Medical secretaries have a key role in helping patients navigate the NHS.

We agree that much communication can be done directly by doctors, but Spence underestimates the role that medical secretaries play.Consultants’ secretaries are not merely typists and diary managers. They can play a key role in helping patients navigate the complex bureaucracy of the NHS. Recent interviews that we conducted on patient experience of cancer care underline this important role. Patients may need surgery, chemotherapy, and radiotherapy that involve multiple appointments, procedures, and staff—a “cast of thousands”—as one patient commented. Patients often felt insecure and feared getting lost along the pathway. Unsure of whom to contact, some cited the positive role of the secretary who could find an answer and call them back. Others were paralysed when they could not find this secretary after restructuring. Some blamed lost letters and poor communication on outsourcing, which may see letters flying halfway round the world before landing back on the desk of a nearby colleague. Patients should have a cancer nurse specialist to help with navigation; nationally 87% of patients reported having the name of one, and 75% of these patients said that the nurse was easy to contact. But some reported frustration when calls to the specialist nurse went to a messaging service, and they missed the privileged access that secretaries have to individual consultants. In the drive for improved “productivity,” the NHS has become ever more impersonal. Systems and pathways seem to be in charge, with patients and staff feeling less valued. Just occasionally, it is reassuring to have a real person you can call, who will try to resolve a problem rather than pass it to someone else.