Published: 17/04/2003, Volume II3, No. 5851 Page 22 23

Many orthopaedic services have found a way to help GPs who do not know which surgeon has a specialist interest in hip revision surgery, or other orthopaedic sub-specialties ('Joint effort', pages 28-29, 3 April).

Surgeons in the service agree between themselves who will specialise in hip revision surgery.

Any patient referred with problems in an existing hip replacement is automatically passed to the appropriate surgeon(s), regardless of who the referral is addressed to. GPs are informed that this will be done unless they, or the patient, request otherwise.

This arrangement ensures that the patient sees the specialist with the most appropriate skills, but leaves the over-riding choice with the patient and GP. If this means that more referrals go to the revision specialist, some redistribution of other referrals may be needed to even out workload between the team.

The introduction of electronic booking systems to the NHS over the next couple of years will help further, by automating the referral process. Guidelines built into the electronic system can ensure that referrals are steered to the most appropriate specialist, and that GPs are prompted to request any preliminary investigations such as x-rays.

The patient will also be able to book a convenient date for their appointment.

David Mudd Head of modernisation North West London strategic health authority