I was impressed by the article on a locality protocol for hip and knee referrals in the October Guidelines in Practice.

Dr John Orchard and his colleagues have shown how helpful a protocol for clinical prioritisation can be, not only in achieving equity in operation waiting time, but also in reducing wastage of outpatient time and resources.

Certainly we experienced inequity between fundholding and non-fundholding referrals, but this has not disappeared since the end of fundholding. Now there are still different 'deals' struck between providers and purchasers from different areas. Another factor can be the inequity between the willingness or effectiveness of GPs in championing the cause of their patients.

A system such as that described must be one that would benefit most districts. As with other guidelines, however, it would be best set up, or at least fine-tuned, at a local level. It is important that all referrers to a provider unit are working to the same ground rules.

Dr Charles Sears, GP, Salisbury

Guidelines in Practice is extremely useful in covering controversial areas of clinical practice in which uncertainty exists as to best management.

The information presented in the journal is valuable in assisting the process of preparing locally relevant guidelines for clinicians in various specialties.

Professor Ariel Lant, Clinical Director of Medicine, Chelsea & Westminster Healthcare NHS Trust

I am dismayed that your otherwise excellent journalrcontinues to exclude a significant part of its membership from the competition. Why should only GPs be eligible?

Mr DB Hocken, Consultant Surgeon, Princess Margaret Hospital, Swindon

The editor replies:

You will be pleased to hear that we have reviewed the criteria for entry to our competition.

From now on, the competition will be open to all doctors, nurses, and members of professions allied to medicine working within the NHS.

Guidelines in Practice, November 1999, Volume 2
© 1999 MGP Ltd
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