The vast majority of GPs are unimpressed with their PCO. There were numerous complaints about poor communication, a failure to listen and managers that do not understand general practice.

There are excellent managers out there, and in some areas they were singled out for praise, but a lot of GPs feel that the quality of staff within PCOs is highly variable, with frequent structural and personnel changes compounding the problems.

Many GPs accept that PCO staff are battling in an inflexible system that is beset by targets, but a significant number complain that local managers have an 'anti-GP' attitude, seeing general practice as a 'problem that needs to be managed'.

PCOs scored badly in all categories, but were rated especially poor on leadership, commissioning and financial management, all areas under the control of senior managers. The message from GPs is clear - management needs to improve.

GPs are, quite rightly, held to account for the clinical decisions they make every day. But there are no standards by which to judge the quality of NHS managers, who make decisions that have a direct impact on the care of hundreds of thousands of patients.

This issue was brought tragically to light when the failings at Mid Staffordshire Hospital Trust were exposed. Following publication of the independent inquiry into the trust last week, health secretary Andy Burnham committed to developing a new system for senior NHS managers to ensure high professional standards.

This is not before time. NHS managers should be regulated in the same way as other health professions. Not only would this help prevent terrible situations such as that in Mid Staffordshire, it would also ensure that managers were capable to do their job.

With proper regulation for managers, maybe GPs would rate their PCO more highly.