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GPSI services cannot do everything

I would agree with Professor Ram Dhillon about the usefulness of GPSIs.

But sometimes GPSI clinics are overused.

The orthopaedic clinical assessment and treatment service (CATS) clinic we run in Norwich is dealing with 66% of all referrals from GPs, despite being run on a shoestring budget.

Musculoskeletal practice requires knowledge and skills from many specialities - orthopaedics, rheumatology, neurology, manual therapies, neuro-physiology, rehabilitation and complementary therapies.

Unfortunately, the success of these clinics depends on the experience and expertise of the individuals doing the paper triage prior to face-to face contact.

NHS managers, driven by a naive approach to cost savings, use physiotherapists who come from a profession 'allied to medicine', but without background medical knowledge.

It is false economy.

The result is patients who should go directly to specialists are seen unnecessarily in the CATS clinic, wasting time and money. Communication, co-ordination and collaboration with secondary care specialists are vital.

Dr Sidha Sambandan, Norwich

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