There is a more serious concern than lack of access to training for medical secretaries and little attention to the development needs in primary care.

That is lack of access to the large sums top-sliced in England for nonmedical education and training.

There is little evidence that education consortia have allocated any serious amounts to management development. Is it possible to find the key to unlock this purse before the end of the financial year?

Rosey Foster Deputy chief executive Institute of Healthcare Management London W1