCGs successfully.

Dr Mayor Lakhani

Chair

South Charnwood PCG

Chris Sutcliffe

Primary care development manager

Leicestershire HA