Further to Paul Smith's news story ('Medical secretaries act over pay grading', page 10, 26 April), it is regrettable that medical secretaries have to threaten strike action to highlight their poor pay and conditions. They certainly seem to be forgotten, but are right at the heart of patient care. Who ensures that referral letters are prepared? Who makes sure that appointments are made with consultants? Who is often the sympathetic person distressed patients turn to? Yes, of course, the medical secretary.

We often hear that there are difficulties in recruiting good, properly trained medical secretaries. But there do not seem to be so many problems for those trusts that value them.

A number of trusts are prepared to pay more to those medical secretaries who hold the AMSPAR diploma in medical secretarial studies. If some, why not all? Investing in properly trained and motivated staff will help with both recruitment and retention.

This association is the largest professional body for nonclinical staff, and we would urge employers to show that they value all their staff, including medical secretaries.

Michael Johnson Membership manager AMSPAR London WC1