Poor use of doctor's clinical skills will be a consequence of this policy. It also belittles the skills and dedication of medical secretaries to safe patient care.

Medical secretaries have always been the most important member of a consultant's team. Mine were outstanding.

The demands on Dr Spence's clinical skills allow hours writing for the BMJ and doing all his own paperwork, in front of a computer or on his phone. Perhaps there are financial savings in a General Practice's expenses?

Surely a consultant or junior doctor (whose training opportunities have already shrunk) is best employed in clinical contact with patients.

A 747 Jumbo pilot can fly the plane or give out the meals. Both are important tasks for the passenger. Common sense suggests the best use of both the pilot's or in medicine the doctor's time is doing what they are specially trained to do.

To suggest that doctors desire power and status by having a reliable medical secretary is ridiculous.

Nigel Jones MS, FRCS

Competing interests: None declared