I know many of our patients actually wanted a bunion operation only in order to be able to wear prettier shoes but I would never recommend an operation for anyone except people with real disability, and there were plenty of those.

   In one area where I was a GP we could refer our patients with bunions to a centre outside our area which used non-medically trained podiatrists. They did a day case operation so patients did not have to stay in hospital then were discharged back to us for medication and dressing s by eh practice or district nurse. Patients thought it was a superb service, and rated it much higher than the service our orthopaedic surgeons performed, which was a different operation and involved two nights in hospital and several follow up visits. They seemed to get better quicker too.

However it cost the health authority extra money so there were moves to stop us referring there. We therefore asked couldn’t our surgeons do the same operation so that our patients had day care? The cost of the podiatrist’s service was a third of our surgeon’s.

However the answer was no. Our surgeons wanted to continue doing the one they were used to.   No doubt they had reasons but they weren’t obvious to us GPs and our patients. Shortly therefore our patients are having to go to our already overstretched orthopaedic services to wait much longer for a service they don't want.

What would you want?