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This article has been withdrawn as it was published elsewhere and accidentally duplicated. The original article can be seen here: 10.1108/14664109910306749. When citing the article, please cite: Paul Hattam, Alison Smeatham, (1999), “Evaluation of an orthopaedic screening service in primary care”, British Journal of Clinical Governance, Vol. 4 Iss: 2, pp. 45 - 49.

This paper aims to show the results from a pioneering primary care‐based extended scope physiotherapist (ESP) led service, which placed patients directly onto the surgical waiting list of secondary care orthopaedic consultants over a two‐year period.

A retrospective data review was performed on all referrals from community‐based ESPs for direct listing at the secondary care hospital between 2 January 2008 and 31 December 2009.

A total of 130 referrals for direct listing were made by the ESP team during the two‐year period. Of these, 127 (98 per cent) went on to undergo a THR. Three patients (2 per cent) did not ultimately have a THR.

This process has continued over the two years of the direct listing service, with ongoing evaluation and refinement of the pathway, so referral criteria and clinical/administrative pathways have been changed in the light of experience.

Patients who were directly listed did not require a hospital orthopaedic outpatient appointment until attendance at preoperative assessment clinic shortly before their surgery. In addition to the reduction in inconvenience and travelling costs incurred by patients, there was an approximate saving of £145 to the primary care trust per directly listed patient.

The authors believe that this service evaluation is the first publication to show that direct listing by primary care based ESPs is a safe and effective process for some patients requiring primary THR.

Historically, provision of orthopaedic services has been hospital based with GPs referring patients for specialist opinion. Growing demands on the service have led to new initiatives to reduce waiting times. One such initiative has been the introduction of orthopaedic assistants, usually physiotherapists, working with an extended scope of practice who see patients after referral to secondary care and determine the patients on‐going management. Studies to date have examined the effect of an orthopaedic assistant working alongside a consultant in the hospital environment. This study describes the impact on the management of the orthopaedic caseload in one general practice resulting from “screening” prior to referral to secondary care by a physiotherapist with an extended scope of practice. It demonstrates the successful management of the majority of patients within primary care.