Your article describing the role of the practice manager was long overdue.

All too often this role is belittled and derided and overlooked in comparison to our trust and health authority colleagues. We are still seen as the 'Doris' so eloquently described in the article.

The reality is that a great many practice managers practise NHS general management in its truest sense - they are the personnel, finance, strategy, complaints and service development departments all rolled into one.

There are no peers within the organisation to turn to. In addition, there is day-to-day contact with a group that our HA/trust colleagues very rarely have direct contact with - the patients.

But the advantages are immense; as Karen Lynas rightly states, experiencing such a broad range of responsibility is priceless, as too is the feeling that you are actually doing something, that your actions make a difference.

What is lacking is the regulation of terms and conditions, salary scales and developmental structures for practice managers. Even an annual appraisal is a nigh-on impossibility in even the very best practices.

I am one of the very few NHS management training scheme graduates who elected for a practice manager role, and my fellow ex-trainees earn much more than I do.

This is a choice that I made and do not regret, as I believe it to be one of the best jobs in the health service.

But recognition needs to come soon for every Doris (and Herbert) who undertakes this, the Cinderella of NHS management.

Zoe Spencer-Davies Practice director Five Oaks Family Practice Manchester