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GPs 'lack confidence' in diagnosing and referring patients with shoulder problems and need clearer guidelines, researchers conclude.

GPs used only a 'limited number' of Read codes for shoulder-related conditions and only rarely referred to a specialist, the study found.

Of 426 Read codes available for shoulder problems, just five accounted for 75 per cent of all those used.

Only 22 per cent of patients were referred to secondary care within three years of initial presentation, with just 27 per cent of these seeing a specialist rheumatologist.

'The criteria used by GPs to decide on which patients to refer to a specialist are unclear and guidelines could prove useful to help prevent misdirected referrals,' said study leader Louise Linsell, medical statistician at the University of Oxford.

Dr Garth Logan, president of the Primary Care Rheumatology Society, said: 'The PCRS has gone to some lengths to improve the general level of knowledge among GPs of shoulder conditions. The average GP is still a generalist so they can't be expert in everything ­ the majority of shoulder problems do fall into five or six categories.'

The University of Oxford team, whose study was published online by Rheumatology, analysed 9,215 incident cases followed up for three years.

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