Managers were dissatisfied when health minister Alan Milburn refused to make guarantees about jobs or places on PCG boards at the IHSM/AMGP primary care conference.

Primary care managers were not impressed. Health minister Alan Milburn arrived late for their conference, delivered an unpalatable message and rushed off after taking only two questions.

His announcement of 9.1m extra funding for PCGs to recruit and pay staff until April and salaries of up to 50,000 for PCG chief executives was not enough to distract managers from concern about their future role.

Mr Milburn was uncompromising. He told delegates the quality of general practice was 'too variable' and 'cheek by jowl we see the good, the bad and the indifferent'.

He wanted PCGs to move on 'from discussions about governance and boundaries to the job of delivering improved care for patients'.

He also wanted PCGs to use 'the expertise built up by practice managers' and to spread 'the benefit of your work' to every patient. But he refused to give guarantees about jobs or about places on PCG boards.

Boards had to be small and 'effective'. 'You have to understand that the be-all and end-all of the PCG is not just the board. Its job is leadership and I do expect evidence of the boards working with others in partnership,' he said.

That 'applies to primary care managers as much as midwives or pharmacists'. Mr Milburn pointed out that pay rates for chief executives, chairs or members would apply to all, 'irrespective of their professional background'.

But managers were not impressed. Liverpool practice business manager Val Kay challenged Mr Milburn. 'Even our GPs think there should be a manager on the board. Every decision that the board makes will have an impact on us,' she told him.

And Bob Shearer, a practice manager from Leicester, pointed out: 'The doctors and nurses on the boards will be providing the theory but it is the managers who put that into practice.'

One delegate commented darkly that PCG management was about 'jobs for the health authority boys', and that practice managers were being left out in the cold.

AMGP chief executive Rosey Foster warned that her members 'feel excluded' from PCGs. And Mr Milburn did nothing to make them feel better.

While promising that 'the last thing I want to see is a loss of the able and expert fund managers I know exist out there', all he could offer was to 'minimise the risk of redundancies' through the local job clearing houses.

IHSM director Karen Caines said: 'With the advent of PCGs only some five months away, it is crucial to get proper management in place swiftly.'

She added that Mr Milburn's comments and his announcement of chief executive salaries of up to 50,000 were a 'recognition' of the role of 'managers as well as clinicians' in making a success of PCGs.

NHS chief executive Sir Alan Langlands, speaking the day after Mr Milburn, told delegates the NHS did not want to lose the skills and experience of GP managers.

Managers could use their 'transferable skills' within primary care, in the wider NHS, or 'in other organisations which will have to work more closely with primary care in the future'.

The changes would lead to only a 'finite' number of job losses, he added. 'It is not a huge number of people.'

Delegates were no more impressed with pledges of 9.1m to pay PCG staff. Suzanne Uprichard, a practice manager in Blaby, Leicestershire, said Mr Milburn 'was trying to confuse us with large sums of money'.

She accused Mr Milburn of 'skipping over the details' and criticised him for only taking two questions. She asked how PCGs could build on the experience of fundholding without including fund and practice managers.

'He is putting 9.1m into the top managers to run the new boards but what about the people further down, who act as support to the high-quality people?'

Loughborough GP Adrian French said there was 'a risk that we will lose' managers and GPs with experience to run PCGs. A fund of 9.1m for 480 groups might not be enough to keep people involved.

'There are some GPs who are enthusiasts and who will do it anyway, but I am not sure that 20,000 is enough to employ six or seven people on the board.'