Objectives: To determine the levels of intra- and inter-grade variability of the vetting of general practice (GP) letters as well as the intra-rater reliability of letterprioritization.

Design: Prospective assessment of letter vetting and questionnaire survey.

Setting: Three otolaryngology secondary referral centres in Bristol and Bath, UK.

Participants: Twelve consultants, nine registrars, four staff and associate specialists (SAS) and 16 senior house officers (SHOs) in otolaryngology.

Methods: Fifty GP letters (not including ’fast-track’ referrals) addressed to one of the ENT departments were chosen sequentially. These were anonymized, photocopied and included in the questionnaire to all participating staff. Participants were asked to vet the letters as ’urgent’, ’soon’ or ’routine’ according to supplied waiting time criteria. The same letters were sent out again six weeks later.

Results: There was no significant difference between grades for the mean number of letters vetted into each category. Intra-grade variability was high; the number of letters vetted urgentvaried from one out of 50 to 15 out of 50 for the consultants.The intra-rater reliability was high.

Conclusion: The grade of trainee seems to make little difference with regard to ability to prioritize referrals, but within grades there is little agreement on what constitutes an urgent referral. We suggest further research, looking at the final outcome of patients, needs to be done to try to establish evidence-based guidelines to assist with letter vetting.