I know it's ridiculous isn't it, and it will only get worse with practice led commissioning (ie the GPs buy services from other trusts and hospitals, instead of having a primary care trust to do that for them). It means the GP had to make all the referrals - refer for tests/scans, get them back; refer results to someone who can understand the results, get advice back; refer to somewhere else to do something about it, another waiting list. It's rubbish. I far preferred Tony Blaire's way which involved everyone talking to eachother, straightforward pathways, shorter waits and happier patients!