Following retirement from playing, he switched to coaching and rejoined Oxford United where after a caretaker spell in charge he had two separate stints as first team manager.

Patterson began his playing career with West Bromwich Albion around the time of their relegation from the First Division in 1986, but failed to make a first-team appearance and was signed by Bryan Hamilton for Wigan Athletic early in the 1989–90 season.

Patterson proved a success in defence for Wigan, making 57 Third Division appearances and scored five goals before being transferred to Crystal Palace at the end of the 1991–92 season.

Patterson enjoyed a longer spell at Palace and played for the club in the FA Premier League before joining Luton Town in a £230,000 deal in August 1995.

He made 66 appearances for Luton (and also had a loan spell at Preston North End) before leaving on a Bosman ruling free transfer in the Summer of 1998 to join Dundee United.

However, no sooner had Patterson been appointed than he lost the job to Jim Smith following the sale of the club by Firoz Kassam to Nick Merry.

[17] Steve Evans was announced as the new manager of Rotherham on 9 April, hours before Ryan Cresswell scored a last minute winner against Cheltenham Town to ensure Patterson had led the club to four wins in five games during his brief time in charge.