Orthopaedic outpatient referral guidelines: experience in an English health district

The suggestion that outpatient referral guidelines may improve patient care in orthopaedic surgery prompted this study in the South Tees Health District. In a postal questionnaire survey of all general practices (n = 48, response rate = 81%) 18 (46%) general practitioners (GPs) perceived guidelines to be helpful. Back pain in the young and middle aged was the most commonly mentioned subject. General practitioners wanted locally developed guidelines (78%), formulated with their participation mainly via the local medical committee (56%), to be distributed by post (89%) and at a special seminar (72%). Subsequent discussions in a multidisciplinary group led to three initiatives: a back pain clinic conducted by a physiotherapist or a trained nurse where all patients could be screened quickly, a policy of open access to physiotherapy for all GPs and special educational seminars on management of back pain. This case study provides valuable perspectives on outpatient referral guidelines in orthopaedic surgery in an English health district. The findings may apply equally to other subjects in other settings.