If there is one theme to emerge from the Institute of Healthcare Management's annual conference, it is the sense of disappointment that the new organisation has not achieved the profile or the influence that it might have done.

But, having missed out on their chance to influence the development of the NHS plan through their own professional body while other organisations seized the initiative, managers now hope to see the IHM taking a tougher line and a more public stance. Management consultant Greg Pike believes the IHM 'must raise its profile'. He feels it has been 'overshadowed by the NHS Confederation'. Working with the confederation is the right way forward, Mr Pike says - as long as the IHM does not 'become part of the confed'.

Mr Pike said he enjoyed the conference, despite disappointment that there weren't many 'big hitters' among the speakers, apart from health secretary Alan Milburn and Commission for Health Improvement director Peter Homa.

Practice manager Marjorie Condie, a former Association of Managers in General Practice member, is less happy.

She is 'reserving judgement' on the performance of the new institute. But she notes that the exhibition is 'not as representative' as in previous years.

She would like to see more emphasis from the IHM on primary care - 'not just primary care trusts and personal medical services, but what's happening on the ground', she says.

Former IHSM president and long-standing member Bob Nicholls says he has been 'a bit nervous' about 'where the institute's going'. But he is 'happier' after hearing incoming president William McKee and chief executive Stuart Marples 'talking about a new style of managing'. This is what can deliver the NHS plan, Mr Nicholls says. If the IHM focuses on getting this message across to the government, 'it can have an influence'.

David Davies of North Glamorgan trust agrees with Mr Nicholls. He says: 'I've been in the institute - in its different guises - since the 1980s. Historically, it hasn't been as vocal as it ought to have been'. But he was cheered by the speeches of Mr Marples and Mr McKee. 'If that's the advice they're passing to the government, it's the right approach. That's a very strong message, 'he says.

Peter Moody of Morecambe Bay Hospital trust wants to look at the wider political context. He says the institute is 'helping me develop a management role', but adds: 'I've come here to get a better handle on the political situation as well. '

The mood to regain influence is widespread. Lucy Samuels, a general manager at Royal Brompton and Harefield trust, is 'hoping' the IHM will 'get back on to the national agenda'.

Doing this in partnerships with other organisations is 'what they've got to do', she says.

Some members are clearly still smarting from the IHM's lack of engagement in the NHS plan process. One primary care manager, unhappy that Alan Milburn had easily parried a question about why the IHM was not a signatory to the plan, asks: 'What's wrong with the word 'sorry'? 'But he also feels that Mr Milburn was 'honest, frank'- and 'much more dynamic than Frank Dobson'. Other members have mixed feelings about Mr Milburn's speech. 'I can't fault the vision and what he's trying to achieve, it's the way it's done. . . 'says one, describing the health secretary's approach as 'rather arrogant'.