Professor Jeremy Dale makes a number of interesting points about computer systems for telephone triage and advice (news, page 3, IT Update, 18 March), particularly his assertion that 'all the professions - especially the Royal College of Nursing - favour the guidelines approach', while 'ambulance services have so far tended to opt for the algorithmic solution'.

This is an overgeneralisation. True, GP co-operatives using the guidelines- based TAS system developed by Professor Dale and his colleagues like using it for their out-of-hours calls and support its extension into NHS Direct.

But this may be no more than the desire for continuation of the familiar and a wish to preserve reliance on the judgement of professionals.

The ambulance services went out to tender for NHS Direct systems, and where there has been competition the result has been more mixed.

Against the trend, here in the West Midlands, the ambulance service opted for TAS for its pilot, even though the professionals in my GP

co-operative preferred the algorithm-based Access Health system, of which they had experience.

There are clear differences between the two types of system, but it may be beneficial for the NHS to integrate their features rather than having a wasteful scrap between their advocates.

For example, the Access Health system, alongside medical judgement in the BADGER co-operative, is producing interesting results which could mean spectacular reductions in emergency admissions with good patient satisfaction and without increasing risk.

Jeremy Dale is an excellent advocate for his system and it is a credit to him and the inventiveness of GPs that Plain Software's TAS system has been taken up outside the world of GP co-operatives.

My experience is that clinical pathways are no substitute for judgement, but neither is judgement a substitute for a well-developed and sound clinical pathway.

Why can't the NHS have the benefit of both?

Dr Fay Wilson

GP Birmingham