Published: 12/12/2001, Volume II2, No. 5835 Page 22 23

I would like to respond, on behalf of Dumfries and Galloway association of practice managers, to John Edmonstone's letter (24 October) on the restrictive mindset of practice managers.

While agreeing that the role of practice manager is ill-defined, low status and highly variable - and that Phoenix agenda-type projects are too task oriented and unlikely to develop managerial roles, we do not agree with his solution.

Using managerial role models to analyse our jobs, we see strong parallels between directorate or business managers in the hospital sectors and ourselves.

However, especially for those of us working for GPs with independent contractor status, our strong entrepreneurial and communication roles align us more with, for example, a manager of a medium-size building firm or a hotelier. After all, unlike our colleagues in the hospital sector, our paymasters' earnings are essentially the difference between the total practice income and its expenditure, and this outcome will do much to determine our success or failure. This factor may also serve to explain why we tend to be middle-class, middleaged white females - we are cheaper than our male counterparts!

If the best method of developing our 'third-in-line' colleagues is to participate in mainstream management education such as MBAs and diplomas, why can't careerminded practice managers have the same opportunities? The restrictive mindset of practice managers must, in part, be due to their isolation which, until recently, was exacerbated by trust policies excluding them from advice or training. Unable to participate in external development opportunities like our third-in-line colleagues who, by definition, are advantaged by both horizontal and vertical support networks, the lone practice manager has relied on pragmatic, practice-based solutions provided by the likes of Croner Handbook of Practice Management. Surely to develop transferable management skills and an understanding of generic management issues, an opportunity to learn in an environment which does not consist solely of practice managers is needed.

There is an urgent need for enhancement of leadership and management capacity at practice level and a need to break down the us-and-them culture, but this is unlikely to be achieved through us-andthem training programmes.

Jane Connechen Practice manager Dr E Fellowes and partners Dumfries