Sir,

This letter is helpful and I am grateful to the author for suggesting how flow optimisation is helpful.1 I would agree that one of the key prospective actions to avoid patients being lost to follow-up is to ensure all patients have an outcome at the end of the clinic. As stated, this requires input from both clinicians and the clerical team on the day of the clinic. For large clinics to have a member of the administrative team in each clinic room is unlikely to be a pragmatic solution; IT may offer more promise. The methodology described in our paper is to provide an efficient process to resolve a backlog of patients who have not been given a follow-up appointment.