Clare Chapman and Professor Ian Gilmore are quite right to encourage the recruitment of senior managers from medical ranks as a means of accelerating the breakdown of 'perceived' barriers between managers and medics.

Clare Chapman and Professor Ian Gilmore are quite right to encourage the recruitment of senior managers from medical ranks as a means of accelerating the breakdown of "perceived" barriers between managers and medics.

But if we want to destroy those barriers altogether, we must be far more radical. The reason many medics want to become managers is because they perceive they are part of a system where you cannot get much done unless you become a manager.

In spite of the rhetoric, the rigid line of command from the Department of Health to strategic health authority chief executive to primary care trust chief executive is alive and well and constrains managers just as it excludes clinicians. This has resulted in an apartheid separating managers, who are generally positive about change, and clinicians, who are generally negative towards it.

The solution is pretty obvious: to enable clinicians to influence and feel part of change while being able to continue as clinicians - after all, that is what they were trained to do. Co-leadership by managers and clinicians would lead to clinically intelligent managers and managerially intelligent clinicians and stop clinicians wanting or needing to become managers.

Resolving the "them and us" of medics and managers will not be solved by "them" becoming "us". It requires a more concerted attempt to enable the two cultures to meet together and respect each other more.

Dr Michael Dixon, chair, NHS Alliance