Media reports on problems in the NHS are mainly centred on the plight of medical and nursing staff and the way patient care is affected.

However, there is a knock-on effect on other key staff in the NHS, who also work under immense pressure. I refer to medical secretaries and personal assistants, who provide essential administrative support to clinical teams.

Without medical secretaries and PAs, a patient's hospital journey from referral to treatment and discharge may be compromised. In general practice, it is the administrative and clerical staff who manage the systems required to start patients' referral to hospital.

Medical secretaries and PAs ensure that all relevant documentation (case notes, x-rays, investigation results) is available when the patient attends an appointment.

When elective surgery is cancelled, in most instances, it is the medical secretary who, in liaison with a waiting list co-ordinator, will manage the waiting time targets.

The increasing trend of outsourcing medical transcription by NHS trusts, with inherent risk factors, is a major concern. The British Society of Medical Secretaries is aware of trusts that have abandoned outsourcing because the returned correspondence was simply not good enough. They are bringing back medical secretariats (tried and abandoned as unsatisfactory many years ago) only to find their experienced medical secretaries have either been made redundant or have left voluntarily. Typists with no appropriate secretarial training are being employed to fill the gaps.

Lack of training will lead to a lack of co-ordination of patients' treatment and many patients may fall into a 'black hole' because trusts do not understand the role played by experienced medical secretaries and PAs.

They are more than glorified typists - they play an important role in the provision of excellent medical care and are the glue that holds a clinical team together. They are essential to the safe care of the patient.

Kathy Perkins is chair of the British Society of Medical Secretaries.