The introduction of airline-style booked admission systems to the NHS presented a series of 'unforeseen challenges and obstacles' that required 'ingenuity and creativity to overcome', according to an independent survey.

Further challenges must be anticipated if prime minister Tony Blair's vision of faster access to the NHS is to be achieved, according to a study of the 24 pilot schemes launched in July last year by Professor Chris Ham and colleagues at Birmingham University's health services management centre.

The study says the pilots have cut waiting time to see a hospital consultant, improved patient attendance at appointments and seem to be well received all round.

One of the first-wave pilots at East Kent Hospital reported a fall in patient non-attendance from 7 per cent to less than 1 per cent. And patient cancellations fell from 15 per cent to 5 per cent.

But the report says introducing the system across the NHS will not be easy.

'To exaggerate only a little, if booking is to become the accepted way of providing care in the NHS in line with the aspirations expressed by the prime minister, then major changes will be required in how consultants and nurses, managers and others treat patients.'

Professor Ham warned that it would take 'skilful management and the provision of resources' to change working practices and, he hinted, curtail some long-held clinical freedoms.

A further 60 pilots began in September and by 2001 more than 2 million people will be able to book admissions with the system.

Modernising the NHS: booking patients for hospital care. HSMC, Birmingham University, P ark House, 40 Edgbaston Park Road, Birmingham B15 2RT, 0121-414 7050.