Hi can you be referred directly to a surgeon by a GP?

Everyone here is correct about the process, but not really explaining the rationale behind it. If they can get away with not operating on you, then that's generally the best way forward for all concerned. Any intervention will come with risk, but physical therapy is probably one of the least risky options here. Surgery is the most invasive, so it's generally last on the list. My experience is with an audiology clinic in the community, and hearing is a good example here. Someone with otosclerosis might be able to fix the problem altogether with surgery, but one of the risks of surgery is permanent hearing damage - essentially, you run the risk of leaving with *worse* hearing than you started with. The other option is to look at hearing aids, which are remarkably effective when it comes to conductive hearing losses with basically no risk at all. You've also got to consider candidacy for surgery - for example, someone older might not be able to tolerate a general anaesthetic. That said, we can actually refer patients directly to our nearest cochlear implant centre if they are a potential candidate. This is a bit of an exception to the rule though - for pretty well everything else the pathway for me is to refer to the GP, who will make the decisions from there. If it's any consolation, I've come across so many occasions where GP's have just photocopied my letter and posted send it directly to ENT with a compliment slip stapled to it saying 'see attached letter'. If something's blatently obvious the clinician will send you up the chain quickly enough, and generally won't waste everyone's time doing something they know won't work. I know my experience isn't directly relevant but hopefully it helps contextualise it a bit better?